Endovascular Aortic Repair: Current Techniques with Fenestrated, Branched and Parallel Stent-Grafts

Description:

 

This text provides a comprehensive, state-of-the art review of complex endovascular aortic techniques. It will serve as a valuable resource for vascular and cardiovascular surgeons, interventionalists, cardiologists, clinicians, bioengineers and researchers with an interest in complex aortic diseases. The book reviews imaging modalities, diagnostic work up and novel endovascular approaches. Technical aspects are provided by experts in the field, with over 600 illustrations and photographs of key steps for each type of procedure. Results of epidemiologic studies and national databases are summarized, as well as large institutional experiences. An evidence-based approach is used for recommendations regarding best therapies. Other highlights of this unique text include: A new, state-of-the-art review on fenestrated, branched and parallel stent-graft techniques from procedure planning to stent design and implantation. A text dedicated to a topic that has been increasingly recognized by vascular specialists as a priority area in aortic management. An updated overview of current designs and future developments. Special attention to technical details of the procedures with use of illustrations. Technical tips on how to get out of problems during these challenging procedures.  Endovascular Aortic Repair: Current Techniques with Fenestrated, Branched and Parallel Stent-Grafts will serve as a very useful resource for physicians and researchers dealing with and interested in complex aortic diseases. It will provide a concise yet comprehensive summary of the current status of the field that will help guide patient management and stimulate investigative efforts. All chapters are written by experts in their fields and include the most up to date scientific and clinical information.  

 

 

Table of Contents:

 

Part I: Basic Concepts, Mechanisms of Disease and Pre-�operative Planning

1: Historical Aspects and Evolution of Fenestrated and Branched Technology

Introduction

Development of the Zenith Fenestrated Graft

Preservation of Normal Anatomy

Directional Branches

Iliac Branch Device

Thoracoabdominal Multibranch Repair

Arch Branch Device

Dissemination of the Technique

References

2: Mechanisms of Disease and Natural History

Introduction

Most Common Types of Thoracic Aortic Pathology

Pathophysiology Involved in the Development of Aortic Aneurysm

Ascending and Descending Aortic Aneurysm Are Two Different Diseases

Thoracic Aortic Aneurysm Is a Genetic Disease

Natural History of Thoracic Aortic Disease

How Big Is the Normal Aorta?

Where Should We Measure the Aorta?

Growth Rate of the Thoracic Aorta

Risk of Adverse Events

Role of Body Surface Area

Mechanical Properties of Thoracic Aorta Underlie Its Natural History

How Does Aortic Dissection Pick a Particular Time to Occur?

Why Do Some Aortic Dissections Occur at Small Sizes?

