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. 2022 Apr;29(2):167-174.
doi: 10.1177/15266028211047967. Epub 2021 Sep 27.

E-nside Off-the-Shelf Inner Branch Stent Graft: Technical Aspects of Planning and Implantation

Alexander Zimmermann  1 , Anna-Leonie Menges  1 , Zoran Rancic  1 , Lorenz Meuli  1 , Philip Dueppers  1 , Benedikt Reutersberg  1
Affiliations

E-nside Off-the-Shelf Inner Branch Stent Graft: Technical Aspects of Planning and Implantation

Alexander Zimmermann et al. J Endovasc Ther. 2022 Apr.

Abstract

Purpose: This article aims to present all aspects regarding patient selection, planning, and implantation technique for a new off-the-shelf pre-cannulated multi-inner branch stent graft. The stent graft comes in 4 different versions with proximal diameters of 33 and 38 mm and distal diameters of 26 and 30 mm. The 4 inner branches are located in the middle segment, which has a diameter of 24 mm.

Technique: With inner branch technology, the field of application for the treatment of thoracoabdominal aortic aneurysms (TAAA) has been further extended. In addition to routine use in elective cases the pre-cannulation of the inner branches predisposes especially for emergencies. Pre-cannulation is intended to reduce the time to cannulation and the radiation dose. All steps of planning, stent-graft deployment, and cannulation of the inner branches are described in detail.

Conclusion: The E-nside stent graft represents a promising new endovascular therapy in the treatment of acute and elective TAAA. By using inner branch technology, this endograft combines the advantages of fenestrated and branched stent grafts. Indication, planning, and implantation require experience in branched and fenestrated stent graft technology.

Keywords: endograft; endovascular therapy; inner branch; off-the-shelf device; thoracoabdominal aortic aneurysm.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Alexander Zimmermann is a proctor for Cryolife/Jotec and for Cook Medical. He is member of an Advisory Board for Medtronic. Benedikt Reutersberg is a proctor for Terumo Aortic.

Figures

Figure 1.
Figure 1.
(a) The main body of the Cryolife/Jotec E-nside multi-inner branch stent graft with its preloaded polyimide tubes for easier cannulation. (b) Illustration of the different markers, distances, and orientation of the outlets of the inner branches. The proximal and distal stent graft portions have a peak-to-valley design, and the middle stent graft portion has a peak-to-peak stent design. RRA, right renal artery; SMA, superior mesenteric artery; TC, celiac trunk; LRA, left renal artery.
Figure 2.
Figure 2.
Different sheets for case planning. (a) Sizing sheet. (b) Branch position sheet. (c) Calculation Sheet. (d) Comments + Product selection sheet.
Figure 3.
Figure 3.
Handlebar with pre-cannulated polyimide tubes and safety wires. The celiac trunk is marked as “1”, the superior mesenteric artery is marked “2”, the right renal artery marked “3”, and finally the left renal artery is marked “4”. The tip capture at the distal end of the delivery system has to be rotated clockwise and pushed to release the proximal part of the E-nside stent graft.
Figure 4.
Figure 4.
Intraoperative angiography of the left renal artery after transbrachial cannulation of the inner branch via the pre-cannulated wire with a sheath and unproblematic probing.
Figure 5.
Figure 5.
Postoperative volume rendering of a computed tomography angiography of a successfully implanted E-nside stent graft.
See this image and copyright information in PMC

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