Treatment of acute visceral aortic pathology with fenestrated/branched endovascular repair in high-surgical-risk patients Salvatore T. Scali, MD, Alyson.

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Presentation transcript:

Treatment of acute visceral aortic pathology with fenestrated/branched endovascular repair in high-surgical-risk patients Salvatore T. Scali, MD, Alyson Waterman, MD, Robert J. Feezor, MD, Tomas D. Martin, MD, Philip J. Hess, MD, Thomas S. Huber, MD, PhD, Adam W. Beck, MD Journal of Vascular Surgery Volume 58, Issue 1, Pages 56-65.e1 (July 2013) DOI: 10.1016/j.jvs.2012.12.043 Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 1 This image demonstrates a graft used for repair of a suprarenal aneurysm. The graft was modified with two fenestrations (white arrows) for the celiac and superior mesenteric arteries and two straight graft branches (black arrows) for the renal arteries. Note the fenestration configuration with a polytetrafluoroethylene grommet (Atrium Advanta SST graft) sewn together with a radiographic marker around the perimeter of the fenestration using a Gore suture. The straight graft branches are ∼3-mm-long branches created from a 7-mm Gore Viabahn stent graft and sewn in place with a Gore suture incorporating the base of the branch along with a radiographic marker. Also note the temporary diameter-reducing sutures located at each stent ring, which allows flow through and around the graft during branch vessel catheterization. The image on the right is a postoperative three-dimensional reconstruction, where the lower portion of the graft (pie symbol) is an unmodified Endologix Powerlink device and the upper portion is a modified Cook Zenith TX2 graft (asterick portion) with four fenestrations, each revascularized with Atrium iCast stent grafts. Journal of Vascular Surgery 2013 58, 56-65.e1DOI: (10.1016/j.jvs.2012.12.043) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 2 The left image demonstrates a Gore TAG sheath with multiple smaller sheaths placed through the hub of the device for revascularization of four branch vessels. The image on the right demonstrates an endograft within an Extent IV thoracoabdominal aortic aneurysm (TAAA) with four target vessels catheterized. Journal of Vascular Surgery 2013 58, 56-65.e1DOI: (10.1016/j.jvs.2012.12.043) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 3 Top panels, Preoperative and postoperative images of a patient with a ruptured pseudoaneurysm adjacent to the visceral vessels 4 weeks after an open Extent IV thoracoabdominal aortic aneurysm (TAAA) repair at an outside institution. A-C, Preoperative computed tomography (CT) demonstrating a large pseudoaneurysm. D, Three-dimensional reconstruction demonstrating the same, with the white arrows in C and D demonstrating the opacified blush within the pseudoaneurysm. E and F, Corresponding postoperative images at 15 months after repair, which demonstrate complete resolution of the pseudoaneurysm and healing around the stent graft. Journal of Vascular Surgery 2013 58, 56-65.e1DOI: (10.1016/j.jvs.2012.12.043) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 4 This graph demonstrates 12-month survival after surgeon-modified endovascular aneurysm repair (sm-EVAR), which was 88%. One patient died during hospitalization after multiple complications following repair, and two patients died of nonaneurysm-related conditions at 1.4 and 13.4 months after repair. Journal of Vascular Surgery 2013 58, 56-65.e1DOI: (10.1016/j.jvs.2012.12.043) Copyright © 2013 Society for Vascular Surgery Terms and Conditions