Scott S. Berman, MD, MHA, FACS, Shonda L. Banegas, DO

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Presentation transcript:

Over-the-balloon placement of the Gore Hybrid Vascular Graft in challenging clinical conditions Scott S. Berman, MD, MHA, FACS, Shonda L. Banegas, DO Journal of Vascular Surgery Cases and Innovative Techniques Volume 2, Issue 3, Pages 123-125 (September 2016) DOI: 10.1016/j.jvscit.2016.04.010 Copyright © 2016 The Author(s) Terms and Conditions

Fig 1 A, Gore Hybrid Vascular Graft (GHVG) as supplied by the manufacturer. B, Image of the open venotomy technique for placement, demonstrating vascular control and opening created in the recipient vein. C, Introduction of the hybrid graft into the venotomy. D, Over-the-wire technique with placement of the hybrid graft through a valveless peel-away sheath. E, The sheath is peeled as the device is advanced. F, Final sheath removal occurs with at least 50% of the nitinol-reinforced section (NRS) introduced into the recipient vein. Images provided by W. L. Gore and Associates and used with permission. Journal of Vascular Surgery Cases and Innovative Techniques 2016 2, 123-125DOI: (10.1016/j.jvscit.2016.04.010) Copyright © 2016 The Author(s) Terms and Conditions

Fig 2 A, Nitinol-reinforced section (NRS) end demonstrating significant step-off between stent edge and 0.035-inch guidewire when it is introduced using standard over-the-wire technique. B, Appearance of the NRS end of the hybrid graft threaded over the angioplasty balloon, providing a more gradual transition between the 0.035-inch wire and the stent edge to facilitate introduction into the recipient vessel. Journal of Vascular Surgery Cases and Innovative Techniques 2016 2, 123-125DOI: (10.1016/j.jvscit.2016.04.010) Copyright © 2016 The Author(s) Terms and Conditions

Fig 3 Completion left iliofemoral angiogram demonstrating preserved flow through the transplant renal artery and flow through the external iliac artery and neo-common femoral artery (CFA) created by the expanded polytetrafluoroethylene (ePTFE) portion of the hybrid graft with profunda and saphenous vein graft runoff. Journal of Vascular Surgery Cases and Innovative Techniques 2016 2, 123-125DOI: (10.1016/j.jvscit.2016.04.010) Copyright © 2016 The Author(s) Terms and Conditions

Fig 4 Completion angiogram through the arteriovenous hybrid graft illustrating the sutureless venous anastomosis created by the nitinol-reinforced section (NRS) with concurrent treatment of the axillary vein stenosis. Journal of Vascular Surgery Cases and Innovative Techniques 2016 2, 123-125DOI: (10.1016/j.jvscit.2016.04.010) Copyright © 2016 The Author(s) Terms and Conditions