TREO Aortic Stent

After the patient is properly positioned and appropriate access is achieved, introduce a .035 inch guide wire into the artery and advance it to the descending thoracic aorta. Once the guide wire is in position, slowly advance the main bifurcated stent graft delivery system into the artery over the guide wire. Note the position of the flush port as it will indicate the approximate radial orientation of the contralateral gate. Continue advancing the sheath until the delivery system tip is near the deployment site in the aorta. While observing the markers at the proximal end of the stent graft, advance until the proximal end of the stent graft is at the deployment site. Further radial adjustments of the contralateral gate can be made by rotating the entire delivery system. the radial position by observing the orientation of the radiopaque markers. To deploy the main bifurcated stent graft, hold the stationary grip and rotate the turn knob in the direction of the arrow to start initial deployment of the stent graft. Observe the proximal end of the stent graft as it starts to deploy. During initial deployment, final cranial and caudal adjustments are done by moving the delivery system using the stationary grip. Continue deployment until the contralateral gate is released and the ipsilateral leg is still constrained in the sheath. This will secure the distal end of the device using the ipsilateral leg. At this point in the procedure, TRIO can be repositioned a final time as the dual fixation of the system is still constrained. The suprarenal barbs are completely covered, and the infrarenal barbs are substantially obscured in valleys created by the proximal stent. To release the proximal clasp, first push the gray knob cranially and turn it to release the black release grip. While observing the proximal clasp assembly under fluoroscopy, pull the release grip caudally until it clicks twice to release the bare stent. At this point, the suprarenal and infrarenal barbs will engage the vessel. Verify proper positioning of the stent graft using the proximal markers. At this time, the contralateral leg extension can be deployed while keeping the end of the ipsilateral leg captured. Cannulate the contralateral gate and ensure proper placement of a .035 inch guide wire far enough into the main bifurcated stent graft to ensure the end of the leg delivery system tip does not go beyond the end of wire during deployment. Ensure that the guide wire does not go between the bare stent and the arterial wall. Advance the contralateral leg extension delivery system into the artery over the guide wire. Continue advancing the tip into the contralateral gate. Continue to advance the leg device noting the markers on the proximal end. The contralateral side of the main device leg has two markers that indicate the maximum and minimum overlap regions. The proximal end of the leg extension must be advanced so that it is between these two markers, while ensuring that the leg's distal markers are positioned at the desired location. Once the proximal end markers of the leg extension are past the minimum overlap marker on the contralateral leg, locate the distal markers of the leg extension and align them with the distal landing target location. Confirm that the proximal markers remain between the maximum and minimum overlap markers on the main body contralateral leg. To deploy the leg extension stent graft, hold the stationary grip and rotate the turn knob in the direction of the arrow to start initial deployment of the leg extension stent graft. Observe the proximal end of the stent graft as it starts to deploy to ensure the markers are within the overlap zone. Completely retract the leg extension sheath until the leg extension stent graft is completely deployed. Observe the distal markers on the leg extension to ensure the sheath clears the stent graft. Finalize the main bifurcated stent graft deployment by pulling the turn knob back to completely release the ipsilateral leg. Continue to pull back until the lead screw stop is seated against the back end of the delivery system. To release the sheath from the delivery system, completely flip over the sheath release lever until it clicks into place. Using gauze to hold the main sheath stationary, continue to slide the main handle away from the main sheath as the sheath hub assembly disconnects from the handle. A passive seal blocks blood flow from the back of the sheath as the main handle pulls away. Continue pulling slowly and observe as the delivery system tip exits from the hemostasis valve housing. If necessary, close the hemostasis valve after the tip exits the housing by turning the knob clockwise. Remove the delivery system handle assembly until it clears the guide wire. While holding the sheath hub assembly with one hand, advance the ipsilateral leg delivery system over the wire until the tip of the delivery system touches the main sheath hub assembly. Adjust the main sheath position to prevent leg extension deployment inside the main sheath. If closed, open the hemostasis valve. Insert the leg delivery system through the sheath hub assembly. Leave the hemostasis valve in the open position for the rest of the placement and deployment of the leg extension. While monitoring under fluoroscopy, continue to advance the leg delivery system into the leg of the bifurcated main stent graft, noting the markers on the proximal end. The ipsilateral leg of the main body has a single marker that indicates the minimum overlap. The maximum overlap marker is the same marker as used on the contralateral side. The proximal end of the leg extension must be advanced so that it is between these two markers, while ensuring that the distal leg marker position is at the desired location. Once the proximal end markers of the leg extension are past the minimum overlap marker on the ipsilateral leg, locate the distal markers of the leg extension and align them with the distant landing target location. Confirm that the proximal markers remain between the maximum and minimum overlap markers on the contralateral leg. To deploy the leg extension stent graft, hold the stationary grip and rotate the turn knob in the direction of the arrow to start initial deployment of the leg extension stent graft. Observe the proximal end of the stent graft as it starts to deploy to ensure the markers are within the overlap zone. Completely retract the leg extension sheath until the leg extension stent graft is completely deployed. Observe the distal markers on the leg extension to ensure the sheath clears both. The ipsilateral leg extension delivery system can now be removed from the main system sheath. It is not necessary to rescath the tip of the ipsilateral leg extension delivery system when it is used in conjunction with the main delivery system sheath. Accessory devices may now be used with the sheath of the main delivery system. If desired, the leg extension delivery system on the contralateral side may be disassembled in the same manner as the main delivery system in order to provide a sheath for the use of compatible accessory devices.