Homemade proximal scalloped stent graft for thoracic endovascular aortic repair of zone 2 acute aortic syndrome Ludovic Canaud, MD, PhD, Thomas Gandet,

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Presentation transcript:

Homemade proximal scalloped stent graft for thoracic endovascular aortic repair of zone 2 acute aortic syndrome Ludovic Canaud, MD, PhD, Thomas Gandet, MD, Ilya Khantalin, MD, Baris Ata Ozdemir, MBBS, BSc, MRCS, Charles-Henri Marty-Ané, MD, PhD, Pierre Alric, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 152, Issue 5, Pages 1301-1306 (November 2016) DOI: 10.1016/j.jtcvs.2016.05.025 Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A, Valiant (Medtronic Vascular, Santa Rosa, Calif) thoracic stent graft was partially unsheathed. The proximal tip capture was held using a cut 5-mL syringe. The scallop was fashioned using a 11 blade. B, The scallop was fashioned on the upper side of the aortic arch. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1301-1306DOI: (10.1016/j.jtcvs.2016.05.025) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A, Two lateral radio-opaque markers were fixed on the fabric with a running locking suture of 5-0. Prolene. B, Two lateral radio-opaque markers were positioned and delineated the distal and lateral position of the scallop. The loop of a snare was used as the raw materials for the radio-opaque markers. C, The stent graft was finally reloaded in the existing sheath using a temporary vessel loop to collapse each stent. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1301-1306DOI: (10.1016/j.jtcvs.2016.05.025) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 A 3-cm in length radio-opaque marker (using the loop of a snare) was fixed by 4 stitches of 5-0 polypropylene and part of an incision drape on the sheath to facilitate radiologic localization of the scallop and positioning on the outer curve of the aorta. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1301-1306DOI: (10.1016/j.jtcvs.2016.05.025) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 A and B, Preoperative computed tomography scan of an acute complicated type B aortic dissection (paraplegia) involving the distal part of the arch. C, Patient treated by homemade scalloped TEVAR with proximal scallop for the LSA. Completion angiography demonstrates the closure of the proximal entry tear and patency of the LSA. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1301-1306DOI: (10.1016/j.jtcvs.2016.05.025) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 A, Preoperative computed tomography scan of an acute complicated type B aortic dissection (rapid aortic expansion) involving the distal part of the arch. The proximal entry tear is 7 mm distal to the LSA. B, Homemade proximal scallop for the LSA in a patient undergoing TEVAR. Three-dimensional reformatted computed tomography angiography demonstrates the closure of the proximal entry tear and patency of the LSA. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1301-1306DOI: (10.1016/j.jtcvs.2016.05.025) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Patient treated by homemade scalloped TEVAR with proximal scallop for the LSA. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1301-1306DOI: (10.1016/j.jtcvs.2016.05.025) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions