Atsushi Kitagawa, MD, Roy K. Greenberg, MD, Matthew J

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Presentation transcript:

Zenith p-branch standard fenestrated endovascular graft for juxtarenal abdominal aortic aneurysms Atsushi Kitagawa, MD, Roy K. Greenberg, MD, Matthew J. Eagleton, MD, Tara M. Mastracci, MD Journal of Vascular Surgery Volume 58, Issue 2, Pages 291-300 (August 2013) DOI: 10.1016/j.jvs.2012.12.087 Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 1 Left, The fundamental design of the Zenith pivotal branched (p-branch) standard fenestrated endovascular graft consists of a tubular graft composed of polyethylene terephthalate fabric with two stainless steel z-stents, including a bare supraceliac barbed stent, with a scallop for celiac artery (CA) and an 8-mm strut-free fenestration for the superior mesenteric artery (SMA) (black arrow) and two pivot fenestrations for the right and left renal arteries (red arrows), with the distal component made of nitinol. Right, The detail of the proximal component system of the Zenith p-branch shows two options for pivot fenestration locations of the renal arteries with respect to the SMA origin: option A (upper) and option B (lower). In option A, the pivot fenestrations come off at same longitudinal position of the device below the SMA. Option B has a staggered longitudinal position of the renal arteries, with the right renal pivot fenestration being 4 mm higher than the left renal pivot fenestration. Journal of Vascular Surgery 2013 58, 291-300DOI: (10.1016/j.jvs.2012.12.087) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 2 On the sizing sheet of the Zenith pivotal branched (p-branch) device, with a transparent sheet to fit for visceral vessel anatomy, the blue line is a grid for option A, and the red line is a grid for option B. Journal of Vascular Surgery 2013 58, 291-300DOI: (10.1016/j.jvs.2012.12.087) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 3 Fluoroscopic image shows full deployment of the Zenith pivotal branched (p-branch) device with visceral vessel reconstructions using stent grafts. CA, Celiac artery; LRA, left renal artery; RRA, right renal artery; SMA, superior mesenteric artery. Journal of Vascular Surgery 2013 58, 291-300DOI: (10.1016/j.jvs.2012.12.087) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 4 The clock position and the distance from the superior mesenteric artery (SMA) of the celiac artery (CA) (red circles), right renal artery (RRA) (blue circles), and left renal artery (LRA) (yellow circles), as the SMA clock position and distance position is adjusted to at 12:00 o'clock and 0, respectively, is shown for (a) option A (n = 11) and (b) option B (n = 5). *Represents a patient with rupture who was treated off protocol. Journal of Vascular Surgery 2013 58, 291-300DOI: (10.1016/j.jvs.2012.12.087) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 5 The applicability of the Zenith pivotal branched (p-branch) device for 288 patients with juxtarenal abdominal aortic aneurysm in our institution from 2001 to 2011. Positions are shown for the celiac artery (CA) (red dots), right renal artery (RRA) (blue dots), and left renal artery (LRA) (yellow dots) (1 mm diameter). The overall applicability of p-branch was 72% (neck applicability; 97%, visceral vessel applicability; 75%), strictly followed by the inclusion criteria of p-branch. Journal of Vascular Surgery 2013 58, 291-300DOI: (10.1016/j.jvs.2012.12.087) Copyright © 2013 Society for Vascular Surgery Terms and Conditions