Custom-made versus off-the-shelf multibranched endografts for endovascular repair of thoracoabdominal aortic aneurysms Theodosios Bisdas, MD, Konstantinos.

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Presentation transcript:

Custom-made versus off-the-shelf multibranched endografts for endovascular repair of thoracoabdominal aortic aneurysms Theodosios Bisdas, MD, Konstantinos P. Donas, MD, Michel J. Bosiers, MD, Giovanni Torsello, MD, Martin Austermann, MD Journal of Vascular Surgery Volume 60, Issue 5, Pages 1186-1195 (November 2014) DOI: 10.1016/j.jvs.2014.06.003 Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 1 The new off-the-shelf multi-branched endograft (t-branch; Cook Medical, Bloomington, Ind): the introduction system consists of a 22F Flexor (Cook Medical) introducer sheath (7.3-mm inner diameter and 8.5-mm outer diameter) and a Captor (Cook Medical) hemostatic valve. The company provides also a universal distal body at four different sizes (proximal diameter (D) always 22 mm; lengths (L) of 81, 98, 115, and 132 mm; 20F introduction system). SMA, Superior mesenteric artery. Journal of Vascular Surgery 2014 60, 1186-1195DOI: (10.1016/j.jvs.2014.06.003) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 2 Use of fusion imaging to identify the orifices (blue circles) of the target vessels during implantation of a multibranched endograft: (A) Angiography before precannulation of the superior mesenteric artery; (B) cannulation of the left renal artery through the marked orifice; and (C) exact alignment between the implanted bridging endograft and the marked orifice of the target vessel. Journal of Vascular Surgery 2014 60, 1186-1195DOI: (10.1016/j.jvs.2014.06.003) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 3 Control angiography (right anterior oblique view, 43°) through the celiac branch (yellow arrow) and identification of an intercostal artery (red arrow) that may serve as a collateral pathway to the anterior spinal artery. Journal of Vascular Surgery 2014 60, 1186-1195DOI: (10.1016/j.jvs.2014.06.003) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 4 A, A preoperative computed tomography (CT) angiography shows a type II thoracoabdominal aortic aneurysm (TAAA) with previous thoracic endografting as a staged procedure. B, Intraoperative angiography before the implantation of the multibranched endograft. C, Control angiography after completion of the procedure. D, A postoperative CT angiography after 12 months of surveillance. Journal of Vascular Surgery 2014 60, 1186-1195DOI: (10.1016/j.jvs.2014.06.003) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 5 A, A preoperative computed tomography (CT) angiography shows a type II thoracoabdominal aortic aneurysm (TAAA) with previous thoracic endografting as staged procedure. B, Intraoperative angiography before t-branch implantation. C, Control angiography after completion of the procedure. D, A postoperative CT angiography after 12 months of surveillance. Journal of Vascular Surgery 2014 60, 1186-1195DOI: (10.1016/j.jvs.2014.06.003) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 6 Percutaneous transbrachial thrombectomy was required for the occluded branch of the right renal artery 7 months after t-branch implantation. A, Intraoperative angiography demonstrates the occluded right renal artery (black arrow). B, Angiographic control of the branch after thrombectomy with the Rotarex thrombectomy system (Straub Medical, Wangs, Switzerland) and (C) implantation of a balloon-expandable stent graft (BeGraft; Bentley InnoMed, Hechingen, Germany). D, Control angiography confirms the successful recanalization of the occluded branch and the perfusion of the right kidney. Journal of Vascular Surgery 2014 60, 1186-1195DOI: (10.1016/j.jvs.2014.06.003) Copyright © 2014 Society for Vascular Surgery Terms and Conditions