Latest on the re-constrainable pla latform of FEVAR Robin Wil - - PowerPoint PPT Presentation

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latest on the re constrainable pla latform of fevar
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Latest on the re-constrainable pla latform of FEVAR Robin Wil - - PowerPoint PPT Presentation

Oct 31, 2022 173 likes •593 views

Latest on the re-constrainable pla latform of FEVAR Robin Wil illiams, Newcastle-upon-Tyne Thanks to: Sandip Nandhra Andrew Hatrick Jamie McCarte www.critical-issues-congress.com Disclosure Speaker name: Robin

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www.critical-issues-congress.com

Latest on the re-constrainable pla latform of FEVAR

Robin Wil illiams, Newcastle-upon-Tyne

Thanks to: Sandip Nandhra Andrew Hatrick Jamie McCarte

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Disclosure Speaker name: Robin Williams................................................................................. I have the following potential conflicts of interest to report: x Consulting Employment in industry Shareholder in a healthcare company Owner of a healthcare company Other(s) I do not have any potential conflict of interest

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Disclosure

  • Terumo Aortic paid for my travel
  • I am paid by Terumo Aortic for proctoring and consultancy
  • I will be paid for the CIEG workshop (hopefully)
  • Data collection and analysis was independent of Terumo Aortic
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TERUMO AORTIC ANACONDA FEVAR

Inher eren ent t advan dvantage ges

Re Re-constraina constrainable ble Un Unsup uppor ported ed fabric bric

  • Almost unlimited positions for fenestrations
  • Less affected by shelves and narrow lumen
  • Flexible, capable of conforming to angulation

Free ee acc ccess ss to proxi ximal mal end during ng deploym yment nt

(without hout prior

  • r planning

ning)

Seque uential ntial stenting ting of f fenestra strati tion

  • ns

Migra ration tion resistance stance

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Total Implanted Devices (3160)

1 1 4 4 5 5 6 6 8 10 12 16 24 35 50 59 66 85 155 220 235 238 291 786 838

South Africa Russia Uruguay Hong Kong Hungary Portugal Sweden Colombia Singapore Poland Greece Chile Monaco Brazil Australia Switzerland Belgium Canada Spain Netherlands Italy France Austria UK Germany

12 78 182 287 358 422 511 604 660 FY2010 FY2011 FY2012 FY2013 FY2014 FY2015 FY2016 FY2017 FY2018

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Design evolution -

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Device Customisations

Pleating

  • Reduces fabric in region of aortic

narrowing

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Additional Fenestration Support

  • Helps to alleviate excess fabric
  • verlapping with fenestrations

Tapered Graft

  • Reduces the fabric diameter in cases of

more extreme narrowing

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Flared Graft

  • Increases the fabric diameter in cases of

more extreme widening

Extra-long Body

  • 90-100mm long. Required joining ring to

attach two pieces of fabric together and the contralateral flare is removed.

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Extending upwards

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TEVAR combinations

Concept

  • A solution to provide a secure proximal

landing zone for a custom Fenestrated Anaconda™ stent graft where there is:

  • Thoracoabdominal aneurysmal disease
  • Unhealthy aorta above CA
  • Dilated vessel above CA >32.5mm

Design

  • Proximal fixation hooks required
  • Bifurcated, cuff or AUI body design

available

  • Proximal Anaconda typically based on

OLB34 ring stents to seal in 28mm or 30mm TEVAR device

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16

TEVAR combinations

Case Planning

  • TEVAR should be planned to land within

5mm of top of CA (or highest target vessel)

  • Bottom of valley hook planned to be 10-

15mm above top of CA to ensure sufficient overlap with TEVAR

  • Aim for min 15mm where possible
  • Peaks of device will be positioned 35-

40mm above top of CA

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Feature Trends (cases by financial year)

356 416 476 543 496 2 7 34 60 162 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2014 2015 2016 2017 2018

Docked in a TEVAR

Yes No

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Extending downwards

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Fenestrated Legs

Concept

  • A solution to allow internal iliac artery to

be preserved where there is no distal sealing zone within the common iliac artery

  • Suitable for use in narrow anatomy where

IBD is not an option

  • Available as straight, flared or tapered

legs Indications

  • Common iliac artery disease
  • Type 1b endoleak of previous EVAR
  • Proximal internal iliac artery disease
  • Used in conjunction with Anaconda™
  • Existing EVAR/FEVAR
  • Isolated iliac repair
  • Previous open bifurcate graft
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  • Results update
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All Newcastle Anaconda fEVAR including AAA , TAAA, redo EVAR, eFEVAR) 2012-18 n=83 30 day mortality 2.4% (both redo EVAR)

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Outcomes at 5 yrs

24 patients (2012-Apr2013) incl 3 redo EVAR

  • 4% peri-op death (1 pt bled from iliac conduit stump)
  • 75% 5yr survival (no late AA related deaths)
  • TVP (no late loss)
  • 98.5% (66/67) procedural
  • 98.1% (52/53)

at 5yrs

  • Secondary intervention
  • 12.5% overall (including patient who died)
  • 11% at 5yrs (2/18)
  • APTUS
  • Open T3EL
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Survival after arterial bypass surgery Survival after amputation surgery

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Innovation of the big snake continues……

  • Indications expand
  • TAAA
  • AAA
  • Iliac AA
  • Early positive results now extend to the medium term
  • 101 multi-centre study
  • 5yr follow-up now complete
  • Global Star 2
  • Global Fenestrated Anaconda™ Clinical sTudy (Global FACT)
  • 160pts out to 10yrs
  • UK COMPASS