Physician modification of Gore C3 excluder endograft for treatment of abdominal aortic aneurysms anatomically unsuitable for conventional endovascular.

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Presentation transcript:

Physician modification of Gore C3 excluder endograft for treatment of abdominal aortic aneurysms anatomically unsuitable for conventional endovascular repair Amy H. Coulter, MD, Tze-Woei Tan, MD, Wayne W. Zhang, MD Journal of Vascular Surgery Volume 59, Issue 6, Pages 1739-1743 (June 2014) DOI: 10.1016/j.jvs.2013.12.027 Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 1 Reconstruction of preoperative computed tomographic angiography (CTA) and localization of branch vessels by means of clock-face orientation. Journal of Vascular Surgery 2014 59, 1739-1743DOI: (10.1016/j.jvs.2013.12.027) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 2 Position and location of fenestrations are measured and marked on the main body graft according to preoperative planning. The stent graft can be rotated a few degrees clockwise or counterclockwise to find a larger space for fenestration between stent struts. Journal of Vascular Surgery 2014 59, 1739-1743DOI: (10.1016/j.jvs.2013.12.027) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 3 Fenestrations are reinforced by suturing EnSnare wire (Merit Medical, South Jordan, Utah) circumferentially with 5-0 Prolene (A and B). Fenestrations are then precannulated through the contralateral gate with V-14 wires (C). Journal of Vascular Surgery 2014 59, 1739-1743DOI: (10.1016/j.jvs.2013.12.027) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 4 Endograft is reconstrained and reloaded into previously cut and loaded DrySeal sheath (W. L. Gore & Associates, Inc, Flagstaff, Ariz). Endograft stents are further collapsed with the use of umbilical tape. When the endograft is fully reloaded, the precannulated V-14 wires extend beyond the tip of the reloaded device. Journal of Vascular Surgery 2014 59, 1739-1743DOI: (10.1016/j.jvs.2013.12.027) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 5 With the bilateral renal artery wire access secured, the main body of the endograft is deployed. The proximal endograft can be reconstrained to reposition the main body if needed. When the position of the endograft is correct, the proximal seal zone was expanded with a Q50 balloon (W. L. Gore & Associates, Inc, Flagstaff, Ariz). Journal of Vascular Surgery 2014 59, 1739-1743DOI: (10.1016/j.jvs.2013.12.027) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 6 Stent grafts are deployed in the renal arteries (A). After deployment, the stent grafts are flared within the main body aortic endograft with the use of an 8-mm angioplasty balloon (B). Two thirds of the branch stent grafts should be within the branch vessel, with one third extending into the aortic endograft. Journal of Vascular Surgery 2014 59, 1739-1743DOI: (10.1016/j.jvs.2013.12.027) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 7 Follow-up computed tomographic angiography (CTA) at 1 month shows patency of superior mesenteric artery (SMA) and bilateral renal arteries with no evidence of endoleak. Journal of Vascular Surgery 2014 59, 1739-1743DOI: (10.1016/j.jvs.2013.12.027) Copyright © 2014 Society for Vascular Surgery Terms and Conditions