Thoracic Aortic Disease in the Setting of a Bicuspid Aortic Valve

Conclusion

References

3: Genetic Considerations in Patients with Aortic Disease

Introduction

Prevalence of Genetically Triggered Aortic Disease

Marfan Syndrome

Mutations

Diagnosis

Differential Diagnosis

Surgical Management

Aortic Root

Descending Thoracic and Abdominal Aorta

Medical Management

Vascular Ehlers-Danlos Syndrome

Mutations

Diagnosis and Clinical Features

Major Diagnostic Criteria

Minor Diagnostic Criteria

Treatment

Loeys-Dietz Syndrome

Mutations

Diagnosis

Clinical Features

Differential Diagnosis of LDS

Treatment

Aneurysms-Osteoarthritis Syndrome

Arterial Tortuosity Syndrome

Familial Thoracic Aortic Aneurysms and Dissections

FTAAD Mutations Affecting the TGFβ Pathway

TGFβR2 Mutations

TGFβ2 Mutations

SMAD3 Mutations

FTAAD Mutations Affecting the Smooth Muscle Cell Contractile Apparatus

ACTA2 Mutations

MYH11 Mutations

MYLK Mutations

PRKG1 Mutations

Familial Abdominal Aortic Aneurysms

Endovascular Repair and Genetically Triggered Aortic Diseases

Conclusion

References

4: Normal Aortic Anatomy and Variations of Its Branches

Introduction

Aorta and Aortic Arch Branches

Mesenteric Branches

Renal Branches

Iliac Branches

References

5: Classification Systems Relevant to Complex Endovascular Aortic Repair

Introduction

Types of Repair

Fenestrated and Branched Stent Grafts

Parallel Stent Grafts

Hybrid Endovascular Repair

Spectrum of Aortic Disease

Atherosclerotic Aneurysms

Inflammatory Aneurysms

Genetically Triggered Aortic Diseases

Classification of Blunt Aortic Traumatic Injuries

Classification of Aortic Coarctation

Classification of Aortic Aneurysms

Ascending Aorta and Arch

Descending Thoracic Aneurysms

Thoracoabdominal Aortic Aneurysms

Abdominal Aortic Aneurysms

Iliac Artery Aneurysms

Classification of Aortic Dissections

DeBakey’s Classification

Stanford Classification

Aortic Arch Dissections

Endovascular Classification Schemes

Aortic Arch Type

Ishimura Zones of Implantation

Society for Vascular Surgery Zones of Implantation

Mayo Clinic Endovascular Complex Abdominal Aneurysm Classification

Mayo Clinic Supra-celiac Coverage Classification

Conclusion

References

6: Intravascular Ultrasound to Guide Complex Endovascular Aortic Repair

Introduction

Intravascular Ultrasound

Aortic IVUS

IVUS and Fenestrated EVAR

References

7: The Spinal Cord Collateral Network: Implications for Endovascular Aortic Repair

Introduction

Background

Anatomy

Pathophysiology

The Impact of the Collateral Network on Endovascular Repair

References

8: Role of Fusion Cone-Beam Computed Tomography Imaging During Complex Aortic Procedures

Introduction

Cone-Beam Computed Tomography

Fusion Imaging

Processing of Preoperative CTA

Intraoperative Volume Acquisition: CBCT

Registration of Preoperative CTA and CBCT

Intraoperative Adjustment

CBCT for Intra-procedural Evaluation

Conclusion

References

9: 3D Printing to Create Templates for Patient-Specific Fenestrated Stent Grafts

Introduction

3D Printing Methodology

Clinical Implications

Concl usion

References

10: Preoperative Evaluation and Clinical Risk Assessment

Introduction

General Assessment

American Society of Anesthesiology (ASA) Physical Status Classification [21]

Society for Vascular Surgery/American Association for Vascular Surgery (SVS/AAVS) Comorbidity Sco

Cardiac Risk Assessment

Active Cardiac Conditions

Recommendations on Perioperative Cardiovascular Assessment

Cardiac Risk Models

Revised Cardiac Risk Index [33]

The ACS NSQIP MICA [34]

ACS NSQIP Surgical Risk Calculator [38]

VSG-CRI Scoring System [36]

Biomarkers

Hypertension

Renal Risk Assessment

Pulmonary Risk Assessment

ARISCAT

The Gupta Calculator

Diabetes

Addendum

Medications

Conclusion

References

11: Computed Tomography/Computed Tomography Angiography for Evaluation, Planning, and Surveillance

Introduction

Imaging Data

Scan Parameters

Reconstruction

Standardized Protocols

Special Protocols

Low Radiation

Low Contrast

Intra-arterial Injection

Initial Aortic Assessment

Analysis of Disease Extent

Aneurysm Size Measurements

Assessment of Landing Zones

Tortuosity

Branch Assessment

Branch Vessel Geometry

Surveillance Protocols

Endoleaks

Branch Stenosis, Kink, or Occlusion

Solid Organ Embolization

Component Separations

Stent Infolding

Progression of Aortic Disease

Device Integrity Issues

Conclusion

Suggested Reading

12: Duplex Ultrasound for Evaluation and Surveillance of Fenestrated, Branched, and Parallel Ste

Introduction

Technique

Mesenteric Arteries

Renal Arteries

Contrast-Enhanced Ultrasound

Other Issues

Median Arcuate Ligament Compression

Conclusion

References

13: Magnetic Resonance Angiography for the Initial Assessment and Follow-Up of Acute Aortic Synd

Introduction

Overview of Magnetic Resonance Angiographic Techniques

Acute Aortic Syndromes

Normal Anatomical Variants

Aortic Dissections

Intramural Hematomas

Penetrating Atherosclerotic Ulcers

Surgical Planning

Entry and Re-entry Tears

Distance from Branches

False Lumen Flow Assessment

Branch Involvement, Static Versus Dynamic Obstructions

Surveillance

Conclusion

References

Part II: Building Advanced Endovascular Aortic Programs

14: Managing Endovascular Inventory

Introduction

Endovascular Coordinator

Space Management

Labeling

Specific Ancillary Tools

Sheaths

Catheters and Guide-Catheters

Guide-Wires

Balloons

Stents

Aortic Stent-Graft Components

Arch Aneurysms

Bolton Medical

Cook a-Branch and Fenestrated Platform

Gore Thoracic Branch Endoprosthesis (TBE)

