Aortic arch aneurysm repair using the Najuta stent graft in a challenging compromised seal zone

Abstract

We report the case of a 67-year-old patient with an anatomically complex aneurysm of the aortic arch treated by fenestrated thoracic endovascular aortic repair with subclavian-carotid extrathoracic bypass. We used the Najuta thoracic stent graft, which was approved for use in January 2013 in Japan and successfully excluded the aneurysm. Our case shows that the Najuta stent graft procedure is a feasible treatment if open repair is unsuitable for cases of aortic arch aneurysm with a challenging compromised seal zone.

Complete neck vessel preservation using a fenestrated stent graft for the treatment of proximal anastomotic leakage after open frozen elephant trunk graft aortic arch repair

“…The use of an anatomic plaster model produced using a three-dimensional printer is effective for obtaining a geometric analysis for the fenestrations. 1 …”

“…A customized full-scale stent graft model was deployed to the patient-specific plaster model before TEVAR. The use of an anatomic plaster model produced by the 3D printer is effective for obtaining a geometric analysis for the fenestrations 1) .…”

Unusual Endovascular Treatment of Iliac Occlusive Disease With a Physician-Modified Endograft to Preserve a Transplant Renal Artery

“…The proposed customization mimicked a concept already in use to treat aortic arch aneurysms, with both CMD and PMEG devices, where wide fenestrations are used to avoid supra-aortic trunk accidental coverage. 14,15 With our experience Endurant Medtronic (Medtronic Cardiovascular, Santa Rosa, CA, USA) deployment mechanism enables easy reloading of the modified graft; moreover, stent architecture offers a possibility for ample fenestrations without compromise of its structural integrity.…”

Fenestrated endovascular repair of aortic arch aneurysm in patients with bovine arch using the Najuta stent graft

“…The use of an anatomic plaster model produced by the 3D printer is effective for obtaining a geometric analysis of the fenestrations. 3 The proximal (and distal) neck diameter is 20 to 38 mm according to the instructions for use. The stent graft diameter of the Najuta is 24 to 42 mm.…”

“…The Najuta fenestrated stent graft was delivered with a 23F J-shaped sheath maintained under continuous strain by traction at both wire ends (body floss technique). 3 , 4 Subsequently, it was delivered and deployed at the zone 0 proximal site with delicate positional adjustment of the fenestration of the Najuta stent graft to the brachiocephalic trunk. After endoprosthesis implantation, angiography revealed a patent brachiocephalic trunk and exclusion of the aneurysm ( Fig 3 , A ).…”