title: Improving endograft stability by accommodation onto the aortic bifurcation.
abstract: OBJECTIVE
  To report the technique for deploying a 3-part endovascular graft onto the native aortic bifurcation for greater stent-graft stability.
  
  
  METHODS
  The Zenith Composite Endovascular Graft is a 3-part system consisting of a proximal tubular body with an uncovered Gianturco Z stent, a distal bifurcated body, and a contralateral leg. Proximally, 8-mm flexible interstent gaps facilitate precise infrarenal aortic placement, even in angulated necks. Technically, the bifurcated part is deployed first and pulled down to the aortic bifurcation, while the tubular main body and contralateral leg deployment follow. Using this technique to accommodate the graft onto the natural aortic bifurcation, distal stability can be enhanced and graft migration minimized.
  
  
  CONCLUSIONS
  The Composite configuration can be an alternative to ensure a higher security index in difficult anatomies. It may be beneficial in patients with short (10-15 mm), angulated (>60 degrees ), or conical necks and deserves investigation in these patient populations.
authors.affiliation: Department of Vascular Surgery, Hellenic Airforce Hospital, Athens, Greece.
authors.forename: Theodossios P
authors.initials: TP
authors.lastname: Perdikides
authors.forename: Efthimios D
authors.initials: ED
authors.lastname: Avgerinos
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Lagios
authors.forename: Peter
authors.initials: P
authors.lastname: Ziegler
authors.forename: Wolf
authors.initials: W
authors.lastname: Stelter
mesh_terms: D001011:Aorta / Q000473:pathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001027:Aortography; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D005548:Foreign-Body Migration / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D011474:Prosthesis Design; D015607:Stents; D016896:Treatment Outcome