Medtronic Valiant Mona LSA

Najuta Next-Gen Fenestrated TEVAR and Innoue Stent

Pararenal and Thoracoabdominal Aneurysms

Cook Patient-Specific and Off-the-Shelf Fenestrated and Branched Platforms

Gore TAMBE® (Thoracoabdominal Multi-Branch Endoprosthesis)

Anaconda Fenestrated

Jotec Multi-Branch Thoracoabdominal Device

Iliac Aneurysms

References

15: Integration of Clinical Practice, Research, Innovation, and Education

Introduction

Dr. Roy Greenberg’s Legacy

Investing in Education

Early Years

Identifying Clinical Need

Dissemination of Endovascular Education

Focus on Durability

Impact on Advanced Endovascular Aortic Programs Worldwide

References

16: Endovascular Training and Learning Curve for Complex Endovascular Procedures

Introduction

Training Paradigms

Credentialing Process

Hospital and Surgeon Volume and Outcomes

Failure to Rescue

Learning Curve

Minimally Invasive Cardiovascular Procedures

Standard EVAR

Complex EVAR

Fenestrated and Branched Stent-Grafts

Conclusion

References

17: Regulatory Pathway for Physician-­Sponsored Studies Evaluating Endovascular Aortic Repair

Introduction

When Is an IDE Needed?

Content of an IDE Application

How to Apply for an IDE?

Common Mistakes Identified During Review of IDEs

What It Takes to Run an IDE

Overview of Good Clinical Practices

What Do We Mean When We Say GCP?

The Sponsor-Investigator and Good Clinical Practice

Overview of Sponsor-Investigator Roles and Responsibilities

Building Quality Into Sponsor-Investigator Clinical Studies of Medical Devices

References

Resources/Useful Links

18: Developing Physician-Sponsored Investigational Device Exemption Protocols

References

Part III: Techniques of Implantation and Adjunctive Procedures to Minimize Complications

19: Principles of Side Branch Incorporation and “Bail Out” Maneuvers

Introduction

Pre-procedure Planning

Alignment of Fenestrations and Fenestrated-Branches

Kinks

Vessel Perforation or Dissection

Endoleaks

Infolding of the Aortic Stent

Stenotic Target Vessels

Stent Dislodgement

Preventing Compression of Side Stents

Sheath Advancement

Crossing Dissection Flaps

Suggested Reading

20: Strategies to Minimize Risk of Spinal Cord Injury During Complex Endovascular Aortic Repair

Introduction

Risk Stratification

Mechanisms of Injury

Spinal Cord Injury Prevention Protocol

Staging

Blood Pressure Management

Cerebrospinal Fluid Drainage

Neuromonitoring

Limb Perfusion

Intra-operative Maneuvers

Peri-operative Management

Delayed Neurologic Deficit

Results

References

21: Strategies to Minimize Risk of Acute Kidney Injury During Complex Endovascular Aortic Repair

Introduction

Renal Outcomes After Complex Endovascular Aneurysm Repair

Measurement of Renal Function and Acute Kidney Injury

Factors Associated with Acute Kidney Injury

Preoperative Measures

Intraoperative Measures

Postoperative Measures

Conclusion

References

22: Anesthetic Considerations for Complex Endovascular Aortic Repair

Introduction

Anesthetic Considerations

Anesthesia Technique and Patient Setup

Cerebrospinal Fluid (CSF) Drainage

Vascular Access, Hemodynamic and Neurologic Monitoring

Radiation Safety

Assessing and Managing the Risk for Contrast-­Induced Nephropathy

Spinal Cord Protection

Strategies to Augment Spinal Cord Perfusion

Strategies to Detect and Manage Spinal Cord Ischemia

Induced Hypotension for Precise Graft Deployment

Rapid Ventricular Pacing

Right Atrial Inflow Occlusion

Medications

Postoperative Considerations

Conclusion

References

23: Techniques of Iliofemoral Conduit for Endovascular Repair

Introduction

Adjunctive Maneuvers

Conduit Selection

Surgical Conduits

Temporary Iliofemoral Conduits

Permanent Iliofemoral Conduits

Endovascular Conduits

Axillary Artery Conduits

Conclusion

Suggested Reading

Part IV: Visceral Artery Incorporation

24: Current Device Designs to Incorporate Visceral Arteries

Introduction

Visceral Incorporation

Patient-Specific Designs

Cook Zenith Fenestrated and Branched Stent Graft

Vascutek Fenestrated Anaconda Endograft

Jotec Extra Design Multibranch Stent Graft

Off-the-Shelf Designs

Cook p-Branch

Cook t-Branch

Endologix Ventana

WL Gore Thoracoabdominal Branched Endoprosthesis (TAMBE)

