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Fig. 3 | CVIR Endovascular

Fig. 3

From: Clinical application and technical details of cook zenith devices modification to treat urgent and elective complex aortic aneurysms

Fig. 3

Steps of modification of the Zenith TX2 Dissection Endovascular Graft with Pro-Form. The device is deployed on a sterile back Table (A). Creation and reinforcement of fenestrations are as described in Fig. 5B. Note the presence of an anterior marker (not yet sutured in place) which aids with device orientation (B). A long spinal needle is used to redirect one of the 3 nitinol wires removed from the inner cannula through and through the endograft fabric (C). The device is constrained posteriorly at every Z stent as described in Figure legend 2C (D). The graft is collapsed using silk ties and resheathed (E&F). Completion angiography and post-operative 3D CTA showing exclusion of the aneurysm and patency of all 6 target vessels (celiac, SMA, 2 right renal arteries, 1 left renal artery, and right internal iliac artery) (G&H). Rationale for device selection: The Zenith TX2 double tapered (32–24-158) was chosen for its size and length (32 mm diameter into a 30 mm diameter existing graft and 158 cm long) to allow seal into the existing TEVAR with a minimum of 3 stent overlap while providing adequate room for creation of five fenestrations. The distal tapered (24 mm diameter) allowed for the use of a Zenith fenestrated universal bifurcated device we had available in our inventory

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