Physician-Modified Endografts, Creating Fenestrations скачать в хорошем качестве

Physician-Modified Endografts, Creating Fenestrations

Endovascular repair of thoracoabdominal aortic aneurysm (TAAA)—a concept which seemed like pie in the sky less than a decade ago—is now an increasingly utilized technique in a growing number of centers worldwide, especially for patients with atherosclerotic TAAA. To this point, a recent multicenter population-based study of patients undergoing TAAA repair between 2006 and 2017 in Ontario, Canada, found that endovascular repairs comprised more than 50% of all TAAA repairs in the province since 2011. Total endovascular approaches to TAAA repair have been developed to minimize the known risks associated with open repair and allow safer repair in the typical high-risk patient population presenting with atherosclerotic TAAA. Although devices such as the Cook T-Branch stent graft, which is available outside the US, and the investigational Gore Excluder Thoracoabdominal Branch Endoprosthesis, which is currently being evaluated in a pivotal clinical trial, have been developed specifically for endovascular TAAA repair, neither is yet commercially available in the US. This lack of a commercially available option has given rise to the use of so-called physician-modified endografts (PMEGs). PMEGs involve the modification of commercially available endografts, most commonly the Zenith Alpha and TX2 thoracic devices, whereby the devices are unsheathed in the operating room under sterile conditions and customized with reinforced fenestrations that correspond precisely to the patient’s visceral anatomy. Temporary diameter-reducing ties are likewise created, allowing for partial deployment of the device without engaging the aortic wall, and thereby provide maneuverability of the endograft in cranial/caudal and rotational directions. Once the device has been fully modified ex vivo, it is then re-sheathed into its original delivery system and deployed endovascularly, subsequently allowing for delivery of branch stents grafts into the visceral vessels to complete the repair.