References

25: Selection of Optimal Bridging Stents for Fenestrations and Branches

Introduction

The Ideal Stent

Balloon-Expandable Stents

Maquet Atrium iCast or V12 Covered Stent

WL Gore Balloon-Expandable Viabahn (VBX)

Bentley BeGraft Stent

Self-Expandable Stents

WL Gore Viabahn Stent Graft

Bard Fluency Plus

Boston Scientific Wallgraft

Bare-Metal Stents

Planning and Selection of Bridging Stents

Fenestrations

Directional Branches

Special Scenarios

Small Renal Branches

Early Bifurcation Lesions

Large Target Vessels

Intentional Branch Occlusion

Conclusion

References

26: Sizing and Planning Fenestrated and Multibranched Endovascular Repair

Introduction

Evidence of Disease Progression

Suboptimal Necks Yield Suboptimal Results

Neck Dimensions Are Not Stable

Rescue Procedures for Failed Necks Are Morbid and Less Effective

CTA Protocol and Measuring Techniques

Selecting the Seal Zone

Selecting the Access Site

Selecting the Type of Incorporation

Selecting Fenestrations Versus Branches

Visceral Artery Triangulation

Measuring Location of Fenestrations and Branches

Graft Tapering

Adjuncts to Facilitate Vessel Catheterization

Special Scenarios

Staged Repairs

Chronic Dissections

Type I TAAAs

Short Distance to Aortic Bifurcation

Conclusion

References

27: Limitations for Branch Incorporation and Implications on Off-the-Shelf Designs

Introduction

Factors Affecting Design

Proximal Extension of Aortic Disease

Renal-Mesenteric Arterial Anatomy

Aortic Angulation

Other Factors

Devices

Sealing Between the Celiac and Renal Artery Segment

Cook p-Branch® Stent-Graft

Endologix Ventana® Stent-Graft

Sealing in the Supra-Celiac and Thoracic Aortic Segment

Cook T-Branch® Stent-Graft

Gore Excluder® TAMBE

Results

Cook p-branch® Stent-Graft

Cook t-Branch® Stent-Graft

Future Directions

References

28: Techniques of Implantation of Fenestrated and Multibranched Stent Grafts for Visceral Artery

Introduction

Definitions

Anatomical Review

Ancillary Tools

Perioperative Measures

Contrast Use and Radiation Safety

Positioning

Arterial Access

Techniques

Patient-Specific Fenestrated Stent-Grafts

Patient-Specific Fenestrated and Branched Stent-Grafts

Multibranched Stent-Grafts

Staging

Preloaded Renal Guide Catheters

Preloaded Catheters and Guide-Wire Systems

Inverted Limb

Conclusion

Suggested Reading

29: Results of Fenestrated, Branched, and Parallel Stent Grafts for Pararenal and Thoracoabdomin

Introduction

Open Conventional Repair

Endovascular Repair

Fenestrated and Branched Stent Grafts

Pararenal Aneurysms

Type IV Thoracoabdominal Aortic Aneurysms

Type I to III Thoracoabdominal Aortic Aneurysms

Spinal Cord Injury

Bridging Stent Characteristics

Late Results

Mayo Clinic Experience

Parallel Stent Grafts

Conclusion

References

30: Parallel Graft Techniques to Treat Complex Aortic Aneurysms Involving the Renal and Mesenteri

Introduction

Preoperative Imaging

Surgical Management

Preoperative Planning

Positioning

Arm Access

Single or Double Chimney Procedure

Renal/Visceral Cannulation and Sheath Advancement

Positioning of Main Body Endograft and Chimney Stent Grafts

Sequence of Stent Graft Deployment and Balloon Molding

Completion of Distal Components

Periscope EVAR/TEVAR

Femoral Access for Introduction of Main Body Endograft

Contralateral Access and Cannulation of Target Visceral Branch(es)

