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Physician-modified endovascular grafts for the treatment of elective, symptomatic, or ruptured juxtarenal aortic aneurysms  Benjamin W. Starnes, MD, FACS 

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Presentation on theme: "Physician-modified endovascular grafts for the treatment of elective, symptomatic, or ruptured juxtarenal aortic aneurysms  Benjamin W. Starnes, MD, FACS "— Presentation transcript:

1 Physician-modified endovascular grafts for the treatment of elective, symptomatic, or ruptured juxtarenal aortic aneurysms  Benjamin W. Starnes, MD, FACS  Journal of Vascular Surgery  Volume 56, Issue 3, Pages (September 2012) DOI: /j.jvs Copyright © 2012 Society for Vascular Surgery Terms and Conditions

2 Fig 1 A computed tomographic angiogram from a representative patient demonstrating a short infrarenal aortic neck and a large juxtarenal aneurysm. A, Coronal computed tomographic angiogram image. B, Left renal artery originating from a short aortic neck immediately cephalad to a large juxtarenal aneurysm (C). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

3 Fig 2 Gold, 15-mm Amplatz Gooseneck Snares (ev3, Plymouth, Minn) were then used to reinforce all fenestrations. These were hand sewn into place using 4-0 Prolene suture in a 720 degree running fashion. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

4 Fig 3 A typical physician-modified endovascular graft (PMEG) prior to device repackaging (A). Fenestrations for the superior mesenteric artery (SMA) (struts present) and left and right renal arteries (strut-free) were created for this particular patient. B, Rerouting of the trigger wire to allow for placement of graft constraining ties. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

5 Fig 4 Contrast aortography demonstrating the origins of all four visceral vessels with the physician-modified endovascular graft (PMEG) device in situ prior to deployment. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

6 Fig 5 Physician-modified endovascular graft (PMEG) procedure. A, Both renal arteries have been selected through the renal fenestrations and a sheath advanced into the left renal artery. B, Seating of the proximal graft with the renal sheaths securely in place. C, Stent grafting and subsequent flaring of the renal artery stents. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

7 Fig 6 Completion aortogram demonstrating absence of endoleak and good alignment of all three visceral vessel fenestrations. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

8 Fig 7 Six-month follow-up imaging in patient depicted in Figs 1-6.
Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

9 Fig 8 Kaplan-Meier survival curves depicting cumulative survival for the entire cohort of patients undergoing physician-modified endovascular graft (PMEG). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

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