1. New Techniques / Devices in Endovascular Treatment of Aortic Diseases
Dr. Haji Zeinali
Interventional Cardiologist
Tehran Heart Center

2. Disclosure Statement Within the past two years:
I have not had an affiliation (financial or otherwise) with a commercial organization that may have a direct or indirect connection to the content of my presentation
I have had an affiliation (financial or otherwise) with a commercial organization that may have a direct or indirect connection to the content of my presentation. Details:
Proctor Consulting Trials Other
Does your presentation describe the off-label use of a device, product or drug that is approved for another purpose?
No Yes (If yes, you must disclose this within your presentation)

3. Summary Chimney Fenestrated: Custom-made / off-the-shelf Sandwich
Iliac Branch Device (IBD)
Ascending aortic stent-grafts
Physician made fenestrated stent-grafts
Aortic Arch
PEVAR
STABLE (for complicated type B dissection)

4. Nellix
Nellix system aims to treat the sac and does not rely on proximal-neck fixation
With this system, the aneurysm itself is anchored with a set of 2 thin-walled polyester polymer-filled endobags that freeze the sac in a definitive and permanent manner 
Only 34 patients treated so far, but device performance and clinical outcomes so far seem promising.1
1. EVAR Using the Nellix Sac-anchoring Endoprosthesis: Treatment of Favourable and Adverse Anatomy, European Journal of Vascular and Endovascular Surgery
Volume 42, Issue 1, July 2011, Pages 38–46

5. Trivascular Ovation
The Trivascular Ovation is a 14Fr stent-graft CE marked in January 2011 and 800 worldwide implantations worlwide so far
It has suprarenal stents for fixation to prevent migration, two sealing “rings” around the trunk to prevent endoleak,  and channels in the main body are then filled with polymer to create a seal against the aorta and provide support for the graft.
It has severeal additional steps (preparation and filling of the polymer) but clinical results so far seem promising

6. Aorto-iliac Aneurysms: Sandwich Technique
The ‘sandwich technique’ aims to preserve flow into the internal iliac artery (IIA) when conducting EVAR for aorto-iliac aneurysms
First the main body is deployed in the aorta, then the IIA is cannulated from contralateral or brachial access, then a peripheral covered stent graft is inserted in the IIA and deployed concurrently with the stent-
graft in the external iliac artery
One study of 21 patients
showed technical success rate
of 88%, limb occlussion was
9%, primary patency at 6mnths
for EIA was 95% and for IIA
was 88%.1
(also called the double barrel technique)
Results of a double-barrel technique with commercially available devices for hypogastric preservation during aortoilac endovascular abdominal aortic aneurysm repair, Journal of Vascular Surgery, Volume 56, Issue 5, November 2012, Pages

7. Aorto-iliac Aneurysms: IBD
Cook Medical Iliac Branch Device (IBD) is the first and only system ever approved specifically for preserving flow to the internal iliac artery in aorto-iliac aneurysms
The IBD helps avoid complications such as buttock claudication, necrosis, ischemia, impotence that may result from iliac embolization

8. Type B Dissection: STABLE Procedure
STABLE: Staged thoraco-abdominal and branch vessel endoluminal repair
STABLE Procedure: Antihypertensive therapy; staged thoracoabdominal and branch vessel endoluminal repair: First, the covered and bare stents are deployed, then covered or bare stent reconstruction of branch vessels and re-entry tears is conducted if necessary to promote false lumen thrombosis and remodeling

9. Type B Dissection
Cook Medical Zenith Dissection System is the first system ever approved specifically for treating Type B Dissections.
Features a proximal covered stent to seal the primary entry tear, and a distal bare stent to support the delimanitaed aortic segment, remodel the true lumen, and promote false lumen thrombosis
New devices recently launched:
Wider 8mm taper
No barbs
Flared bare stent

10. Chimney Chimney EVAR (CHEVAR)
In juxta-renal AAA (where there is no infrarenal landing zone) a covered balloon expandable stent-graft is deployed in the renal arteries, and extended proximally in the supra-renal aorta, therefore allowing the aortic stent graft to also be extended proximally in the aorta, thereby increasing the landing zone
Literature shows technical success rate to be 91%, peri-operative major morbidity of 17%, mortality rates of 5%, and early type 1 endoleaks of 13%.1
1. Chimney technique in the endovascular management of complex aortic disease, Vascular Journal, October 2012 vol. 20 no. 5 

11. Fenestrated: Custom-Made
Cook Medical Zenith Fenestrated is the first stent-graft designed for precise positioning in patients with juxtra-renal AAA
Custom made device specifically designed for each patient, contains two ‘fenestrations’ for the renal arteries, and one scallop for the SMA

12. Fenestrated: Custom-Made

13. Fenestrated: Off-the-shelf
Cook Medical Zenith t-Branch is the only off-the-shelf endovascular stent-graft indicated to treat thoraco-abdominal aortic aneurysms (TAAA)
No need to wait for custom made device (CMD)
Of the patients suitable for CMD, 88% fit the criteria for the t-Branch1
Figure legend: Scatter plot of branch position of the 59 patients meeting the initial 4 criteria with standard endograft overlaid. The angled lines indicate the boundary conditions as outlined in the text. The 3 branches that fall outside the boundary conditions are circled. CA: celiac artery, SMA: superior mesenteric artery, RRA: right renal artery, LRA: left renal artery.
1. J Endovas Ther. 2009;16:

14. Future: Ascending Aortic EVAR
Figure legend: Scatter plot of branch position of the 59 patients meeting the initial 4 criteria with standard endograft overlaid. The angled lines indicate the boundary conditions as outlined in the text. The 3 branches that fall outside the boundary conditions are circled. CA: celiac artery, SMA: superior mesenteric artery, RRA: right renal artery, LRA: left renal artery.

15. Thank you!