Impact of transrenal aortic endograft placement on endovascular graft repair of abdominal aortic aneurysms Michael L. Marin, MD, Richard E. Parsons,

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Presentation transcript:

Impact of transrenal aortic endograft placement on endovascular graft repair of abdominal aortic aneurysms Michael L. Marin, MD, Richard E. Parsons, MD, Larry H. Hollier, MD, Harold A. Mitty, MD, Jiyong Ahn, MD, Rosaleen E. Parsons, MD, Thamrongraj Temudom, MD, Marcus D'Ayala, MD, Maryann McLaughlin, MD, Louis DePalo, MD, Ronald Kahn, MD Journal of Vascular Surgery Volume 28, Issue 4, Pages 638-646 (October 1998) DOI: 10.1016/S0741-5214(98)70088-6 Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Balloon expandable polytetrafluoroethylene endograft for repair of an abdominal aortic aneurysm. A tapered (28 mm to 8 mm) expanded polytetrafluoroethylene graft is used for aortic reconstruction. A Palmaz balloon expandable stent is sutured to the proximal end of the graft (arrow) so 2 cm of stent is exposed and uncovered by the overlying prosthesis. A gold marker (open arrow) is affixed to the margin of the graft to facilitate radiographic localization. Journal of Vascular Surgery 1998 28, 638-646DOI: (10.1016/S0741-5214(98)70088-6) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Palmaz balloon expandable stent—deployed. A large Palmaz balloon expandable stent in the deployed state (26 mm) contains diamond configured spaces that measure on average 6.3 × 6.0 mm (arrows). Journal of Vascular Surgery 1998 28, 638-646DOI: (10.1016/S0741-5214(98)70088-6) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Introducer catheter system for endoluminal graft insertion. Each endograft is inserted into the vascular system contained within a specialized delivery sheath (23F). The endoluminal graft is coaxially mounted onto a balloon catheter shaft. This balloon catheter shaft contains a second balloon (arrow), which seals the distal end of the catheter during device insertion and transit through the vascular system. While the tip balloon is inflated, the endoluminal graft delivery catheter may be pressurized with normal saline to vary its stiffness during passage through the iliac artery and aorta. G, Graft; S, stent; V, valve; I, infusion port. Journal of Vascular Surgery 1998 28, 638-646DOI: (10.1016/S0741-5214(98)70088-6) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Endovascular repair of an abdominal aortic aneurysm. Endoluminal graft is advanced through the right common femoral artery to the renal vessels. A diagnostic catheter (arrow) is inserted through the contralateral femoral artery and positioned adjacent to the renal arteries to permit continuous angiography for precise positioning. After contrast injection through the diagnostic catheter, the endoluminal graft is positioned precisely at the site of intended implantation. A gold marker bead on the margin of the expanded polytetrafluoroethylene graft (open arrow) is aligned with the inferior border of the lowest renal artery. Journal of Vascular Surgery 1998 28, 638-646DOI: (10.1016/S0741-5214(98)70088-6) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Postdeployment angiogram of an endoluminal graft for repair of an abdominal aortic aneurysm. A, The uncovered portion of the stent (bound by the small arrows) is completely below the renal artery orifices (open arrows) in this patient from group 1. B, After transrenal stent fixation, the uncovered portion of the attachment system (bound by the small arrows) extends across the renal artery orifices (open arrows). Note the pre-existing left renal artery stenosis. Journal of Vascular Surgery 1998 28, 638-646DOI: (10.1016/S0741-5214(98)70088-6) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Schematic drawing of the completed aorto-femoral-femoral reconstruction for endoluminal repair of an abdominal aortic aneurysm. An endoluminal anastomosis to the right common femoral artery (arrow) followed by a femoral-femoral crossover graft completes the contralateral reconstruction. A covered occluding stent is deployed in the common iliac artery on the left (open arrow) to prevent retrograde flow into the aortic aneurysm. Journal of Vascular Surgery 1998 28, 638-646DOI: (10.1016/S0741-5214(98)70088-6) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Improper deployment of an endograft for repair of an abdominal aortic aneurysm demonstrated by means of completion angiogram. A, Preoperative aortogram of a patient with an abdominal aortic aneurysm. B, Because of the severe aortic neck tortuosity, the precise location of the right renal artery was incorrectly identified and covered by the prosthetic endograft. Arrow, Top of stent; open arrow, edge of graft. Journal of Vascular Surgery 1998 28, 638-646DOI: (10.1016/S0741-5214(98)70088-6) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 8 Delayed image during a follow-up angiogram of a patient 3 months after endoluminal repair of an abdominal aortic aneurysm employing a transrenal stent device. Normal nephrograms without evidence of truncation of intra-renal or parenchymal vessels are seen. S, stent. Journal of Vascular Surgery 1998 28, 638-646DOI: (10.1016/S0741-5214(98)70088-6) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 9 CT scan performed 3 days after endografting. The right kidney has a segmental wedge shaped infarct (arrow). Journal of Vascular Surgery 1998 28, 638-646DOI: (10.1016/S0741-5214(98)70088-6) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions