G Pratesi
Vascular SurgeryVascular Surgery
PoliclinicoPoliclinico Tor Tor VergataVergata
University of Rome “Tor University of Rome “Tor VergataVergata””
Vascular SurgeryVascular Surgery
PoliclinicoPoliclinico Tor Tor VergataVergata
University of Rome “Tor University of Rome “Tor VergataVergata””
Vascular SurgeryVascular Surgery
PoliclinicoPoliclinico CareggiCareggi
University of FlorenceUniversity of Florence
Vascular SurgeryVascular Surgery
PoliclinicoPoliclinico CareggiCareggi
University of FlorenceUniversity of Florence
Endovascular Endovascular repairrepair of of juxtarenaljuxtarenal
AAAsAAAs: : durabledurable resultsresults with Zenith with Zenith
FFenestratedenestrated SStenttent GGraftsrafts
Endovascular Endovascular repairrepair of of juxtarenaljuxtarenal
AAAsAAAs: : durabledurable resultsresults with Zenith with Zenith
FFenestratedenestrated SStenttent GGraftsrafts
EVAR evolution:
endovascular advanced technology
nnImagingImaging
nnPlanningPlanning
nnMaterialsMaterials
nnTechniquesTechniques
Endovascular advanced technology:
fenestrated and branch endograft
Juxtarenal aneurysms:
Zenith Fenestrated Stent Graft
Standard
Zenith Fenestrated Stent Graft
DISTAL GRAFT
LEG EXTENSION GRAFT
PROXIMAL GRAFT
SCALLOP
SMALL
FENESTRATION
Standard
Zenith Fenestrated Stent Graft
Scallop
Scallops along the graft’s
proximal edge are 10 mm
wide and 6-12 mm high.
Small Fenestration
Small fenestrations
are 6 mm wide and
6 or 8 mm high.
Large Fenestration
Large fenestrations
range from 8-12 mm
in diameter.
CE
C2
01
1
CE
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1
Standard
Zenith Fenestrated Stent Graft
Anterior
Posterior
Standard
Zenith Fenestrated Stent Graft
Juxtarenal aneurysms:
Zenith Fenestrated Stent Graft
Durable results with
Zenith Fenestrated Stent Graft
Durable results with
Zenith Fenestrated Stent Graft
FollowFollow--up up ccomplicationsomplications
Greenberg R et al., J Vasc Surg 2009
CE
C2
01
1
CE
C2
01
1
Amiot S, Haulon S al., Eur J Vasc Endovasc Surg 2010
134 patients in 5 ys; 403 visceral vessel, 265 renal arteries
How to get durable results with
Zenith Fenestrated Stent Graft?
nn Suitable anatomySuitable anatomy
nn EExpertisexpertise
(equipment, (equipment,
infrastructure)infrastructure)
nn StadardizedStadardized
techniquetechnique
Zenith Fenestrated Stent Graft:
SUITABLE ANATOMY
nn Proximal aortic neckProximal aortic neck
nn TTortuosityortuosity, thrombus, thrombus
calcificationcalcification
nn RRealeal arteriesarteries
nn IIliacliac vesselsvessels
Suitable anatomy:
short neck
Suitable anatomy:
short neck
Suitable anatomy:
irregular neck
CE
C2
01
1
CE
C2
01
1
Appropriate indication:
irregular neck
Suitable anatomy:
tapered neck
Suitable anatomy:
tapered neck
Zenith Fenestrated Stent Graft:
EXPERTISE
Expertise:
Dedicated planning software
Expertise
Dedicated angio-suite
CE
C2
01
1
CE
C2
01
1
Zenith Fenestrated Stent Graft:
STANDARDIZED PROCEDURE
Standardized procedure:
fenestrated component deployment
Standardized procedure:
renal arteries cannulation
Standardized procedure:
renal arteries stenting
Standardized procedure:
renal arteries flaring
Standardized procedure:
bifurcated component deployment
CE
C2
01
1
CE
C2
01
1
Fenestrated and branch endograft
(January 2007 – June 2011)
Fenestrated
for juxtarenal
19 (22.6%)
Fenestrated and branch
for thoracoabdominal
10 (11.9%)
Iliac branch
for iliac aneurysm
55 (65.4%)
84 84 patientspatients
Juxtarenal AAA: fenestrated stent grafts
(January 2007 – June 2011)
Mean ages 76 years(67-83)
Mean aortic neck
length
4.5 mm
(2-9mm)
Mean AAA diameter 56.2 mm(51-70)
19 19 patientspatients
Juxtarenal AAA: fenestrated stent grafts
(January 2007 – June 2011)
1 fen + scallop 1 (5.4%)
2 fen + scallop 9 (47.4%)
3 fen + scallop 9 (47.4%)
46 46 fenestrationsfenestrations
Juxtarenal AAA: fenestrated stent grafts
(January 2007 – June 2011)
Technical success 18/19 (94.7%)
Target vessel patency 46/46(100%)
Mortality -
Reintervention 1(5.3%)
Endoleak (type II) 2(10.5%)
EarlyEarly outcomeoutcome
Juxtarenal AAA: fenestrated stent grafts
(January 2007 – June 2011)
Mean follow-up
duration
18 m
(1-48
Target vessel patency 45/46(97%)
Mortality 1(5.3)
Morbidity 3(15.7%)
Reintervention 1(5.3%)
MidMid--termterm outcomeoutcome
Learning curve…
step by step procedure
Start with the more simple cases first
CE
C2
01
1
CE
C2
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1
Learning curve…
one fenestration+scallop
Learning curve…
two fenestrations+scallop
Learning curve…
three fenestrations+scallop
Future development:
pararenal device
Conclusions
nn FFeasibleeasible techniquetechnique
nn Standardized Standardized
procedureprocedure
nn Know the deviceKnow the device
nn EExpertisexpertise (planning, (planning,
equipment)equipment)
CE
C2
01
1
CE
C2
01
1
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