Fenestrated Endograft
Fenestrated aortic endograft - Planning
• CTA 1mm tickness
• MPR
•3D
• CLL evaluation
Fenestrated endograft – Anatomical considerations
• Proximal neck angulation < 45°
• Distal neck angulation < 45°
• No circumferential sealin zone thrombus/calcification
• Absence of aorto-iliac:
• occlusive disease
• tortuosity
•calcification
Fenestrated endograft – Anatomical considerations
• Ensure 2 cm sealing zone above AAA
• No visceral vessels stenosis (>50 %)
• No small Ø visceral vessels (≥5 mm)
• No severe visceral vessels angulation
• Adequate (>15 mm) main visceral vessel lenght
Fenestrated endograft
Fenestrated endograft
Bifurcated Endograt
12:00
3:00
9:00
6:00
Visceral vessels distance evaluation
Baseline
Lower CT
Baseline
Lower CT
Mid SMA
Baseline
Lower CT
Lower SMA
Baseline
Lower CT
Mid SMA
Mid LRA
Baseline
Lower CT
Mid SMA
Mid LRA
Mid RRA
Baseline
Lower CT
Lower SMA
2 mm below
Mid LRA
Mid RRA
Baseline
Lower CT
TOP OF THE GRAFT
12 mm
Lower SMA
2 mm below
Mid LRA
Mid RRA
Baseline
Lower CT
TOP OF THE GRAFT
12 mm
Lower SMA
Mid LRA
Mid RRA
Baseline
Lower CT
TOP OF THE GRAFT
12 mm
Lower SMA
Mid LRA
Mid RRA
Endoprotesi Fenestrate nel trattamento degli AAA
• Planning
TAC
Impianto
4 – 6 settimane
Follow up 3 years
Follow up 3 years
B.A. male, 65 years
• COPD
• CAD (IMA)
• BMI
31.9
• AAA
Ø 52 mm
• Creatinine 1.2 mg/dl
• ASA: III
Vascular Surgery – University of Bologna
2012
MPR
Vascular Surgery – University of Bologna
Risk factors for type II endoleaks
IMA
Lumbars
Vascular Surgery – University of Bologna
MPR
Visceral vessels evaluation
Vascular Surgery – University of Bologna
Visceral vessels evaluation
Vascular Surgery – University of Bologna
Visceral vessels evaluation
Clock View
SMA 12.15
Vascular Surgery – University of Bologna
Visceral vessels evaluation
Clock View
LRA 15.00
Vascular Surgery – University of Bologna
Visceral vessels evaluation
RRA Center Lumen Line
Vascular Surgery – University of Bologna
Visceral vessels evaluation
Clock View
LRA 9.30
Vascular Surgery – University of Bologna
Fenestrated endograft
• Fenestrated module
CT Scallop
SMA large fenestraion
RRA small fenestration
LRA small fenestration
• Bifurcated endograft
Vascular Surgery – University of Bologna
Fenestrated endograft
Vascular Surgery – University of Bologna
Bone landmarks
T12
Vascular Surgery – University of Bologna
Bone landmarks
L5
Vascular Surgery – University of Bologna
Femoral Access
Vascular Surgery – University of Bologna
Pre-operative C-Arm evaluation
.
Vascular Surgery – University of Bologna
Pre-operative C-Arm evaluation
20°
.
Vascular Surgery – University of Bologna
Pre-operative C-Arm evaluation
90°
.
Vascular Surgery – University of Bologna
Vascular Surgery – University of Bologna
Vascular Surgery – University of Bologna
Vascular Surgery – University of Bologna
Vascular Surgery – University of Bologna
Vascular Surgery – University of Bologna
Vascular Surgery – University of Bologna
Vascular Surgery – University of Bologna
Vascular Surgery – University of Bologna