Treovance Implantation TechniquePrecise deployment with safe access

First worldwide real-life P-EVAR experience (after CE Mark trial)

Vicente Riambau, MD;PhD

Nilo J Mosquera, MD

Case Presentation and planning.

Ultrasound guided percutaneus access and Perclose ProglideTM PreClose.

Sizing and final planning. GRAFTS

PreClosing Technique and bilateral 9F working sheath

Main Body - Advancement

Main Body - Positioning

Perform an angiogram to check renals, position and alignment

Main Body - Deployment

Rotate the Gray Turn Handle to expand the first covered stentContinue rotating the Gray Turn Handle till contralateral gate is unsheathed

Main Body - DeploymentPerform angiogram to confirm final deployment position (optional)

NOTE: Uncovered stent still captured. If necessary, longitudinal adjustment of the proximal position is possible

Main Body – Release technique

Unscrew the thumb screw and remove the Release Grip. Retract the release Grip

Contralateral cannulation / tip released

Contralateral Limb – Hypogastric Angio

Check distance to hypogastric and location

Sizing catheter

C-Arm orientation for right hypogastric artery (planning)

Contralateral Limb – Deployment

Main Body - Sheath detachment

(1): release screw

(2): retract the Black Handle

(3): hold introducer. Completely detach delivery system

Ipsilateral Sheath – Check position and distance to HypogastricBuilt-in introducer:

1. Lateral flushing port: Angiogram to confirm and locate Hypogastric artery

2. Hemosthasis valve to continue procedure:

1. Ipsilateral extension2. Ballooning and Chek runs.

Ipsilateral Limb – positioning and deployment

Procedure conclusion - Ballooning

Proximal sealing zone

Balloon with a molding balloon catheter: sealing and overlapping zones

Both gates overlapping

Distal sealing zones

Procedure conclusion – Angiogram

Final angiogram, once retrieved stiff wires, confirm exclusion of the aneurysm, graft patency and identify potential endoleaks

Patent lumbars at proximal sealing

zone but no type II

Procedure conclusion: retrieve introducer and Closing sequence

Final angiogram, once retrieved stiff wiresconfirming the exclusion of the aneurysm, patency of the graft and absence of endoleaks

Thank You!!

First worldwide real-life P-EVAR experience (after CE Mark trial)

Vicente Riambau, MD;PhD

Nilo J Mosquera, MD