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In situ bending of thoracic stent grafts: Clinical application of a novel technique to improve conformance to the aortic arch  Tilo Kölbel, MD, PhD, Nuno.

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Presentation on theme: "In situ bending of thoracic stent grafts: Clinical application of a novel technique to improve conformance to the aortic arch  Tilo Kölbel, MD, PhD, Nuno."— Presentation transcript:

1 In situ bending of thoracic stent grafts: Clinical application of a novel technique to improve conformance to the aortic arch  Tilo Kölbel, MD, PhD, Nuno Dias, MD, PhD, Timothy Resch, MD, PhD, Jan Holst, MD, PhD, Björn Sonesson, MD, PhD, Martin Malina, MD, PhD  Journal of Vascular Surgery  Volume 49, Issue 6, Pages (June 2009) DOI: /j.jvs Copyright © 2009 Society for Vascular Surgery Terms and Conditions

2 Fig 1 Customization of a conventional thoracic stent graft (Cook Inc). A, the Bowden cable enters the central rod (arrow) of the distal part of the introducer system. The Bowden cable contains a pulling line and a trigger wire for its detachment. B, The proximal part of the stent graft is attached to the central rod at the nose cone. The sliding knot is positioned just proximal to the Bowden cable housing on the inner curve (arrow). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

3 Fig 2 A, In this preoperative computed tomography angiography (CTA) in patient 1, the maximum intensity projection of the aortic arch shows a contrast-filling defect distally to the left subclavian artery (arrow). B, Completion angiogram after placement of a thoracic stent graft and in situ bending shows full apposition to the inner curve. C, CTA after 1 year shows the apposition of the stent graft is unchanged. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

4 Fig 3 A, In this preoperative computed tomography angiography in patient 2, multiplanar reformation shows a calcified pseudoaneurysm of the descending aorta with a short neck and a steep angle of the aortic arch. B, Completion angiogram after placement and in-situ bending of a thoracic stent graft shows full apposition to the inner curve of the gothic aortic arch. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

5 Fig 4 A, Maximum intensity projection of the preoperative computed tomography angiography in patient 3 demonstrates a 7-cm thoracic aortic aneurysm. B, A notch at the outer aspect of the introducer tip confirms correct orientation of the device in the aortic arch (arrow). C, In the fully deployed sent graft before in situ bending, a gap is present between the proximal stent and the aortic wall at the inner curve (arrow). D, Full apposition at the inner curve has been achieved after in situ bending. Note that the protrusion of the stent graft into the left subclavian artery occurred during early deployment and was not caused by the subsequent bending procedure. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

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