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KMID : 1235920090010010056
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Medical Journal of Catholoc University of Daegu
2009 Volume.1 No. 1 p.56 ~ p.61
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Malrotation and Bending of Multi-Branched Thoracoabdominal Stent Grafts
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Park Ki-Hyuk
Hiramoto Jade S
Reilly Linda M
Chuter Timothy A M
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Abstract
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Purpose: To assess the accuracy of thoracoabdominal stent graft deployment and the effect of stent graft orientation on angulation of the visceral branches.
Method: Multi-branched stent grafts were assembled in-situ, using covered stents to connect short, caudally-directed cuffs on the stent graft with the corresponding visceral arteries. Actual cuff orientation (ACO), actual vessel orientation (AVO), and longitudinal branch length (LBL) were measured on 3-dimensional analysis (TeraRecon) of postoperative CT scans. The ACO was compared with the planned orientation (PCO) to assess malorientation (ACOPCO). The ACO was also compared with AVO to assess branch angulation in trans-axial (ACO-AVO) and longitudinal (LBA) planes.
Results: Between Nov 2005 and Dec 2008, 38 patients underwent multi-branched endovascular aortic aneurysm
repair with a total of 141 branches to the visceral arteries. Small degrees of malorientation (ACO-PCO) were common, but severe malorientation (>45 degrees) was rare. The cuff-bearing portion of the stent graft usually rotated as a single unit. Only one patient had > 30 degrees of twisting between the CA and SMA cuffs and only 4 had > 30 degrees between the CA and LRA (Left renal artery). 91% of visceral arteries lay within a vertical 60 degree-wide arc (LBA Х2), centered on the outer orifice of the corresponding cuff. All 141 branches were inserted as planned. None have migrated, disconnected, or kinked.
Conclusion: The branches of a thoracoabdominal stent graft bend to accommodate the malorientation, but these
angles do not compromise the feasibility of stability of branch implantation.
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KEYWORD
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Surgery, Vascular, Graft
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