Emory Vascular Surgery Offers 1st FDA-Approved Fenestrated Stent Graft

December 2012

Continuing its prominent regional and national role as a top-tier center for the treatment of arterial and venous disease, the division of vascular surgery and endovascular therapy of the Emory University School of Medicine, Atlanta, GA, now provides implantation of the FDA-approved Zenith® Fenestrated Endovascular Graft. Emory vascular surgeons Dr. Yazan Duwayri and Dr. Ravi Veeraswamy recently performed Georgia's first implantation of the stent graft, which has been approved as a minimally invasive treatment option for patients with abdominal aortic aneurysms (AAA) that possess an aneurysm anatomy that is incompatible with currently available devices.

In recent years, endovascular techniques have greatly improved the safety of surgical treatment of AAA, though certain high risk patients do not qualify for these methods because their aneurysms are too close to the arteries that feed the kidneys. If placed, the endovascular graft itself would block blood flow. In addition, traditional, open techniques of repair have significantly high morbidity and mortality rates for such patients.

Designed as an endovascular alternative for those at high risk, the fenestrated system is associated with faster recovery and decreased risk of complications. The most unique factor of the graft—essentially a tube of fabric and metal that functions as a sleeve inside the aorta that excludes the aneurysm from blood flow—is that it can be customized to accommodate the anatomical specifications of each individual patient. "We use specialized software to design the fenestrations or scallops of the Zenith device so that they line up with the patient's renal and mesenteric arteries," says Dr. Duwayri. "Through these holes, we can place additional stents into the branch arteries to repair the aneurysm."

The graft is inserted through small punctures in the groin and femoral arteries and guided into place using x-ray images. Wires, catheters, and stents can be placed inside the artery without the external aorta ever being touched.

By offering this new, FDA-approved technology and other devices in the clinical trial phase, Emory vascular surgeons Dr. Luke Brewster, Dr. Tom Dodson, Dr. Duwayri, Dr. Ravi Rajani, Dr. James Reeves, and Dr. Veeraswamy are advancing the delivery of care to patients with various complex conditions.