Sheath Advancement and Periscope Stent Graft Positioning

Sequence of Deployment and Balloon Molding

Octopus Off-the-Shelf Branch Repair

Chimney Stage

SMA Revascularization

Contralateral Gate Positioning and Renal Cannulation

Infrarenal Completion

“Sandwich” Grafts

Postoperative Care and Outcomes

Complications

References

31: Hybrid Repair Using Visceral Debranching and Aortic Stent Grafts to Treat Complex Aortic Aneur

Introduction

Rationale

Preoperative Evaluation

Clinical Risk Assessment

Aortic Imaging and Planning

Techniques

Exposure

Graft Selection and Preparation

Proximal Anastomosis

Distal Renal and Mesenteric Anastomosis

Results

Single-Center Experiences

Systematic Reviews

North American Complex Abdominal Aortic Debranching (NACAAD) Registry

Conclusion

References

Part V: Arch Branch Incorporation

32: Current Device Designs to Incorporate Supra-aortic Arch Trunks for Endovascular Repair

Introduction

Arch Anatomy Requirements

Historical Perspective

Kawasumi Najuta Fenestrated Endograft

Cook Medical

Fenestrated Stent Grafts

Inner Branches

WL Gore Thoracic Branch Endoprosthesis (TBE)

Medtronic Mona LSA

Bolton Relay Plus Thoracic Arch System

Frozen Elephant Trunk Devices

References

33: Technical Aspects and Results of Branched Endografts for Repair of Aortic Arch Aneurysms

Introduction

Important Considerations for Endovascular Arch Repair

Seal Zone

Device Durability

Aortic Valve

Device Alignment

Stroke

Mortality

Endograft Design

Scalloped and Fenestrated Endografts

Branched Endografts

A-Branch Stent-Graft (Cook Medical)

Patient Selection

Technique

Preparation and Setup

Subclavian Artery Revascularization

Arterial Access

Establishing the Delivery Platform

Delivery and Deployment of the Branched Stent-Graft

Innominate Artery Bridging Stent

Left Common Carotid Artery Bridging Stent

Distal Thoracic Extension

Special Situations

Through-and-Through Wire Technique

Modified “Bullet” Nose Tip

Thoracic Branch Endoprosthesis® (WL Gore, Flagstaff, AZ)

Zone 2 TBE® Implantation Steps

Zone 0 TBE® Implantation Steps

Early Results

References

34: Techniques and Results of Endovascular In Situ Arch Fenestrations

Introduction

Development of In Situ Arch Fenestrations in TEVAR

Pathology

Anatomic Limitations and Patient Selection

Needle Versus Laser In Situ Arch Fenestration

Technique

Establishing Access

Creating the In Situ Fenestration

Passage of Guidewire

Angioplasty and Stenting

Completion Angiogram

Complex In Situ Arch Fenestration of the Left Common Carotid

Application of New Technologies

Outcomes of In Situ Laser Fenestration

Conclusion

References

35: Parallel Stent Graft Techniques to Facilitate Endovascular Repair in the Aortic Arch

Introduction

Basic Principles

Techniques

Zone 2 Deployment

Zone 1 Deployment

Zone 0 Deployment

Conclusion

References

36: Techniques and Results of Aortic Arch Hybrid Repair

Introduction

Anatomy and Patient Selection

Distal Arch Debranching

Left Subclavian Artery Revascularization

Left Common Carotid Artery Revascularization

Proximal Arch Debranching

Frozen Elephant Trunk

Results

References

37: Techniques and Results of Hybrid Arch Replacement with Elephant Trunk

Introduction

Technique

Results

Modification for Acute Type I Aortic Dissection

References

Part VI: Internal Iliac Artery Branch Stent-Grafts

38: Iliac Branch Device Designs

Introduction

Device Designs

Cook Medical

Straight and Helical Branch Devices

Bi-Branch Bifurcated-Bifurcated Device

Gore Excluder Iliac Branch Endoprosthesis (IBE)

