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T-branchDeviceDescription

Nuno Dias

ParisEndovascular Aortic Course

Paris,2018-05-31

T-branch objectiveOff-the-shelf solutionforThoracoabdominal aneurysmsbased onZenithplatform

T-branch:Off-the-shelf solution

T-branch +UniversalUnibody +Iliac Extensions• Woven polyester• Self-expanding stainless steel Cook-Z® stents

• Braided polyester and monofilament polypropylene suture

• Proximal covered stent with fixation barbs

• Tubular graft with 4 caudal oriented branches with cuff bearing segment

T-branchGraftDescription

One size fits all:• Proximal diameter: 34 mm

• Distal diameter: 18 mm• Graft length: 202 mm

• 4 branches• 1:00, 12:00, 3:00 and 10:00• 99 mm, 117mm and 135 mm x2

202 mm

34 mm

18 mm

GraftDescription Radiopaque Markers• 4 gold markers 2 mm from proximal edge

• 1 gold marker on the distal edge

• Branch markers (each branch)

• 3 gold markers at the proximal internal edge

• 2 gold markers at the distal outer edge

• Orientation markers

• 3 Anterior orientating gold markers x 2

• Anterior tick marker

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Internal-external branches

Distal edge of graft

Proximal edge of graft

Diameter-reducing ties

TriggerWires

T-branch– IntroductionSystem

•22 Fr Flexor Sheath(7.3 mm ID, 8.5 mm OD)

•60 cm long

•Captor® Hemostatic Valve

UniversalDistalBody

•Four sizes:-UNIBODY 22-81-UNIBODY 22-98-UNIBODY 22-115-UNIBODY 22-132

•Distal diam: 11 mm

22 mm

81, 98, 115, 132

mm

UniversalDistalBodyIntroductionSystem

11

•20 Fr Flexor sheath•40 cm

•Captor® Hemostatic Valve

•2 trigger wires

IFU – Proximal to Aneurysm

•Non-aneurysmal thoracic aorta fixation segment :-Angle less than 90 degrees -Length of at least 25 mm -50 mm of wall contact preferred

-Diameter 24-30 mm

•Or previous TEVAR

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IFU – Visceral Vessel Anatomy

• Four indispensible arteries• Aortic diameter of > 25 mm

• Target vessels • accessible from antegrade approach• Celiac and SMA diameter 6-10 mm• Renal arteries diameter 4-8 mm• Distance between the cuff and artery < 50 mm• Takeoff angle < 45 degrees

Access

•22 Fr (8.5 mm OD) delivery system

•Brachial, axillary or subclavian access vessel size •10 or 12 Fr introducer sheath (3.3 or 4 mm OD)

Anatomicalsuitabiltyofoff-the-shelf4-branchedbEVAR

Sweetetal,JEVT2009Bisdasetal,JEVT2013

49- 88%

Accepting50mmdistancetoTV Accepting40mmdistancetoTV

T-branch:Off-the-shelf solution

T-branch +UniversalUnibody +Iliac Extensions

Deploymenttechnique

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IntroductionandOrientation IntroductionandOrientation

IntroductionandOrientation

NOFUSION

TBranch Compromises

• Longdistance to renal arteries• Upward facing renal arteries• Repair extended to middescending aorta

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Deployment

1. Establishfemoralaccess2. Fullyheparin(ACT>250-300)3. EstablishCranialaccess4. Deployaorticgrafts5. Deployiliacextensions6. Closegroins7. Bridgethecuffstotargetvessels8. Closecranialaccess

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