1. Fenestrated Endograft

2. Fenestrated aortic endograft - Planning
CTA 1mm tickness
MPR
3 D
CLL evaluation

3. 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

4. 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

5. Fenestrated endograft

6. Fenestrated endograft

7. Bifurcated Endograt

10. 12:00
9:00
3:00
6:00

11. Visceral vessels distance evaluation

12. Baseline
Lower CT

13. Baseline
Lower CT
Mid SMA

14. Baseline
Lower CT
Lower SMA

15. Baseline
Lower CT
Mid SMA
Mid LRA

16. Baseline
Lower CT
Mid SMA
Mid LRA
Mid RRA

17. Baseline
Lower CT
Lower SMA
2 mm below
Mid LRA
Mid RRA

18. TOP OF THE GRAFT Baseline Lower CT 12 mm Lower SMA 2 mm below Mid LRA
Mid RRA

19. Baseline
Lower CT
TOP OF THE GRAFT
12 mm
Lower SMA
Mid LRA
Mid RRA

20. Baseline
Lower CT
TOP OF THE GRAFT
12 mm
Lower SMA
Mid LRA
Mid RRA

24. Endoprotesi Fenestrate nel trattamento degli AAA
Planning
TAC
Impianto
4 – 6 settimane

25. Follow up 3 years

26. Follow up 3 years

27. Vascular Surgery – University of Bologna
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

28. 2012

29. Vascular Surgery – University of Bologna
MPR
Vascular Surgery – University of Bologna

30. Vascular Surgery – University of Bologna
Risk factors for type II endoleaks
MPR
IMA
Lumbars
Vascular Surgery – University of Bologna

31. Vascular Surgery – University of Bologna
Visceral vessels evaluation
Vascular Surgery – University of Bologna

32. Vascular Surgery – University of Bologna
Visceral vessels evaluation
Vascular Surgery – University of Bologna

33. Vascular Surgery – University of Bologna
Visceral vessels evaluation
Clock View
SMA 12.15
Vascular Surgery – University of Bologna

34. Vascular Surgery – University of Bologna
Visceral vessels evaluation
Clock View
LRA 15.00
Vascular Surgery – University of Bologna

35. Vascular Surgery – University of Bologna
Visceral vessels evaluation
RRA Center Lumen Line
Vascular Surgery – University of Bologna

36. Vascular Surgery – University of Bologna
Visceral vessels evaluation
Clock View
LRA 9.30
Vascular Surgery – University of Bologna

37. 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

38. Vascular Surgery – University of Bologna
Fenestrated endograft
Vascular Surgery – University of Bologna

39. Vascular Surgery – University of Bologna
Bone landmarks
T12
Vascular Surgery – University of Bologna

40. Vascular Surgery – University of Bologna
Bone landmarks L5
Vascular Surgery – University of Bologna

41. Vascular Surgery – University of Bologna
Femoral Access
Vascular Surgery – University of Bologna

42. Vascular Surgery – University of Bologna
Pre-operative C-Arm evaluation .
Vascular Surgery – University of Bologna

43. Vascular Surgery – University of Bologna
Pre-operative C-Arm evaluation
20° .
Vascular Surgery – University of Bologna

44. Vascular Surgery – University of Bologna
Pre-operative C-Arm evaluation
90° .
Vascular Surgery – University of Bologna

45. Vascular Surgery – University of Bologna

46. Vascular Surgery – University of Bologna

47. Vascular Surgery – University of Bologna

48. Vascular Surgery – University of Bologna

49. Vascular Surgery – University of Bologna

50. Vascular Surgery – University of Bologna

51. Vascular Surgery – University of Bologna

52. Vascular Surgery – University of Bologna