Advantage of a precurved fenestrated endograft for aortic arch disease: Simplified arch aneurysm treatment in Japan 2010 and 2011 Yoshihiko Yokoi, MD,

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Presentation transcript:

Advantage of a precurved fenestrated endograft for aortic arch disease: Simplified arch aneurysm treatment in Japan 2010 and 2011 Yoshihiko Yokoi, MD, Takashi Azuma, MD, Kenji Yamazaki, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 145, Issue 3, Pages S103-S109 (March 2013) DOI: 10.1016/j.jtcvs.2012.11.058 Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A1, Preoperative 3-dimensional computed tomography (3D-CT) of a zone 1 aortic arch aneurysm with appropriate proximal landing zone and short proximal sealing length (red line). A2, Postoperative 3-dimensional computed tomography with complete exclusion of the aortic arch aneurysm demonstrates that the appropriate proximal landing zone provides good results. B1, Preoperative 3-dimensional computed tomography of a zone 1 aortic arch aneurysm with substantial proximal sealing length (red line) and inadequate proximal landing zone. B2, Postoperative 3-dimensional computed tomography with complete exclusion of the aortic arch aneurysm demonstrates that the substantial proximal sealing length provides feasible results. C1, Preoperative 3-dimensional computed tomography of a zone 1 aortic arch aneurysm with short proximal sealing length (red line) and inadequate (proximal diameter >40 mm) proximal landing zone. C2, Postoperative 3-dimensional computed tomography with type I endoleak (arrow) demonstrates blood flow into the lesion through the posterior side of the stent-graft, causing insufficient contact between fenestrations and aortic wall. The Journal of Thoracic and Cardiovascular Surgery 2013 145, S103-S109DOI: (10.1016/j.jtcvs.2012.11.058) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A, Preoperative 3-dimensional computed tomographic (3D-CT) anteroposterior view of an aortic arch aneurysm with guiding red line used to design proximal fenestrated stent-graft. B, Preoperative 3-dimensional computed tomographic left anterior oblique 30° view with guiding yellow line used to design distal stent-graft. C, Head-to-foot view demonstrates complex configuration of the aortic arch aneurysm. D, The precurved fenestrated endograft (proximal stent-graft) was fabricated by selecting from these kinds of 3-dimensional curved stainless stent skeleton and fenestrated expanded polytetrafluoroethylene grafts (e-PTFE). E, Distal stent-graft had a twisted formation similar to complicated configuration of this patient. The Journal of Thoracic and Cardiovascular Surgery 2013 145, S103-S109DOI: (10.1016/j.jtcvs.2012.11.058) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Implantation strategy. A, Intraoperative digital subtraction angiography before deployment of distal device. B, Intraoperative digital subtraction angiography (DSA) after deployment of distal stent-graft, which prevented migration of the proximal graft. C, Intraoperative digital subtraction angiography after deployment of the proximal stent-graft shows absence of endoleak. D, Postoperative 3-dimensional computed tomography (3D-CT) demonstrates that this device has good conformability for the complicated configuration of this aortic arch aneurysm. The Journal of Thoracic and Cardiovascular Surgery 2013 145, S103-S109DOI: (10.1016/j.jtcvs.2012.11.058) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 A, The proximal tip has a concavity for fixation (top), and the proximal end of the stent-graft has a stainless steel hock (bottom). B, The proximal end of the stent-graft is anchored to the tip (top), and the traction suture to shrink proximal end is fixed at distal end of the stent-graft (bottom). C, The proximal end of the stent-graft is shrunk by traction suture (top), and the proximal end of the device is pulled down to a smaller coverture (bottom). D, Predeployment digital subtraction angiographic (DSA) (top), intradeployment fluoroscopic (middle), and postdeployment digital subtraction angiographic (bottom) images demonstrate precise deployment and exhibit device behaviors during the deployment period. E, As the traction suture is gradually straightening during the stent-graft deployment, the proximal end of the stent-graft is gradually opening. The Journal of Thoracic and Cardiovascular Surgery 2013 145, S103-S109DOI: (10.1016/j.jtcvs.2012.11.058) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 The numbers of patients for proximal ends of the lesion and the stent-graft in anatomic zone mapping. The Journal of Thoracic and Cardiovascular Surgery 2013 145, S103-S109DOI: (10.1016/j.jtcvs.2012.11.058) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions