METHOD FOR ENDOPROSTHESIS REPLACEMENT OF AORTIC ARCH WITH DIRECTED FENESTRATION IN MOUTH OF LEFT SUBCLAVIAN ARTERY WITH COMPLEX ANATOMY Russian patent published in 2025 - IPC A61F2/07 A61B17/00 

FIELD: medicine.

SUBSTANCE: method refers to medicine, namely to cardiovascular and endovascular surgery. Endoprosthesis replacement of an aortic arch is performed with directed fenestration in the mouth of the left subclavian artery with complex anatomy. Common femoral and brachial arteries are approached; a stent-graft is brought in and implanted into the aortic arch with overlapping the mouth of the left subclavian artery. Fenestration is formed in the mouth of the left subclavian artery after implantation of the stent graft according to the "in situ" technique using a fenestration system with a flexible needle, followed by insertion of conductor 0.018ʺ diameter into stent-graft cavity, dilatation of fenestra with a balloon catheter of small diameter 4-5 mm, replacement of a guide with super-rigid guide 0.035ʺ diameter and further dialatation of fenestra with balloon catheter of larger diameter 7-8 mm and implantation of peripheral stent-graft into artery with diameter and length pre-calculated according to results of preoperative MSCT-angiography. Access through the left brachial artery, before the stent graft implantation into the aortic arch, introducer 10F is installed, rigid conductor 0.035ʺ diameter is brought through the introducer into the descending aorta to guide the proximal end of introducer 10F towards the mouth of the left subclavian artery and parallel installation of the fenestration system with a flexible needle after implantation of the stent-graft into the aortic arch.

EFFECT: method enables to perform fenestration in case of acute angle of origin of left subclavian artery in combination with or without its crimp, as well as reduce the risk of damage to the wall of the aorta or the leftmost subclavian artery during fenestration and the risk of developing endolics.

1 cl, 5 dwg, 1 ex