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Alternative techniques for management of distal anastomoses of aortofemoral and iliofemoral endovascular grafts  Reese A. Wain, MD, Ross T. Lyon, MD,

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Presentation on theme: "Alternative techniques for management of distal anastomoses of aortofemoral and iliofemoral endovascular grafts  Reese A. Wain, MD, Ross T. Lyon, MD,"— Presentation transcript:

1 Alternative techniques for management of distal anastomoses of aortofemoral and iliofemoral endovascular grafts  Reese A. Wain, MD, Ross T. Lyon, MD, Frank J. Veith, MD, Michael L. Marin, MD, Takao Ohki, MD, William A. Suggs, MD, Evan Lipsitz, MD  Journal of Vascular Surgery  Volume 32, Issue 2, Pages (August 2000) DOI: /mva Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

2 Fig. 1 Diagram depicting the components of an endovascular stented graft and delivery system, including guidewire (a ), guiding balloon (b ), proximal stent (c ), prosthetic graft (d ), sutures (e ), deployment balloon (f ), introducer sheath (g ), and hemostatic valve (h ). Journal of Vascular Surgery  , DOI: ( /mva ) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

3 Fig. 2 Schematic drawing of an aortofemoral endovascular graft after deployment of the proximal stent (arrow ) but before construction of the distal anastomosis. The distal portion of the graft has been brought out through the common femoral arteriotomy, which was initially created to allow insertion of the device. Journal of Vascular Surgery  , DOI: ( /mva ) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

4 Fig. 3 Sutured endovascular anastomosis and overlying primary arteriotomy closure of an iliofemoral endovascular graft. Appearance of the anastomosis before completion (a ). This configuration is used when the branches of the common femoral artery are obstructed. Journal of Vascular Surgery  , DOI: ( /mva ) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

5 Fig. 4 Right, Distal sutured endovascular graft anastomosis with overlying patch angioplasty. Left, Sagittal section of endoluminal anastomosis and patch angioplasty. This anastomotic configuration is used in the presence of a small or diseased common femoral artery and unobstructed deep and superficial femoral arteries. Journal of Vascular Surgery  , DOI: ( /mva ) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

6 Fig. 5 Sutured endoluminal anastomosis with the hood of a distal bypass graft originating from the arteriotomy overlying the endoluminal anastomosis. This configuration is used for simultaneous revascularization of contralateral aortoiliac or infrainguinal arterial occlusive disease. Journal of Vascular Surgery  , DOI: ( /mva ) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

7 Fig. 6 In the presence of significant occlusive disease of the common femoral artery and its branches or of the contralateral iliac artery, the distal portion of the endovascular grafts are brought out from the arterial lumen, and anastomoses are fashioned as follows: A, end-to-side configuration of the graft to the deep femoral artery; B, end-to-end (or end-to-side) anastomosis to a concomitant deep femoral-popliteal bypass graft; C, endovascular graft extended directly to the popliteal artery because of diffuse disease of the superficial femoral and deep femoral arteries; D, femoral-femoral bypass graft originating from the distal externalized portion of the endoluminal bypass graft. Journal of Vascular Surgery  , DOI: ( /mva ) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

8 Fig. 7 Angiogram demonstrating a high-grade stenosis (arrow ) of the common femoral artery at the site of a distal endovascular graft anastomosis performed without an overlying patch angioplasty. Journal of Vascular Surgery  , DOI: ( /mva ) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

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