EVAR Overview and stent-graft implantation in complex iliac anatomy

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Presentation transcript:

EVAR Overview and stent-graft implantation in complex iliac anatomy Angiomed Workshop Deineka Conference Room 22TH JUNE 2019 Dr. G. Kalender DRK Kliniken Berlin

Anaconda Stentgraft modular design flexible safe repositionable easily probed with magnet wire 22.06.2019 Dr. G. Kalender

Indications Morphology suitable for Endovascular Aneurysm Repair (EVAR) Proximal aortic neck length of ≥15mm with non-significant calcification and/or thrombus Native proximal neck diameter 17,5- 31 mm Anaconda™ ONE-LOK™ Adequate iliac or femoral vessel access Native iliac artery diameters of 8,5- 21 mm Distal Fixation Length Of ≥20mm 22.06.2019 Dr. G. Kalender

Modular concept wide range of main bodys and iliac legs durable ultrathin- polyester ring- stent design (nitinol) 22.06.2019 Dr. G. Kalender

contralateral radiopaque markers leg docking radiopaque bifurcated main body proximal ring contralateral radiopaque markers secondary ring valley hooks peek hooks leg docking radiopaque distal radiopaque marker contralateral cannulation flare with radiopaque markers 22.06.2019 Dr. G. Kalender

proximal radiopaque marker distal radiopaque marker Iliac leg proximal radiopaque marker individual ring stents with radiopaque alignment markers distal radiopaque marker 22.06.2019 Dr. G. Kalender

Iliac leg – flared und tapered proximal radiopaque marker transition marker distal radiopaque marker 22.06.2019 Dr. G. Kalender

fast and easy cannulation patented magnet wire cannulation 22.06.2019 Dr. G. Kalender

Fully repositionable 22.06.2019 Dr. G. Kalender

Range of sizes bifurcated main body diameter 21,5 – 34 mm length 65 mm Iliac leg diameter 10 – 23 mm length 60 – 140 mm 22.06.2019 Dr. G. Kalender

Anaconda Stentgraft System NEW ONE-LOK™ BODY: Additional ring stents: maximize the lumen und blood flow large lumen for ipsilateral cannulation standard diameter in the docking zone indicated to treat infra-renal neck angulations > 90° 22.06.2019 Dr. G. Kalender

Proactive Sealing System 12 Proactive Sealing System Excellent sealing function - dual, proximal ring stent design with hooks - security against stent graft migration 22.06.2019 Dr. G. Kalender

FDA Clinical Trial Phase II One Year Results of the Vascutek Anaconda™. ONE-LOK EVAR trial. Christopher Kwolek, MD. Randy Moore, MD. On behalf of the Anaconda™ Investigators 23 hospitals (18 USA, 5 Canada), 195 patients, >15 mm neck of aneurysm, <60° angulation 98 % technical success , no conversion 0% mortality, 100 % open iliac leg 98% no endoleak Typ I oder III Typ II endoleak: 32 % (30 Tagen), 26% (1Jahr) summary: Anaconda- stentgraft- safe and effektive after 12 months 22.06.2019 Dr. G. Kalender

Fenestrated Anaconda™ Body section without stents: maximise the available area for fenestrations optimal flexibility for varying patient anatomies fully repositionable system for optimal positioning no deformation of fenestration by stent material 22.06.2019 Dr. G. Kalender

Fenestrated Anaconda™ patented magnet system: significantly reduce bifurcate body cannulation time dual proximal ring stent design with hooks provides excellent sealing function multiple independent ring stent design provides maximum flexibility for varying patient anatomies minimises the potential for kinking 22.06.2019 Dr. G. Kalender

Fenestrated Anaconda™ > 3000 implantations > 8000 target vessels since 06/2010 Vacutek Terumo News, fenestrated anaconda, Jahrgang XVIV 2015 22.06.2019 Dr. G. Kalender

Custom Made Leg Example Concepts 22.06.2019 Dr. G. Kalender

Design Possibilitys Sealingring, Hooks, Fenestrations… 22.06.2019 Dr. G. Kalender

Access Possibilitys 22.06.2019 Dr. G. Kalender

POST-OP Pictures 22.06.2019 Dr. G. Kalender

Device Customisations Pleating Reduces fabric in region of aortic narrowing 22.06.2019 Dr. G. Kalender

Additional Fenestration Support Tapered Graft Helps to alleviate excess fabric overlapping with fenestrations Reduces the fabric diameter in cases of more extreme narrowing 22.06.2019 Dr. G. Kalender

Flared Graft Extra-long Body Increases the fabric diameter in cases of more extreme widening 90-100mm long. Required joining ring to attach two pieces of fabric together and the contralateral flare is removed. 22.06.2019 Dr. G. Kalender

Legs Lateral Useful when close to the bifurcation of an existing device or aorta 22.06.2019 Dr. G. Kalender

22.06.2019 Dr. G. Kalender