Anatomic feasibility of off-the-shelf fenestrated stent grafts to treat juxtarenal and pararenal abdominal aortic aneurysms Bernardo C. Mendes, MD, Gustavo.

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Anatomic feasibility of off-the-shelf fenestrated stent grafts to treat juxtarenal and pararenal abdominal aortic aneurysms Bernardo C. Mendes, MD, Gustavo S. Oderich, MD, Thanila A. Macedo, MD, Alexandre A. Pereira, MD, Stephen Cha, MS, Audra A. Duncan, MD, Peter Gloviczki, MD, Thomas C. Bower, MD Journal of Vascular Surgery Volume 60, Issue 4, Pages 839-848.e2 (October 2014) DOI: 10.1016/j.jvs.2014.04.038 Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 1 Photograph of (A) p-Branch (Cook Medical, Brisbane, Australia) and (B) Ventana (Endologix Inc, Irvine, Calif) off-the-shelf stent grafts. Journal of Vascular Surgery 2014 60, 839-848.e2DOI: (10.1016/j.jvs.2014.04.038) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 2 Volumetric kidney parenchyma analysis for assessment of percentage of volume of kidney perfused by accessory renal artery. Note that 22% (30.5 cm3 of 134 cm3) of the kidney would be sacrificed with endovascular repair in this patient. Reproduced with permission of the Mayo Foundation for Medical Education and Research. All rights reserved. Journal of Vascular Surgery 2014 60, 839-848.e2DOI: (10.1016/j.jvs.2014.04.038) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 3 The dots denote the most proximal location of aneurysm extent among 520 patients treated for complex aortic aneurysms. The green dot denotes aneurysm not suitable for repair within the device design anatomic recommendation, whereas the blue dot denotes aneurysm within the anatomic guidelines. For juxtarenal and pararenal aneurysms extending up to the lower aspect of the superior mesenteric artery (SMA), proximal seal was achieved in 61% of patients with Ventana (A) and in all patients with p-Branch (B) design. Reproduced with permission of the Mayo Foundation for Medical Education and Research. All rights reserved. Journal of Vascular Surgery 2014 60, 839-848.e2DOI: (10.1016/j.jvs.2014.04.038) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 4 The location of the celiac axis (yellow), right renal artery (green), and left renal artery (blue) is depicted relative to the mid aspect of the superior mesenteric artery (SMA) in the 0 axis (A). For the Ventana device (B), visceral incorporation was achieved in 90% of patients because of the wide range of suitability of movable renal fenestrations (shaded blue area). For the p-Branch device using either the A (C) or B (D) configuration, incorporation was achieved in 61% of patients. The main limitation was noted in the ability to incorporate renal arteries with pivot fenestrations. Journal of Vascular Surgery 2014 60, 839-848.e2DOI: (10.1016/j.jvs.2014.04.038) Copyright © 2014 Society for Vascular Surgery Terms and Conditions