Early endovascular grafts at Montefiore Hospital and their effect on vascular surgery Frank J. Veith, MD, Jacob Cynamon, MD, Claudio J. Schonholz, MD,

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Presentation transcript:

Early endovascular grafts at Montefiore Hospital and their effect on vascular surgery Frank J. Veith, MD, Jacob Cynamon, MD, Claudio J. Schonholz, MD, Juan C. Parodi, MD Journal of Vascular Surgery Volume 59, Issue 2, Pages 547-550 (February 2014) DOI: 10.1016/j.jvs.2013.09.051 Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 1 A model similar to the endograft used in the first U.S. endovascular aneurysm repair (EVAR) patient. A Dacron graft was hand-sewn to a large Palmaz-like balloon expandable stent. The compressed stent was mounted on a minimally compliant balloon, which was expanded in the abdominal aortic aneurysm (AAA) neck to fix the proximal end of the endograft to the normal-sized aortic neck. Journal of Vascular Surgery 2014 59, 547-550DOI: (10.1016/j.jvs.2013.09.051) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 2 Early surgeon-made stent grafts based on Parodi's concepts. Top left, An occlusion device consisting of a Palmaz stent covered by a polytetrafluoroethylene (PTFE) graft closed at one end by ligatures. This was used for occluding the common iliac artery opposite to an aortofemoral or aortoiliac endograft in an abdominal aortic aneurysm (AAA) repair.5,8 Top right, A covered stent fabricated by hand-sewing a PTFE graft to a balloon-expandable Palmaz stent, used for treating arterial injuries (eg, of the subclavian artery).7 Bottom, A PTFE graft with a Palmaz stent at either end, used for some long iliac or popliteal aneurysms.10 Journal of Vascular Surgery 2014 59, 547-550DOI: (10.1016/j.jvs.2013.09.051) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 3 Schematic configuration of a unilateral aortofemoral endograft used for treating complex and ruptured abdominal aortic aneurysms (AAAs). Note the large Palmaz stent (p) is partly covered (m) and partly uncovered. The open portion of the stent covers the renal arteries (r) for secure fixation. An endovascular anastomosis (e) fixes the distal end of the endograft within the common femoral artery. The endograft is dilated (not shown) to entirely fill the lumen of the femoral and external iliac artery. When a common iliac aneurysm is present, the ipsilateral hypogastric artery is occluded by coils (c). The contralateral common iliac artery is occluded by a covered stent (o) closed at one end by ligatures (s). The procedure is completed by performing a femorofemoral bypass (f).5,8 Journal of Vascular Surgery 2014 59, 547-550DOI: (10.1016/j.jvs.2013.09.051) Copyright © 2014 Society for Vascular Surgery Terms and Conditions