Australia & New Zealand Society of Vascular Surgeons

Objective To provide an overview of the FORTRONTM AAA Stent Graft System and the capabilities of the TributaryTM Iliac Bifurcation Stent Graft System. Endovascular repair of abdominal aortic aneurysms has been clinically practiced for over a decade with continued adoption as an alternative to open surgical repair. A primary shortcoming of many first and second-generation devices has been durability. The Cordis FORTRONTM AAA Stent Graft System was designed to provide enhanced durability and the ability to treat a broad range of anatomies. The FORTRONTM system is a three-piece modular design that employs nitinol stents and polyester prostheses. Bifurcate/Main body The bifurcate or main body is composed of a suprarenal bare stent and trans-renal strut section, barbs located just infrarenally are oriented in the caudal direction to prevent distal migration. The main body section is capable of treating up to a 30mm proximal aortic neck diameter. The immediate infrarenal and tapered graft material is tightly sutured to the stents to prevent micro-motion and abrasive wear to the graft material. The bifurcate limbs are constructed of a series of independent Z-stents that are tightly sutured to the graft material with individually tied sutures. Endolegs The FORTRONTM system has the ability to adjust the length in the Endolegs as they telescope into the bifurcate limbs by up to 30mm during the deployment procedure. When the leg is fully extended there is still 20mm of safety overlap between the distal gate and the end of the bifurcate limb. The Endolegs are constructed of a series of independent Z-stents that are tightly sutured to the graft material. The distal portions of the Endolegs employ a ‘Bell-bottom’ design that enables it to accommodate up to a 20mm diameter aneurismal iliac artery. The legs come in lengths of 10, 12 & 14cm and can all be adjusted in their working length by 30mm using the ‘In-Situ’ sizing feature. Delivery System The delivery profile is 20 F outer diameter for the combined Bifurcate trunk and Ipsilateral leg delivery system and 19 F for the Contralateral leg and incorporates an integrated delivery sheath. Iliac & Aortic Extenders Both iliac and aortic extenders are available for the FORTRONTM system. TributaryTM Bifurcation Stent Graft System The TributaryTM iliac stent graft system incorporates a side branch technology platform which enables the physician to deploy a bifurcated stent graft within the iliac limb of an aortic endograft, extending it distal into the external iliac and into the internal iliac arteries. The TributaryTM iliac system enables the preservation of the internal iliac artery and the pelvic vasculature in patients where the aneurismal disease extends into the external iliac artery. This technique is an alternative to conventional internal to external iliac bypass or coil embolization and is accomplished with the use of a highly specialized catheter delivery system. The Tributary iliac bifurcation system is in the early clinical study phase. This technology also has applicability in thoracoabdominal and arch aneurysms.