Surgeon modified Fenestrated EVAR: step by step procedure
This is a tutorial about performing on table standard EVAR fenestration and subsequent aneurysm repair in the present case the patient was unfit for surgery and had a large left accessory renal artery. He was treated with infrarenal surgeon modified endograft and accessory renal artery overstenting. Successful treatment and satisfying control CT scan
Hi. Congratulations on the case.
Why the polypropylene 6/0 constraints sutures?
the circumferential suture serves just for the same porpoise of the reducing tie in the CM Cook grafts. once the graft is deployed it prevents justaposition with the aortic wall so the surgeon is able to rotate the device and adjust height.
once the introducer sheat is secured inside the target vessel, ballooning the graft leads to suture rupture with proximal sealing
congratulations its a great case and quite descriptive.. my question will be regarding the alignment of fenestrations to ostium of the renal artery? before deployment how do you make sure that the rotation of the stent graft is correct in order to have the fenestration is aligned to the renal artery? or do you align it after partial deployment? but I believe still there could be a margin of error, how do you prevent this ?