In situ fenestration in the aortic arch

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Presentation transcript:

In situ fenestration in the aortic arch Brian J. Manning, MD, FRCSI, Krassi Ivancev, MD, PhD, Peter L. Harris, MD, FRCS Journal of Vascular Surgery Volume 52, Issue 2, Pages 491-494 (August 2010) DOI: 10.1016/j.jvs.2009.07.088 Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 1 Computed tomography scan showing a 5.5 cm saccular aneurysm of the thoracic aorta, originating from the lesser curve of the arch. The acute angulation between the LSA and the aorta is also seen. Journal of Vascular Surgery 2010 52, 491-494DOI: (10.1016/j.jvs.2009.07.088) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 2 (a) The partially deployed stent graft is positioned following establishment of through-and-through wire access, and a rigid 7 Fr trochar is positioned adjacent to the stent graft, which is then punctured with a 22G needle. (b) The obturator is withdrawn from the needle and replaced with a 0.014-in wire, over which a larger needle is passed and followed by a series of cutting balloons (c). (d) The 0.014-in wire was replaced with a stiff 0.035-in wire and a larger 8 Fr sheath was delivered across the fenestration. With the balloon-mounted stent in position, the thoracic stent graft deployment was completed, in order to optimize alignment of the fenestration with the target vessel. The covered stent across the fenestration was then deployed and subsequently dilated with a high pressure balloon to complete the process (e). Journal of Vascular Surgery 2010 52, 491-494DOI: (10.1016/j.jvs.2009.07.088) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 3 The modified TIPS sheath, which has an inner metal core. It has been bent into the desired shape and allows a spinal needle to be safely introduced to the level of the graft, which is then punctured and accessed with an 0.014-in wire. Journal of Vascular Surgery 2010 52, 491-494DOI: (10.1016/j.jvs.2009.07.088) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 4 Completion angiogram shows good position of the covered stents allowing perfusion of the left subclavian artery, while the fully deployed thoracic stent graft has excluded the previously perfused aneurysm. Journal of Vascular Surgery 2010 52, 491-494DOI: (10.1016/j.jvs.2009.07.088) Copyright © 2010 Society for Vascular Surgery Terms and Conditions