The Vanguard prosthesis (Boston Scientific Vascular, Natick, MA) has been in clinical use since 1996 for endoluminal repair of abdominal aortic aneurysm, with more than 3,500 implants worldwide. The device is a second-generation modular stent-graft consisting of a nitinol metal framework covered with polyester graft material. Proximal aneurysm neck diameters of 20 to 25 mm and lengths of greater than or equal to 15 mm are required for both the tube and bifurcated stent-graft. An infra-aneurysmal neck with the same dimensions allows placement of tube stent-graft. Neck angulation of greater than 60° and/or iliac artery angulation greater than 90° are exclusion criteria, Iliac artery attachment sites must be less than or equal to 13 mm in diameter and greater than or equal to 15 mm in length. Distal limb extensions and a proximal cuff are available. Careful preprocedural imaging and planning ensures a smooth, successful procedure. Flushing the preloaded delivery systems with iced saline before insertion in the body is an important feature of the Vanguard stent-grafts. The delivery process is simple, requiring withdrawal of an outer sheath while maintaining stability of the entire system. Intraprocedural problems such as negotiating an angled neck, proximal and distal leaks, difficult cannulation of the contralateral stump, and long or short grafts are discussed.
|Number of pages
|Techniques in Vascular and Interventional Radiology
|Published - 1999
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging
- Cardiology and Cardiovascular Medicine