Fenestrated Endograft

Fenestrated aortic endograft - Planning

• CTA 1mm tickness

• MPR

• 3 D

• CLL evaluation

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

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

Fenestrated endograft

Fenestrated endograft

Bifurcated Endograt

12:00

9:00 3:00

6:00

Visceral vessels distance evaluation

Lower CTBaseline

Lower CTBaseline

Mid SMA

Lower CTBaseline

Lower SMA

Lower CTBaseline

Mid SMA

Mid LRA

Lower CTBaseline

Mid SMA

Mid LRA

Mid RRA

Lower CTBaseline

Lower SMA

Mid LRA

Mid RRA

2 mm below

Lower CTBaseline

Lower SMA

Mid LRA

Mid RRA

2 mm below

TOP OF THE GRAFT

12 mm

Lower CTBaseline

Lower SMA

Mid LRA

Mid RRA

TOP OF THE GRAFT

12 mm

Lower CTBaseline

Lower SMA

Mid LRA

Mid RRA

TOP OF THE GRAFT

12 mm

Endoprotesi Fenestrate nel trattamento degli AAA

• Planning

TAC Impianto

4 – 6 settimane

Follow up 3 years

Follow up 3 years

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

2012

MPR

Vascular Surgery – University of Bologna

MPR

Vascular Surgery – University of Bologna

Risk factors for type II endoleaks

IMA

Lumbars

Visceral vessels evaluation

Vascular Surgery – University of Bologna

Vascular Surgery – University of Bologna

Visceral vessels evaluation

Visceral vessels evaluation

Vascular Surgery – University of Bologna

Clock ViewSMA 12.15

Visceral vessels evaluation Clock ViewLRA 15.00

Vascular Surgery – University of Bologna

Visceral vessels evaluation

RRA Center Lumen Line

Vascular Surgery – University of Bologna

Visceral vessels evaluation Clock ViewLRA 9.30

Vascular Surgery – University of Bologna

Fenestrated endograft

• Fenestrated module CT ScallopSMA large fenestraionRRA small fenestrationLRA small fenestration

• Bifurcated endograft

Vascular Surgery – University of Bologna

Fenestrated endograft

Vascular Surgery – University of Bologna

Bone landmarks

T12

Vascular Surgery – University of Bologna

L5

Bone landmarks

Vascular Surgery – University of Bologna

Femoral Access

Vascular Surgery – University of Bologna

Pre-operative C-Arm evaluation

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Vascular Surgery – University of Bologna

.

20°

Pre-operative C-Arm evaluation

Vascular Surgery – University of Bologna

.

90°

Pre-operative C-Arm evaluation

Vascular Surgery – University of Bologna

Vascular Surgery – University of Bologna

Vascular Surgery – University of Bologna

Vascular Surgery – University of Bologna

Vascular Surgery – University of Bologna

Vascular Surgery – University of Bologna

Vascular Surgery – University of Bologna

Vascular Surgery – University of Bologna

Vascular Surgery – University of Bologna