Back-table modification of a bifurcated infrarenal stent-graft to aortomonoiliac for emergencies
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Back-table modification of a bifurcated infrarenal stent-graft to aortomonoiliac for emergencies. / Tsilimparis, Nikolaos; Lohrenz, Christina; Pflugradt, Axel; Wipper, Sabine; Debus, Sebastian; Kölbel, Tilo.
in: J ENDOVASC THER, Jahrgang 21, Nr. 2, 04.2014, S. 348-352.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Back-table modification of a bifurcated infrarenal stent-graft to aortomonoiliac for emergencies
AU - Tsilimparis, Nikolaos
AU - Lohrenz, Christina
AU - Pflugradt, Axel
AU - Wipper, Sabine
AU - Debus, Sebastian
AU - Kölbel, Tilo
PY - 2014/4
Y1 - 2014/4
N2 - PURPOSE: To describe a simple and quick technique for converting a Zenith bifurcated stent-graft to an aortouni-iliac device for emergency treatment of hemorrhage when a suitable marketed stent-graft is not readily available.TECHNIQUE: The technique is described in an emergent case involving a 72-year-old man presenting with an aortoduodenal fistula and acute gastrointestinal bleeding. The Zenith device was prepared and flushed in the typical fashion. An extra stiff Lunderquist wire was advanced through the graft for better stability during the modification. The peel-away sheath was advanced beyond the hemostatic valve to allow partial release of the graft from the back then the grey positioner was retracted while the sheath was held firmly on the table, partially deploying the iliac limbs from the back side of the sheath. An occluding non-absorbable braided suture was placed at the short limb of the bifurcated graft close to the middle of the contralateral limb stent, through the webbing connecting both limbs below the flow divider of the bifurcated Zenith device. The graft was then resheathed using manual pinching of the graft or compression with umbilical tape. In the illustrated case, the stent-graft was intentionally deployed with the uncovered stents below the renal arteries to facilitate easier explantation later on.CONCLUSION: Back-table modification of stent-grafts is feasible in emergencies for operators familiar with all technical aspects and potential risks of the modifications.
AB - PURPOSE: To describe a simple and quick technique for converting a Zenith bifurcated stent-graft to an aortouni-iliac device for emergency treatment of hemorrhage when a suitable marketed stent-graft is not readily available.TECHNIQUE: The technique is described in an emergent case involving a 72-year-old man presenting with an aortoduodenal fistula and acute gastrointestinal bleeding. The Zenith device was prepared and flushed in the typical fashion. An extra stiff Lunderquist wire was advanced through the graft for better stability during the modification. The peel-away sheath was advanced beyond the hemostatic valve to allow partial release of the graft from the back then the grey positioner was retracted while the sheath was held firmly on the table, partially deploying the iliac limbs from the back side of the sheath. An occluding non-absorbable braided suture was placed at the short limb of the bifurcated graft close to the middle of the contralateral limb stent, through the webbing connecting both limbs below the flow divider of the bifurcated Zenith device. The graft was then resheathed using manual pinching of the graft or compression with umbilical tape. In the illustrated case, the stent-graft was intentionally deployed with the uncovered stents below the renal arteries to facilitate easier explantation later on.CONCLUSION: Back-table modification of stent-grafts is feasible in emergencies for operators familiar with all technical aspects and potential risks of the modifications.
KW - Aged
KW - Aortic Diseases/complications
KW - Aortography/methods
KW - Blood Vessel Prosthesis
KW - Blood Vessel Prosthesis Implantation/instrumentation
KW - Duodenal Diseases/complications
KW - Emergencies
KW - Gastrointestinal Hemorrhage/diagnosis
KW - Humans
KW - Iliac Artery/diagnostic imaging
KW - Intestinal Fistula/complications
KW - Ligation
KW - Male
KW - Prosthesis Design
KW - Stents
KW - Suture Techniques
KW - Tomography, X-Ray Computed
KW - Treatment Outcome
KW - Vascular Fistula/complications
U2 - 10.1583/13-4567R.1
DO - 10.1583/13-4567R.1
M3 - SCORING: Journal article
C2 - 24754298
VL - 21
SP - 348
EP - 352
JO - J ENDOVASC THER
JF - J ENDOVASC THER
SN - 1526-6028
IS - 2
ER -
