IP029. Fenestrated Thoracic Endovascular Aortic Repair Using Physician-Modified Stent Grafts for Acute Type B Aortic Dissection With Unhealthy Proximal.

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Presentation transcript:

IP029. Fenestrated Thoracic Endovascular Aortic Repair Using Physician-Modified Stent Grafts for Acute Type B Aortic Dissection With Unhealthy Proximal Landing Zone Jiechang Zhu, Lujing Zhao, Xiangchen Dai, Zhou Feng, Hailun Fan, Yudong Luo, Yiwei Zhang, Fanguo Hu Journal of Vascular Surgery Volume 65, Issue 6, Pages 62S-64S (June 2017) DOI: 10.1016/j.jvs.2017.03.118 Copyright © 2017 Terms and Conditions

Fig Device preparation and physician-modified stent graft implantation. A, The Relay thoracic stent graft was fully unsheathed. The LSA fenestration was created using an ophthalmology cautery (OASIS Medical, Glendora, Calif). B, The LSA fenestration was reinforced using the loop of a snare (Amplatz Goose Neck, ev3, Plymouth, Min), fixed to the fabric with a continuous running suture of CV-5 (Gore, Flagstaff, Ariz) with about 8 mm in diameter. C and D, A 300-cm, 0.014-inch nitinol guidewire (ASAHI, Nagoya, Aichi, Japan) was used to pass through the LSA fenestration into the endograft, and the stiff tip of the guidewire was pushed about 40-cm length into the inner secondary sheath of the device. E and F, The stent graft was reloaded finally in the inner secondary sheath and the primary outer sheath. G, A preoperative computed tomography scan showed the primary tear entry (red arrow) in the descending aorta and the retrograde dissection extending to the LSA. H, A diagnostic angiogram confirmed the acute type B aortic dissection without healthy proximal landing zone for TEVAR. I, After ensuring that the fenestration was oriented toward the LSA by hand-injection of iodinated contrast through the 6F sheath placed at the ostium of the LSA (red arrow), the endograft was fully deployed. J, A catheter and the 6F sheath was then advanced sequentially over the preloaded guidewire into the endograft through the fenestration from the retrograde brachial artery access. K, The LSA alignment bare nitinol stent (SMART [10 mm in diameter, 40 mm in length]) (Cordis, Miami Lakes, Fla) was deployed. Completion aortography was performed to confirm endograft and LSA fenestration patency without endoleak. L, One month postoperative CT showed the patency of the LSA and complete thrombosis of false lumen in the descending aorta. Journal of Vascular Surgery 2017 65, 62S-64SDOI: (10.1016/j.jvs.2017.03.118) Copyright © 2017 Terms and Conditions