Aortic arch aneurysm repair using the Najuta stent graft in a challenging compromised seal zone Naoki Toya, MD, Kota Shukuzawa, MD, Soichiro Fukushima,

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Aortic arch aneurysm repair using the Najuta stent graft in a challenging compromised seal zone Naoki Toya, MD, Kota Shukuzawa, MD, Soichiro Fukushima, MD, Masamichi Momose, MD, Tadashi Akiba, MD, Takao Ohki, MD Journal of Vascular Surgery Cases Volume 2, Issue 1, Pages 21-24 (March 2016) DOI: 10.1016/j.jvsc.2016.02.004 Copyright © 2016 The Authors Terms and Conditions

Fig 1 A, Preoperative contrast-enhanced computed tomography (CT) showed a rapidly growing aneurysm in the distal arch involving the left subclavian artery (LSCA) with a short proximal neck and right axillofemoral (Ax-F) bypass (arrow). a, Aneurysm; b, Dacron tube graft; c, innominate artery. B, The Najuta fenestrated stent graft is a customized fenestrated device comprising a self-expandable stainless steel Z-stent and an expanded polytetrafluoroethylene graft. C, A fenestration of the Najuta to the innominate artery (arrow). D, Surgical strategy (schema); white arrow, guiding sheath; black arrow, delivery sheath of the Najuta. Journal of Vascular Surgery Cases 2016 2, 21-24DOI: (10.1016/j.jvsc.2016.02.004) Copyright © 2016 The Authors Terms and Conditions

Fig 2 The first fenestration was opened from the first marker to the second marker, and the second fenestration was opened between the second marker and the third marker. A, Before deployment (arrows, markers). B, After deployment (arrows, markers). Journal of Vascular Surgery Cases 2016 2, 21-24DOI: (10.1016/j.jvsc.2016.02.004) Copyright © 2016 The Authors Terms and Conditions

Fig 3 A and B, Follow-up contrast-enhanced computed tomography (CT) showed accurate device fixation, no major endoleak, and patency of the innominate artery and debranching bypass. C and D, A customized full-scale Najuta stent graft model was deployed to the plaster model before thoracic endovascular aneurysm repair (TEVAR). E and F, The final appearance of the Najuta. Journal of Vascular Surgery Cases 2016 2, 21-24DOI: (10.1016/j.jvsc.2016.02.004) Copyright © 2016 The Authors Terms and Conditions