Giovanni Pratesi 开窗支架血管治疗近肾腹主动脉瘤

G Pratesi Vascular SurgeryVascular Surgery PoliclinicoPoliclinico Tor Tor VergataVergata University of Rome “Tor University of Rome “Tor VergataVergata”” Vascular SurgeryVascular Surgery PoliclinicoPoliclinico Tor Tor VergataVergata University of Rome “Tor University of Rome “Tor VergataVergata”” Vascular SurgeryVascular Surgery PoliclinicoPoliclinico CareggiCareggi University of FlorenceUniversity of Florence Vascular SurgeryVascular Surgery PoliclinicoPoliclinico CareggiCareggi University of FlorenceUniversity of Florence Endovascular Endovascular repairrepair of of juxtarenaljuxtarenal AAAsAAAs: : durabledurable resultsresults with Zenith with Zenith FFenestratedenestrated SStenttent GGraftsrafts Endovascular Endovascular repairrepair of of juxtarenaljuxtarenal AAAsAAAs: : durabledurable resultsresults with Zenith with Zenith FFenestratedenestrated SStenttent GGraftsrafts EVAR evolution: endovascular advanced technology nnImagingImaging nnPlanningPlanning nnMaterialsMaterials nnTechniquesTechniques Endovascular advanced technology: fenestrated and branch endograft Juxtarenal aneurysms: Zenith Fenestrated Stent Graft Standard Zenith Fenestrated Stent Graft DISTAL GRAFT LEG EXTENSION GRAFT PROXIMAL GRAFT SCALLOP SMALL FENESTRATION Standard Zenith Fenestrated Stent Graft Scallop Scallops along the graft’s proximal edge are 10 mm wide and 6-12 mm high. Small Fenestration Small fenestrations are 6 mm wide and 6 or 8 mm high. Large Fenestration Large fenestrations range from 8-12 mm in diameter. CE C2 01 1 CE C2 01 1 Standard Zenith Fenestrated Stent Graft Anterior Posterior Standard Zenith Fenestrated Stent Graft Juxtarenal aneurysms: Zenith Fenestrated Stent Graft Durable results with Zenith Fenestrated Stent Graft Durable results with Zenith Fenestrated Stent Graft FollowFollow--up up ccomplicationsomplications Greenberg R et al., J Vasc Surg 2009 CE C2 01 1 CE C2 01 1 Amiot S, Haulon S al., Eur J Vasc Endovasc Surg 2010 134 patients in 5 ys; 403 visceral vessel, 265 renal arteries How to get durable results with Zenith Fenestrated Stent Graft? nn Suitable anatomySuitable anatomy nn EExpertisexpertise (equipment, (equipment, infrastructure)infrastructure) nn StadardizedStadardized techniquetechnique Zenith Fenestrated Stent Graft: SUITABLE ANATOMY nn Proximal aortic neckProximal aortic neck nn TTortuosityortuosity, thrombus, thrombus calcificationcalcification nn RRealeal arteriesarteries nn IIliacliac vesselsvessels Suitable anatomy: short neck Suitable anatomy: short neck Suitable anatomy: irregular neck CE C2 01 1 CE C2 01 1 Appropriate indication: irregular neck Suitable anatomy: tapered neck Suitable anatomy: tapered neck Zenith Fenestrated Stent Graft: EXPERTISE Expertise: Dedicated planning software Expertise Dedicated angio-suite CE C2 01 1 CE C2 01 1 Zenith Fenestrated Stent Graft: STANDARDIZED PROCEDURE Standardized procedure: fenestrated component deployment Standardized procedure: renal arteries cannulation Standardized procedure: renal arteries stenting Standardized procedure: renal arteries flaring Standardized procedure: bifurcated component deployment CE C2 01 1 CE C2 01 1 Fenestrated and branch endograft (January 2007 – June 2011) Fenestrated for juxtarenal 19 (22.6%) Fenestrated and branch for thoracoabdominal 10 (11.9%) Iliac branch for iliac aneurysm 55 (65.4%) 84 84 patientspatients Juxtarenal AAA: fenestrated stent grafts (January 2007 – June 2011) Mean ages 76 years(67-83) Mean aortic neck length 4.5 mm (2-9mm) Mean AAA diameter 56.2 mm(51-70) 19 19 patientspatients Juxtarenal AAA: fenestrated stent grafts (January 2007 – June 2011) 1 fen + scallop 1 (5.4%) 2 fen + scallop 9 (47.4%) 3 fen + scallop 9 (47.4%) 46 46 fenestrationsfenestrations Juxtarenal AAA: fenestrated stent grafts (January 2007 – June 2011) Technical success 18/19 (94.7%) Target vessel patency 46/46(100%) Mortality - Reintervention 1(5.3%) Endoleak (type II) 2(10.5%) EarlyEarly outcomeoutcome Juxtarenal AAA: fenestrated stent grafts (January 2007 – June 2011) Mean follow-up duration 18 m (1-48 Target vessel patency 45/46(97%) Mortality 1(5.3) Morbidity 3(15.7%) Reintervention 1(5.3%) MidMid--termterm outcomeoutcome Learning curve… step by step procedure Start with the more simple cases first CE C2 01 1 CE C2 01 1 Learning curve… one fenestration+scallop Learning curve… two fenestrations+scallop Learning curve… three fenestrations+scallop Future development: pararenal device Conclusions nn FFeasibleeasible techniquetechnique nn Standardized Standardized procedureprocedure nn Know the deviceKnow the device nn EExpertisexpertise (planning, (planning, equipment)equipment) CE C2 01 1 CE C2 01 1