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Prediction of altered endograft path during endovascular abdominal aortic aneurysm repair with the Gore Excluder  David R. Whittaker, MD, Jeff Dwyer,

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Presentation on theme: "Prediction of altered endograft path during endovascular abdominal aortic aneurysm repair with the Gore Excluder  David R. Whittaker, MD, Jeff Dwyer,"— Presentation transcript:

1 Prediction of altered endograft path during endovascular abdominal aortic aneurysm repair with the Gore Excluder  David R. Whittaker, MD, Jeff Dwyer, BA, Mark F. Fillinger, MD  Journal of Vascular Surgery  Volume 41, Issue 4, Pages (April 2005) DOI: /j.jvs Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

2 Fig 1 Comparison of length measurements with three-dimensional (3D) and angiographic marker catheter imaging, illustrating that multiple interpretations of the potential endograft path are possible. In A, the 3D lumen centerline length from the renal artery to the left hypogastric artery is 17 cm., whereas in B, the 3D user-defined path using “virtual graft” technique to account for the actual graft size is 15.8 cm. In C, the angiographic marker catheter length is 22 cm if the catheter is unconstrained but is only 14 cm if a stiff guidewire is placed within the marker catheter. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

3 Fig 2 Example of measurements used to evaluate tortuosity. Shown here are 3D measurements for the renal artery-to-hypogastric artery tortuosity index (RHTI), where RHTI = (lumen centerline length – straight line length) as measured from the center of the aorta just below the lowest renal artery to the center of the common iliac artery just proximal to the hypogastric artery origin. The other tortuosity indices are calculated in similar fashion as described in Table I. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

4 Fig 3 Virtual graft simulation to demonstrate the potential effect of endograft rotation and insertion site for the main device (trunk and ipsilateral limb). Configurations shown are A, main device inserted via right with docking limb in standard contralateral position; B, main device inserted via right with docking limb rotated 90 degrees, to an anterior position; C, main device inserted via left with docking limb in standard contralateral position; D, and main device inserted via left with docking limb rotated 90 degrees, to an anterior position. The device length is the same in each simulation, but has different endpoints because of the side of insertion and rotation. A shorter device should be chosen in each case and illustrates the utility of simulating the endograft insertion side, length, diameter, and amount of rotation within the anatomy rather than constraining the simulation rigidly to the centerline. Configurations B or D are preferred in this case, as they allow the device to bend along its most flexible axis. The configuration shown in A might compress the docking limb and collapse it before cannulation, and the configuration shown in C would make cannulation of the docking limb much more difficult. Device length would be adjusted to account for the chosen configuration and where the device will be deployed relative to the renal arteries. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

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