Jotec E-liac Stent Graft System

39: Preoperative Planning and Sizing for Iliac Branch Devices

Introduction

CTA Imaging

Anatomic Considerations

Cook Iliac Branched Devices

Gore Excluder Iliac Branch Endoprosthesis

Jotec E-liac Branch Stent Graft

Pitfalls and Anatomical Challenges

Ostial Disease

Short Length

Narrow Diameter

Internal Iliac Artery Aneurysm

Dissections

Saccular Aneurysms

Bilateral Aneurysms

Suggested Reading

40: Techniques of Endovascular Repair of Aorto-Iliac Aneurysms Using Iliac Branch Devices

Introduction

Rationale

Design Options

Ancillary Tools

Technique

Access

Straight and Helical IBDs

BB-IBD

Gore Excluder IBE

Bilateral Aneurysms

Internal Iliac Aneurysms

Concomitant Fenestrated and Branched Stent-Graft Repair

Prior Bifurcated Aortic Stents

Common Problems and “Bail Out” Maneuvers

Pseudo-Occlusion of the Internal Iliac Artery

Difficult Catheterization of the Internal Iliac Artery

Kinks

Branch Occlusion

Perforations and Dissections

Integrity Issues

Results

Lessons Learned

Future Considerations

Conclusion

References

41: Results of Iliac Branch Stent-Grafts

Introduction

Anatomical Feasibility

Results of Commercially Available IBGs

Indications

Technical Success

Early Outcomes

Mid-Term and Late Outcomes

The Perugia Experience

Physician-Modified IBGs

Results for Bilateral Iliac Aneurysms

Conclusion

References

42: Technical Aspects and Results of Hybrid Iliac Revascularization

Introduction

Indications

Technique

Aneurysmal Internal Iliac Artery

Iliofemoral Conduit with Internal Iliac Reconstruction

External to Internal Iliac Stents with Femoral Crossover Graft

Results

References

43: Off-Label Use of Aortic Devices and Parallel Stent Grafts for Iliac Revascularization

Introduction

The Perimeter Method for Sizing

The Minimum Combined Length of the Perimeters of the Parallel Extensions

The Length of the Segment of Apposition Between the Parallel Extensions

Possible Shapes

The Effect of Angioplasty

Conclusion

References

Part VII: Physician-Modified Endovascular Stent-Grafts

44: Clinical Applications and Regulatory Issues for Physician-Modified Endovascular Grafts (PMEGs)

Introduction

Obtaining an IDE

Conducting an IDE Clinical Trial

Patient Selection for PMEG

Conclusion

References

45: Techniques of Physician-Modified Endovascular Grafts (PMEGs) for Incorporation of Renal Mesen

Introduction

Indications

Ancillary Tools

Preoperative Planning

Stent Graft Design

Stent Graft Modifications

Reinforced Fenestrations

Mini-Cuff Reinforced Fenestration

Directional Branches

Diameter-Reducing Wire

Preloaded Guidewires

Re-sheathing

Orientation Markers

Modified Bifurcated Stent Graft

Perioperative Measures

Techniques of Implantation

Four-Vessel Fenestrated Stent Graft

Combination of Directional Branches and Fenestrations

Mini-Cuffs

Preloaded System

Postoperative Management

Suggested Reading

Part VIII: Complications of Complex Endovascular Aortic Repair

46: Thromboembolic Complications During Endovascular Repair of Complex Aortic Aneurysms

Introduction

Clinical Implications

Risk Stratification

Aortic Wall Thrombus Assessment

Study Patients

Clinical Events

Cases Examples

Case 1

Case 2

Case 3

Case 4

Conclusion

References

47: Spinal Cord Injury Prevention and Management

Introduction

SCI Following Endovascular Aortic Repair

Spinal Perfusion

Risk Reduction and SCI Management Strategies

Current Strategies

Preoperative

Intraoperatively

Postoperatively

Conclusion

References

48: Renal Function Deterioration in Complex Aortic Repair

Introduction

Definitions and Classification

Pathogenesis and Etiology

Risk Factors

Comparing Different Strategies

Renal Protection

Conclusion

References

49: Late Branch-Related Complications and Management

Introduction

Branch-Related Outcomes

Classification of Branch Complications

Endoleak

Case 1

Case 2

Case 3

Case 4

Occlusion and Stenosis

Case 5

Case 6

Case 7

Case 8

Case 9

Case 10

Case 11

 

An aparitie	2017
Autor	Gustavo S. Oderich , David Factor
Dimensiuni	21.8 x 4.9 x 29 cm
Editura	Springer
Format	Hardback
ISBN	9783319151915
Limba	Engleza
Nr pag	757