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Home > Vascular Annual Meeting > RR29. Malrotation and Bending of Multi-Branched...

RR29. Malrotation and Bending of Multi-Branched Thoracoabdominal Stent Grafts

Ki-Hyuk Park1,2, Jade S. Hiramoto1, Linda M. Reilly1, Timothy A.M. Chuter1
1UCSF, San Francisco, CA; 2Daegu Catholic University School of Medicine, Daegu, Republic of Korea

OBJECTIVES: To assess the accuracy of thoracoabdominal stent graft deployment and the effect of stent graft orientation on angulation of the visceral branches.

METHODS: 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. Measurements of actual cuff orientation (ACO), actual vessel orientation (AVO), and longitudinal branch length (LBL) were based on 3-dimensional analysis (TeraRecon) of postoperative CT scans. The actual orientation of the cuff (ACO) was compared with the planned orientation (PCO) to assess malorientation (ACO-PCO). The ACO was also compared with AVO to assess branch angulation in trans-axial (ACO-AVO) and longitudinal (LBA) planes. The ACO-PCO of the CA cuff was compared with the ACO-PCO of distal cuffs to assess twisting between cuffs.

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. For any given degree of malrotation, higher LBL resulted in lower LBA. 91% of visceral arteries lay within a vertical 60 degree-wide arc (LBA x2), centered on the outer orifice of the corresponding cuff. Although the mean values of PCO and AVO were similar, individual values often differed because PCO referred to the centerline of the aorta and AVO to the centerline of the stent graft.

Table 1.

All 141 branches were inserted as planned. None have migrated, disconnected, or kinked.

CONCLUSIONS: The branches of a thoracoabdominal stent graft bend to accommodate the malorientation and eccentric position of the trunk, but these angles do not compromise the feasibility or stability of branch implantation.

AUTHOR DISCLOSURES: K. Park, None; J.S. Hiramoto, None; L.M. Reilly, None; T.A.M. Chuter, Cook Medical, Inc.; Cook Medical, Inc.; Cook Medical, Inc.