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Since their introduction about 60 years ago, vascular grafts have been constantly improved to better simulate a native vessel. Their long-term performance is now quite satisfactory for replacement of large arteries, but research is still looking for the ideal substitute to replace small vessels. The chapter aims to present the currently available materials, with a focus on new concepts, in particular...
Open surgical reconstruction of extensive thoraco-abdominal aortic aneurysms involving the ascending aorta, arch and supra-renal descending aorta, is a technically challenging procedure. A two-stage hybrid approach by first performing a conventional ascending aorta replacement and debranching of the epiaortic and visceral vessels using a new Dacron multi-branched vascular prosthesis (Lupiae prosthesis)...
The Cook Zenith family of devices includes a wide range of custom and off-the-shelf endovascular grafts and devices capable of treating patients with complex anatomy and pathology, including those previously considered unsuitable for endovascular repair. Available devices include the Zenith AAA, Zenith TX2 TAA, Zenith Fenestrated Graft, Iliac Branch Graft, and Helical Branch Graft, and the Zenith...
The Relay stent-graft is an endovascular device dedicated solely to the treatment of thoracic aortic pathologies. The Relay thoracic stent-graft and delivery system has a high flexibility and trackability, and allows controlled and accurate deployment. It is available with two different proximal configurations: a bare and a non-bare stent. The stent-graft is available in a wide range of diameters...
Jotec endovascular stent-grafts are based on polyester/nitinol technology. E-vita thoracic was the first device for thoracic endovascular repair with controlled release of the proximal graft end. It was followed by the E-vita abdominal bifurcated stent-graft and by E-vita open, a combination of endovascular stent-graft and a surgical polyester graft designed for open antegrade implantation and aortic...
The pathology affecting the thoracic aorta is complex and adds to the challenges that must be faced with thoracic endografting. Common conditions now treated with endovascular techniques include thoracic aneurysms, acute aortic syndromes, chronic dissections, and transections. As experience with thoracic endografting grows, the case mix has become increasingly complex, with the indications for thoracic...
Thoracic endovascular aortic repair has been shown to be an attractive alternative to open surgery with low procedural morbidity and mortality, and acceptable satisfactory mediumterm results, and is therefore the treatment of first choice in most thoracic aortic pathologies. Many pathologies involve the aortic arch, where device deployment and positioning is challenging. The use of a device in this...
From January 2000 to December 2009, in the Division of Vascular Surgery of the hospitals of Pisa and Naples (Monaldi Hospital), InterGard silver (InterVascular, La Ciotat, France) grafts were implanted in 1,424 patients (93.6% male and 6.4% female) for the treatment of aorto-iliac diseases. The mean age of patients was 71.4 ± 7.4 years. Some patient characteristics were considered as increased risk...
One of the most critical issues in contemporary surgery remains the management of operative bleeding. Intra- and postoperative bleeding that is unresponsive to conventional methods of hemostasis is a cause for concern, as it may reduce visualization of the surgical field, prolong surgery, and contribute to postoperative complications. Suture-line hemostasis, reinforcement of fragile tissue, and prevention...
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