Low-profile Zenith Alpha™ Thoracic Stent Graft Modification Using Preloaded Wires for Urgent Repair of Thoracoabdominal and Pararenal Abdominal Aortic Aneurysms

Abstract

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Intercostal artery incorporation to prevent spinal cord ischemia during total endovascular thoracoabdominal aortic repair

“…A Zenith Alpha 38 × 34 × 167 mm thoracic endograft (Cook Medical, Bloomington, Ind) was modified with a single caudally directed side branch and a precannulated wire as previously described. 6 Next, left brachial to right femoral through-wire access was obtained for placement of the precannulated wire. An aortogram was performed to demonstrate the location of the intercostal patch pseudoaneurysm and the large intercostal artery ( Figure 2 ).…”

“…The modification steps have been previously published. 6 After bilateral femoral access was established, an angiogram with 3-dimensional fusion was performed to appropriately mark the location of visceral branches. After deployment of the branched-fenestrated endograft, each visceral branch was individually selected and stented.…”

“…The procedures described represent off-label use of devices using techniques that have been previously described. 6 …”

Physician-modified fenestrated endovascular repair of type 1A endoleaks from polymer-based low-profile endografts

“…The modification technique included placement of preloaded wires, as previously described. 9 Under general anesthesia, a left high brachial cut down was performed for branch vessel cannulation, and percutaneous femoral access was used for aortic component implantation. Six branch vessels were sequentially catheterized with staggered deployment of the fenestrated endograft (Figure 2(c) and (d)).…”

Total realignment of multibranch stent graft using redo branch-in-branch endovascular repair for occult endoleak with rapid aneurysm sac expansion

“…The inner branches allowed luminal space outside the new endograft to be minimized, given that the inner aortic diameter was already limited from tapering of the original PMEG. 8,9 To facilitate catheterization, four preloaded wires were added using a technique previously described. 10 The procedure was performed in a hybrid operating room with a GE Discovery IGS 740 (GE Healthcare, Chicago, Ill).…”