Radiofrequency Perforation System for In Vivo Antegrade Fenestration of Aortic Stent-Grafts

To report our first clinical application of a new technique for in situ fenestration of a thoracic stent-graft. After completing a series of in vitro and in vivo experiments, in situ stent-graft fenestration was employed during endograft repair of a saccular thoracic aortic aneurysm in a 77-year-old woman. Because the stent-graft would have covered the left subclavian artery ostium, a modified Zenith TX1 thoracic stent-graft was deployed then fenestrated transluminally using a guidewire followed by serial cutting balloons, which created a fenestration over the LSA sufficiently large to accommodate a Jomed covered stent on an 8-mm balloon. Completion angiography showed exclusion of the aneurysm and brisk flow into the LSA. Following the procedure, the arm pressures were nearly equal. The 6-month CT scan showed no endoleak and a patent subclavian artery stent. In situ graft fenestration to preserve the left subclavian artery after deliberate coverage during endovascular repair of a thoracic aortic aneurysm appears feasible in this initial clinical application. There are uncertainties regarding the long-term stability of the fabric tears that are an inherent part of this technique.

to address the clinical problem of inadequate neck length of abdominal aortic aneurysms in endoluminal surgery. a covered suprarenal aortic stent was designed with a fenestration to preserve blood flow in a targeted renal artery. a Dacron-covered stent was accurately cut to size with a fenestration according to pre-imaging studies. the stent was successfully deployed in canine models, preserving the visceral and renal artery of interest. by accurately placing a covered stent in the aorta and preserving the blood flow to its branches, it may be possible to extend the indications for endoluminal aortic aneurysm grafting. Copyright 1999 Harcourt Publishers Ltd.

We describe a modular stent graft for use in endovascular repair of aneurysms of the aortic arch. Carotid-carotid and left carotid-subclavian bypass grafts are created surgically. Two large, fully stented grafts are inserted endoluminally. The proximal component is bifurcated, with a wide proximal trunk and two distal limbs, one long and narrow, the other short and wide. This component is inserted through the carotid artery and deployed with the trunk and short wide limb in the ascending thoracic aorta; the long narrow limb opens into the innominate artery. After delivery system removal and carotid artery repair, a distal component is inserted through a femoral approach to bridge the gap between the short, wide distal limb of the proximal component and the nondilated descending thoracic aorta. The result is a branched stent graft, implanted proximally into the ascending aorta and distally into the innominate artery and descending thoracic aorta. The system has been used successfully to treat a large wide-necked pseudoaneurysm of the aortic arch.