Publication:
Surgical Technology International XV - Cardiovascular Surgery
Article title:
Isthmus Endoprosthesis Stent-Graft Treatment: Implantation of Relay™ Dedicated Device
Author(s)

Alessandro S. Bortone, M.D., Ph.D., F.E.S.C.
Chief of Interventional Laboratory, Institute of Cardiac Surgery

 

Emanuela de Cillis, M.D.
Resident Cardiologist, Institute of Cardiac Surgery

 

Donato D'Agostino, M.D.
Cardiac Surgeon, Institute of Cardiac Surgery

 

Michele Sciascia, M.S.
Medical Student, Fellow of Interventional Laboratory

Institute of Cardiac Surgery

 

Luigi de Luca Tupputi Schinosa, M.D.
Chief of Cardiac Surgery, Institute of Cardiac Surgery


Department of Emergency and Transplantation
University of Bari School of Medicine, Bari, Italy

Abstract
Among the 123 patients treated in our department by endovascular stent graft, 113 (91.8%) were identified as having involvement of the isthmus. Therefore, the incorrectly defined descending aortic disease is essentially a pathology of the isthmus that represents the distal portion of the arch. The key to the treatment of all types of aortic lesions rests on understanding the morphology of this region gifted with a "double S" configuration. Current thoracic devices are noncompliant systems and should be modified greatly, taking into account that the media of the aorta has a semi-compliant behavior. The resultant of power transmission is oriented at 45° and produces a transmural radial force that animal implantation has demonstrated to be a torsional movement. The improvements in new devices actually result in a new generation of endoprostheses that seem to be closely related to the anatomy of the patient by increasing the conformability and, therefore, we expect an increase in durability. To test these features, we have studied a new stent graft in different settings of thoracic aortic disease. The new device should conform to current standards while simultaneously transmitting torsional forces. The dedicated delivery system should be arch-compatible, flexible but sufficiently rigid, and able to be three-dimensionally oriented. Moreover, the new stent graft should follow the three-dimensional anatomy of the "double S" configuration of the isthmus area and thus reduce the mismatch between the aorta and the device itself.