W. Anthony Lee, MD, FACS Director of Endovascular Program

Christine E. Lynn Heart and Vascular Institute Boca Raton, Florida

AAA/TAA

Problem

Availability: Regulatory, CMD

Support: Expertise/skill/training

Disease prevalence

Institutional infrastructure: imaging, critical care

Cost: endograft, ancillary devices

Solutions

Open repair

Hybrid repair

Chimney (sandwich, terraced)

Surgeon-modified

Fenestrations

Fenestrations + branch

2

1

1 2

TAAA

Zenith t-Branch System

Off-the-shelf (non-CMD)

Modular

Branched (vs. fenestrated)

“visceral adapter”

Mates with TEVAR/EVAR devices

Case Example

71 year old woman

s/p CABG, AAA tube graft repair

6.9-cm type III TAAA

Serum creatinine 1.2 mg/dl

Pre-Case Planning

Pre-Case Planning

Access

LEFT BRACHIAL BILATERAL FEMORAL

T

O

P

B

O

T

T

O

M

12 F

9 F

LEFT RENAL

R

I

G

H

T

R

E

N

A

L

SMA

CELIAC

2 weeks postop

Special Considerations

Up-going renal arteries

Chronically occluded visceral vessel

>30-mm proximal landing zones

Branch mating technology

Variable lengths

Oversizing tolerances (prox-dist mismatch)

Flexibility

Delivery system (trackable, low-profile)

occl celiac

Amplatzer plug