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New temporary internal introducer shunt for brain perfusion during total endovascular arch replacement with in situ fenestration technique  Björn Sonesson,

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Presentation on theme: "New temporary internal introducer shunt for brain perfusion during total endovascular arch replacement with in situ fenestration technique  Björn Sonesson,"— Presentation transcript:

1 New temporary internal introducer shunt for brain perfusion during total endovascular arch replacement with in situ fenestration technique  Björn Sonesson, MD, PhD, Tim Resch, MD, PhD, Nuno Dias, MD, PhD, Martin Malina, MD, PhD  Journal of Vascular Surgery  Volume 56, Issue 4, Pages (October 2012) DOI: /j.jvs Copyright © 2012 Society for Vascular Surgery Terms and Conditions

2 Fig 1 Schematic drawing of the introducer shunt shows that when the aortic stent graft is deployed, the flow (arrows) will go from the descending aorta into the introducer shunt and innominate and left carotid arteries. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

3 Fig 2 Schematic drawing shows the experimental setup in a porcine model to validate the theoretic volume flow values calculated of a certain introducer size. The blood flow is directed into the introducer shunts in the arch, passes through the shunt in the thoracoabdominal aorta, and enters in native aorta just above the aortic bifurcation. At the same time, the aorta is tied around the introducer shunt, allowing no blood to flow outside the shunt. Blood pressure is measured in the arch simultaneously with blood pressure and blood flow above the aortic bifurcation. Actual values are compared with theoretic values according to Poiseuille's law and compiled in the Table. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

4 Fig 3 The introducer shunts are placed in the innominate and carotid arteries, the thoracic stent graft is deployed, and the needle is in place for the first fenestration. The inset shows a multiplanar reconstructed image perpendicular to the aortic graft and the introducer shunt. Note the compression of the stent graft by the introducer shunt. This is probably a lesser problem in the aneurysmal aorta. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

5 Fig 4 The introducer-shunts are withdrawn, and the aortic stent graft is fully expanded. The inset shows a multiplanar reconstructed image of the fenestration with the stent in the center. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

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