Whats Needed? Tim Chuter, MB, ChB, MD UCSF, Division of Vascular - - PDF document

1 EVAR: What's New?

EVAR: What’s New? What’s Needed?

Tim Chuter, MB, ChB, MD UCSF, Division of Vascular Surgery

EVAR: What's New?

Disclosure

• Cook Medical

– Patents – Grants

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Newer vs. Better

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Device Development

• Pre-clinical testing

– Replicate the endovasular environment

• Clinical testing

– Learn from your mistakes

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Fabric failure

Side of stent Apex of stent Beebe et al JVS 2001;33:S55-S63

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Nitinol Corrosion

Heintz C. et al. J Endovasc Ther 2001;8:248-53 EVAR: What's New?

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Suprarenal Stent

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Convergent Evolution

• Barbed uncovered proximal stent
• Polished Nitinol stents
• Tightly woven Dacron fabric
• Short widely spaced Z-stents

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The Ustable Neck

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7 EVAR: What's New? Year 5 Year 4 Year 1 EVAR: What's New?

Long-Term Follow-Up of Neck Expansion after Endovascular Aortic Aneurysm Repair

Thomas S Monahan, Timothy AM Chuter, Linda M Reilly, Joseph H Rapp, and Jade S Hiramoto

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Long-term Zenith

• 14-yr freedom from

– Aneurysm rupture 98% – Re-intervention 78%

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Zenith Stability

• The stent grafts lasted longer than the

patients

• No large necks
• Adherence to IFU

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Long-Term Data

• Zenith
• Endurant
• Excluder

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Functional Match

• Anatomy
• Device
• Technique

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Stent-Based

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Polymer-Based

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Endoanchors

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Fenestrations, Branches

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What’s Needed

• Long-term data (on modern devices)
• Quicker pathways to regulatory approval
• Lower device cost

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