Oderich Gustavo S
Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Ann Vasc Surg. 2010 Oct;24(7):980-4. doi: 10.1016/j.avsg.2010.05.011.
Modified fenestrated stent grafts have been used for compassionate treatment of large complex aortic aneurysms in high-risk patients who do not have access to a manufactured device and are not candidates for conventional open surgical repair. Accurate device design and precise implantation are key components of the procedure. A technique of device modification with diameter-reducing wire is described to facilitate catheterization of side branches.
The modified Cook Zenith stent graft was created using reinforced fenestrations with gold nitinol markers. The stainless steel wire, which secures the top cap into the uncovered stent, was partially withdrawn, retrieved, and redirected externally through-and-through the fabric of the stent graft. Each Z-stent was constrained using the stainless steel wire for support and by two nonlocking prolene loops. The constrained stent graft was 30% narrower than the unconstrained device, which allowed flow between the stent graft and the aortic wall, as well as longitudinal and rotational movement of the stent graft. After successful catheterization of the fenestrations, balloon-expandable stent grafts were advanced over hydrophilic sheaths, and the stainless steel diameter-reducing wire was removed with full expansion of the Z-stents to its unconstrained diameter. The fenestrations were stented with balloon-expandable stent grafts, followed by placement of iliac limbs
The use of a diameter-reducing wire allows longitudinal and rotational movement to the modified fenestrated stent graft and facilitates side branch catherization in patients in whom there is misalignment between the fenestration and the origin of the target vessel.
改良开窗支架型人工血管已被用于对无法获得定制器械且不适合传统开放手术修复的高危患者的大型复杂主动脉瘤进行同情治疗。精确的器械设计和精准的植入是该手术的关键组成部分。本文描述了一种使用缩径钢丝进行器械改良的技术，以利于侧支血管的插管。
使用带有金镍钛诺标记物的强化开窗技术制作改良的库克天顶支架型人工血管。将固定顶盖至裸支架的不锈钢丝部分抽出、回收，并从外部贯穿支架型人工血管的织物重新导向。每个Z形支架通过不锈钢丝支撑并由两个非锁定的普理灵环约束。约束后的支架型人工血管比未约束的器械窄30%，这使得支架型人工血管与主动脉壁之间能够有血流，以及支架型人工血管能够进行纵向和旋转运动。在成功完成开窗的插管后，将球囊可扩张支架型人工血管通过亲水鞘管推进，随着Z形支架完全扩张至其未约束直径，移除不锈钢缩径钢丝。用球囊可扩张支架型人工血管对开窗进行支架置入，随后放置髂支。
使用缩径钢丝可使改良开窗支架型人工血管进行纵向和旋转运动，并便于在开窗与目标血管起源存在错位的患者中进行侧支血管插管。
