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Initial experience with the Ventana fenestrated system for endovascular repair of juxtarenal and pararenal aortic aneurysms  Andrew Holden, MD, Renato.

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Presentation on theme: "Initial experience with the Ventana fenestrated system for endovascular repair of juxtarenal and pararenal aortic aneurysms  Andrew Holden, MD, Renato."— Presentation transcript:

1 Initial experience with the Ventana fenestrated system for endovascular repair of juxtarenal and pararenal aortic aneurysms  Andrew Holden, MD, Renato Mertens, MD, Andrew Hill, MD, Leopoldo Mariné, MD, Daniel G. Clair, MD  Journal of Vascular Surgery  Volume 57, Issue 5, Pages (May 2013) DOI: /j.jvs Copyright © 2013 Society for Vascular Surgery Terms and Conditions

2 Fig 1 Anatomic illustration of the implant. Note the bifurcated unibody stent graft (short arrow), anatomically fixed at the aortic bifurcation; Ventana fenestrated/scalloped proximal extension stent graft (long arrow); Xpand renal stent grafts (arrowheads). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

3 Fig 2 Ventana stent graft system fluoroscopic image. The Ventana stent graft is constrained within its delivery system, which is advanced through a deployed bifurcated stent graft (arrowhead). Note the “U” shaped radio-opaque marker outlining the visceral scallop (short arrows) and the right and left fenestration circumferential markers (long arrows). Front sheath, outer sheath, and renal guide sheath markers are also visible. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

4 Fig 3 Ventana delivery system user interface. The central handle is bounded on the left and right by the 6.5F guide sheaths (long arrows) and fenestration pushers (short arrows). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

5 Fig 4 Initial renal artery cannulation. A downward-seeking catheter (long arrow) has been introduced through the right renal sheath allowing cannulation of the right renal artery. Note the control pigtail catheter introduced from the contralateral femoral artery (short arrow). Angiographic catheters with guidewires (black arrows) are advanced into renal artery ostia. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

6 Fig 5 Renal guide sheath advancement. After successful renal artery cannulation, 6.5F renal guide sheaths are advanced into each renal artery. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

7 Fig 6 Proximal scallop to superior mesenteric artery (SMA) alignment. The central scallop marker (arrow) is oriented a few millimeters above the base of the SMA as viewed in a lateral projection. The scallop can be lowered into optimum position after the proximal graft segment has been deployed. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

8 Fig 7 Deployed proximal segment of Ventana stent graft. A, Frontal projection: The radiopaque markers along the sides of the visceral artery scallop (arrows). B, Lateral projection: The graft has been retracted caudally to position the radiopaque marker at the base of the visceral artery scallop immediately below the superior mesenteric artery (SMA) (arrow). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

9 Fig 8 Xpand renal stent graft catheter placement. The most proximal 5 mm of the renal stent graft remains in the aorta for flaring (arrows). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

10 Fig 9 Final angiographic runs. A, Lateral projection showing a patent superior mesenteric artery (SMA). B, Frontal projection shows the oversized graft (arrows) in the visceral segment creating extended seal zones with the aortic anatomy. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

11 Fig 10 Examples of preoperative and 1-month case computed tomography (CT) images. SMA, Superior mesenteric artery. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

12 Fig 11 Challenging renal cannulation example. A, Preoperative computed tomography (CT) anatomy in the oblique and posterior projections (note the tortuous left renal artery [arrow]). B, Intraoperative arteriography of the renal arteries showing the irregular, downward pointing right renal artery and the tortuous left renal artery (arrows). C, Completion angiogram. D, CT at 1 month showing conformance of the oversized graft midsection to the anatomy. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

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