Elongated Aortic Aneurysms

Aortic aneurysms are frequently associated with severe elongations and angulations. In these cases the endovas-cular devices are not easy to push upwards and to handle during the deployment. Intra- and post-procedural problems are not rare. The curved delivery system is under tension and graft deployment may be problematic [11, 39, 40]. This usually arises in aortic arch or descending aortic aneurysms that have c- or s-shaped elongations (Fig. 5.4.4). This occurrence is further worsened if the stent graft is deployed by the pull-back technique such as in Medtronic Talent®, Endomed Endofit® and Cook TX1/ TX2® stent graft systems. The use of flexible and kink-resistant devices with a long profile tip is essential. Some authors recommend heating the stiff dilatators (Endofit® stent graft system) in boiling water in order to make them more soft and flexible [40]. For the implantation of TAG/ Excluder® devices, there is no need to pass a sheath for descending aorta and aortic arch aneurysms (Fig. 5.4.4). Pre-curved devices are developed in order to make deployment of the graft easier in the aortic arch. The decrease of systemic blood pressure minimizes further the risk of intra-procedural dislocation [24, 25]. The use of stiff guidewires in various modifications is necessary and helps to neutralize some angulations or elongations, but increases the risk of distal embolization. Systemic hepa-rinization and the careful use of catheter and guidewires are therefore very important for minimizing such risk [30]. If two stent grafts or more are necessary to cover preop 3-D

m postop anqio postop stent

Fig. 5.4.4 This case demonstrates double descending aortic aneurysms (3D reconstruction) with s-shaped elongation. Only very flexible devices are able to treat such cases. An Excluder™ stent graft device was used and adequate exclusion of aneurysms was achieved the aneurysmal area, disconnection of the graft during the follow-up can occur. Long overlap between the grafts placed using the trombone technique is recommended. A graft-to-graft overlapping zone of more 50 mm is the current recommendation [19, 35, 39].

Was this article helpful?

0 0
Diabetes Sustenance

Diabetes Sustenance

Get All The Support And Guidance You Need To Be A Success At Dealing With Diabetes The Healthy Way. This Book Is One Of The Most Valuable Resources In The World When It Comes To Learning How Nutritional Supplements Can Control Sugar Levels.

Get My Free Ebook

Post a comment