Fenestrated and branched devices in the pipeline

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Presentation transcript:

Fenestrated and branched devices in the pipeline Roy K. Greenberg, MD, Moqueet Qureshi, MD Journal of Vascular Surgery Volume 52, Issue 4, Pages 15S-21S (October 2010) DOI: 10.1016/j.jvs.2010.07.001 Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 1 A, Helical iliac branch device. A catheter and wire are preloaded into the limb, which wraps around the limb that transcends from the common iliac to the external iliac artery. The curved nature of the limb provides support to create a gradual curvature for the branch intended for the internal iliac artery, allowing considerable overlap (2.5 cm) between the internal iliac device and iliac limb. B, Helical iliac branch device with bridging stent graft. It shows the same graft mated with a Fluency graft that is intended to extend deep into the internal iliac circulation. C, Straight side-arm iliac branch device. This device is mated with a balloon-expandable stent to couple with the internal iliac artery. D, Bifurcated bifurcated iliac branch device. Journal of Vascular Surgery 2010 52, 15S-21SDOI: (10.1016/j.jvs.2010.07.001) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 2 A, Preloaded fenestrated delivery system manufactured by Cook Inc delivery system manufactured by Cook Inc. The device consists of a sheath into which the fenestrated device is loaded along with two catheters and sheaths, mounted on trigger wires that traverse both of the renal arteries. The catheters can then be advanced over the wires to exit the fenestrations allowing renal access with specifically designed catheters (B). Journal of Vascular Surgery 2010 52, 15S-21SDOI: (10.1016/j.jvs.2010.07.001) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 3 Endologix device. This image represents an off-the-shelf version of a fenestrated device that contains two renal fenestrations and a scallop for the SMA. Journal of Vascular Surgery 2010 52, 15S-21SDOI: (10.1016/j.jvs.2010.07.001) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 4 A, Standard side-arm device intended to treat most type II and III thoracoabdominal aneurysms, made by Cook Inc, consists of short side-arm branches for the celiac, superior mesenteric, and renal arteries. These are intended to be mated with Fluency grafts that are then lined with Wall Stents (Boston Scientific, Natick, Mass). Longer side-arm branches can be used that wrap helically around the aortic component of the device in the setting of larger lumens. This provides additional overlap for mating devices, as well as direct orientation into the target vessel (B). Typically, these are used in conjunction with a Fluency graft without additional lining. However, renal fenestrations are used to given the frequent upward nature of the renal arteries in large proximal aneurysms. C, Helical standard side-arm device with a preloaded catheter and wire. The wire is snared from an axillary approach providing ready access into the target branch, allowing cannulation of the target vessel. Journal of Vascular Surgery 2010 52, 15S-21SDOI: (10.1016/j.jvs.2010.07.001) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 5 A, Cook arch branch device. B, Medtronic arch branch device. C, Gore arch branch device. The Cook device depicted has two branches intended for the innominate and left common carotid arteries. The Medtronic and Gore devices each have one branch, with all other branches intended to be accommodated with extra-anatomic bypasses. The Cook and Gore devices mate distally with self-expanding stents, while the Medtronic device is coupled with a balloon-expandable stent graft. Journal of Vascular Surgery 2010 52, 15S-21SDOI: (10.1016/j.jvs.2010.07.001) Copyright © 2010 Society for Vascular Surgery Terms and Conditions