Retrograde fenestration of endoluminal grafts from target vessels: feasibility, technique, and potential usage.
OBJECTIVE
To report initial experiments involving a new method for percutaneous intraprocedural stent-graft fenestration from the target vessel.


METHODS
In bench and canine models, the fabric of an implanted Zenith endograft was punctured easily using the stiff end of a coronary 0.014-inch guidewire delivered through the target vessel (e.g., renal or iliac artery). A 20-G cutting needle was passed over the coronary wire to enlarge the puncture site, followed by a cutting balloon to create a fenestration that was of sufficient size to allow deployment of a stent.


CONCLUSIONS
In vivo endograft fenestration of a Zenith endograft is feasible. In addition to providing a percutaneous means of intentionally fenestrating a stent-graft from the artery to be perfused, the technique has potential application as a bailout maneuver after inadvertent side branch occlusion. Although the time to achieve successful fenestration in the experimental model was long, refinement may achieve performance times adequate to maintain viability of the end organ.
McWilliams
Richard G
RG
Royal Liverpool University Hospital, Liverpool, England, UK. richard@mcwilliams.u-net.com
Fearn
Shirley J
SJ
Harris
Peter L
PL
Hartley
David
D
Semmens
James B
JB
Lawrence-Brown
Michael M D
MM
D000818:Animals; D001807:Blood Vessel Prosthesis; D004285:Dogs; D005240:Feasibility Studies; D007083:Iliac Artery; D011474:Prosthesis Design; D015607:Stents; D014656:Vascular Surgical Procedures / Q000379:methods*