Fenestrated Endograft

1. Fenestrated Endograft

2. Fenestratedaorticendograft - Planning • CTA 1mm tickness • MPR • 3 D • CLL evaluation

3. 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

4. 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

5. Fenestrated endograft

6. Fenestrated endograft

7. Bifurcated Endograt

10. 12:00 3:00 9:00 6:00

11. Visceral vessels distance evaluation

12. Baseline Lower CT

13. Baseline Lower CT Mid SMA

14. Baseline Lower CT Lower SMA

15. Baseline Lower CT Mid SMA Mid LRA

16. Baseline Lower CT Mid SMA Mid LRA Mid RRA

17. Baseline Lower CT Lower SMA 2 mmbelow Mid LRA Mid RRA

18. Baseline Lower CT TOP OF THE GRAFT 12 mm Lower SMA 2 mmbelow Mid LRA Mid RRA

19. Baseline Lower CT TOP OF THE GRAFT 12 mm Lower SMA Mid LRA Mid RRA

20. Baseline Lower CT TOP OF THE GRAFT 12 mm Lower SMA Mid LRA Mid RRA

24. Endoprotesi Fenestrate nel trattamento degli AAA • Planning TAC Impianto 4 – 6 settimane

25. Follow up 3 years

26. Follow up 3 years

27. Vascular Surgery – University of Bologna B.A. male, 65 years • COPD • CAD (IMA) • BMI 31.9 • AAA Ø 52 mm • Creatinine 1.2 mg/dl • ASA: III

28. 2012

29. Vascular Surgery – University of Bologna MPR

30. Vascular Surgery – University of Bologna Risk factors for type II endoleaks MPR IMA Lumbars

31. Vascular Surgery – University of Bologna Visceral vessels evaluation

32. Vascular Surgery – University of Bologna Visceral vessels evaluation

33. Vascular Surgery – University of Bologna Visceral vessels evaluation Clock View SMA 12.15

34. Visceral vessels evaluation Clock View LRA 15.00 Vascular Surgery – University of Bologna

35. Visceral vessels evaluation RRA Center Lumen Line Vascular Surgery – University of Bologna

36. Vascular Surgery – University of Bologna Visceral vessels evaluation Clock View LRA 9.30

37. Vascular Surgery – University of Bologna Fenestrated endograft • Fenestrated module • CT Scallop • SMA large fenestraion • RRA small fenestration • LRA small fenestration • Bifurcated endograft

38. Vascular Surgery – University of Bologna Fenestrated endograft

39. Vascular Surgery – University of Bologna Bone landmarks T12

40. Vascular Surgery – University of Bologna Bone landmarks L5

41. Vascular Surgery – University of Bologna Femoral Access

42. Vascular Surgery – University of Bologna Pre-operative C-Arm evaluation .

43. Vascular Surgery – University of Bologna Pre-operative C-Arm evaluation 20° .

44. Vascular Surgery – University of Bologna Pre-operative C-Arm evaluation 90° .

45. Vascular Surgery – University of Bologna

46. Vascular Surgery – University of Bologna

47. Vascular Surgery – University of Bologna

48. Vascular Surgery – University of Bologna

49. Vascular Surgery – University of Bologna

50. Vascular Surgery – University of Bologna