Initial experience with a new fenestrated stent graft

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Presentation transcript:

Initial experience with a new fenestrated stent graft Peter Mark Bungay, MA, MRCP, FRCR, Nick Burfitt, MRCS, FRCR, Kaji Sritharan, MD (Res), FRCS, Lorna Muir, RN, BA, Sumaira L. Khan, FRCS, Mario Cosimo De Nunzio, MRCP, FRCR, Krishna Lingam, FRCS, Alun Huw Davies, MA, DM, FRCS Journal of Vascular Surgery Volume 54, Issue 6, Pages 1832-1838 (December 2011) DOI: 10.1016/j.jvs.2011.05.115 Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 1 An illustration of a custom fenestrated Anaconda shows two fenestrations for the renal arteries and superior mesenteric artery accommodated in the anterior valley. Journal of Vascular Surgery 2011 54, 1832-1838DOI: (10.1016/j.jvs.2011.05.115) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 2 When planning for Anaconda custom fenestrated devices, the distance from the superior mesenteric artery (SMA) to the renal arteries is measured (c). The stent graft design takes into consideration the oversize of the device and the relative distance from the peak to the valley (b), to allow flow to the SMA. The distance from the peak of the device to the top of the fenestration (a) is also calculated for accurate placement below the sealing zone in the suprarenal aorta. Journal of Vascular Surgery 2011 54, 1832-1838DOI: (10.1016/j.jvs.2011.05.115) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 3 A, A computed tomography angiography (CTA) reconstruction of the 74-mm juxtarenal abdominal aortic aneurysm is shown for patient 1. A web-like stenosis of the left renal artery is clearly seen. B, A volume-rendered reconstruction of the 6-month follow-up CTA shows the fenestrated graft has excluded the aneurysm. Journal of Vascular Surgery 2011 54, 1832-1838DOI: (10.1016/j.jvs.2011.05.115) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 4 A, A computed tomography angiography (CTA) reconstruction shows the short neck of the aneurysm in patient 2, and a 50° angulation is seen in this coronal plane. B, A volume-rendered reconstruction of the 1-month follow-up CTA shows the graft conforms to the angulated neck anatomy, patent renal stents/arteries, and the superior mesenteric artery is accommodated within the anteriorly oriented valley of the proximal graft. Journal of Vascular Surgery 2011 54, 1832-1838DOI: (10.1016/j.jvs.2011.05.115) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 5 A, A computed tomography angiography (CTA) maximum intensity projection (MIP) image for patient 3 shows the neck anatomy before fenestrated endovascular aneurysm repair (FEVAR). B, A CTA MIP image shows the position of the stent graft and renal artery stents after FEVAR. Journal of Vascular Surgery 2011 54, 1832-1838DOI: (10.1016/j.jvs.2011.05.115) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 6 A, A computed tomography angiography (CTA) maximum intensity projection (MIP) in patient 4 shows the neck anatomy before fenestrated endovascular aneurysm repair (FEVAR). B, The CTA MIP image shows the position of the stent graft and renal artery stents after FEVAR. Journal of Vascular Surgery 2011 54, 1832-1838DOI: (10.1016/j.jvs.2011.05.115) Copyright © 2011 Society for Vascular Surgery Terms and Conditions