PP77. Pulmonary Artery Catheter Directed Rapid Right Ventricular Pacing to Facilitate Precise Deployment of Endografts in the Thoracic Aorta: A Novel Approach

Harbuzariu, Catalin; Ricotta, Joseph J.; Pulido, Juan N.; Oderich, Gustavo S.; Bower, Thomas C.; Kalra, Manju; Duncan, Audra A.; Gloviczki, Péter

doi:10.1016/j.jvs.2009.02.107

Cited by 1 publication

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“…If the proximal landing zone extends beyond the subclavian artery, we revascularize the subclavian artery with a carotidsubclavian bypass prior to the procedure and use rapid ventricular pacing via pulmonary artery catheter to induce hypotension during deployment and ballooning of the proximal component. 20 An activated clotting time of >300 seconds is maintained throughout the entire endovascular procedure with frequent rechecks every 30 minutes. Induced diuresis with mannitol and/or lasix is often used prior to deployment of the fenestrated component.…”

Section: Operative Considerationsmentioning

confidence: 99%

Modified Fenestrated Stent Grafts: Device Design, Modifications, Implantation, and Current Applications

Oderich¹,

Ricotta²

2009

Perspectives in Vascular Surgery and Endovascular Therapy

117

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Patients with aneurysms with short or angulated necks and those with involvement of the renal, visceral, and hypogastric arteries may not be candidates for endovascular treatment using infrarenal stent graft. Fenestrated stent grafts with reinforced fenestrations permit the incorporation of the visceral and renal arteries into the endovascular repair enabling an adequate proximal sealing zone. These devices require a 6-week to 8-week period for customization and are not currently commercially available in the United States. Modified fenestrated stent grafts may have a future role in the compassionate treatment of selected high-risk patients with complex aneurysms who otherwise would not have access to a manufactured fenestrated stent graft, or for those in need of urgent or emergent repair because of impending or contained ruptured, rapidly expanding or excessively large aneurysm. The authors have used modified fenestrated stent grafts selectively in patients with large aortoiliac, juxtarenal, pararenal, or thoracoabdominal aortic aneurysms. In this article, the authors summarize the principles applied for device design and procedure planning, as well as the technique for device modification and implantation.

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Section: Operative Considerationsmentioning

confidence: 99%