Comparison of fenestrated endografts and the snorkel/chimney technique

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Presentation transcript:

Comparison of fenestrated endografts and the snorkel/chimney technique Jason T. Lee, MD, George K. Lee, MD, Venita Chandra, MD, Ronald L. Dalman, MD Journal of Vascular Surgery Volume 60, Issue 4, Pages 849-857 (October 2014) DOI: 10.1016/j.jvs.2014.03.255 Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 1 Modification of 10-mm Dacron graft by bisecting it in a longitudinal fashion to allow patch angioplasty to be created and increased flexibility during sheath insertion. Journal of Vascular Surgery 2014 60, 849-857DOI: (10.1016/j.jvs.2014.03.255) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 2 Floppy 0.018-inch wires are placed into each renal artery at the beginning of the case to help mark the position of the renal origins and facilitate lining up of fenestrations. Journal of Vascular Surgery 2014 60, 849-857DOI: (10.1016/j.jvs.2014.03.255) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 3 Severe downward angulation of the renal arteries increases the difficulty of ZFEN catheterizations. Left, Downward-going right renal artery. Right, Adjusted maximum intensity projection image shows a less angulated left renal artery. Journal of Vascular Surgery 2014 60, 849-857DOI: (10.1016/j.jvs.2014.03.255) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 4 Placement of an 0.018-inch buddy wire out the fenestration into the suprarenal aorta holds the 7F Ansel sheath in place to allow separate catheterization of the target visceral vessel with more stability. Journal of Vascular Surgery 2014 60, 849-857DOI: (10.1016/j.jvs.2014.03.255) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 5 Multiple 0.018-inch wires into the left renal artery allows gradual stiffness to build up, facilitating catheter and sheath insertion into the target vessel when slight misalignment is present. Journal of Vascular Surgery 2014 60, 849-857DOI: (10.1016/j.jvs.2014.03.255) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 6 Inflating a small angioplasty balloon into the origin of a difficult-to-cannulate renal artery centers the sheath to allow insertion into the target visceral vessel while the balloon is slowly deflated. Journal of Vascular Surgery 2014 60, 849-857DOI: (10.1016/j.jvs.2014.03.255) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 7 Creation of a renal shunt by connection of the larger femoral sheath side port into the 7F Ansel side port of the renal artery catheterized first provides systolic renal perfusion while the second visceral vessel is being worked on. Journal of Vascular Surgery 2014 60, 849-857DOI: (10.1016/j.jvs.2014.03.255) Copyright © 2014 Society for Vascular Surgery Terms and Conditions