ABSTRACT
The first reports of fenestrated endografting emerged in 1999 and were in animal models using home-made devices.17,18
Most of the centers performing appreciable numbers of fenestrated grafts have now reported their intermediate-term results.15,19,20 The only commercially available fenestrated endograft at present is the Zenith device (Cook, Bloomington, IN). Currently in the US, the device is limited to investigational use but is now available as a commercial device for sale in the European Union, Canada, Australia, and New Zealand. The design is similar to the standard Zenith device with stainless steel Gianturco stents sewn on to a woven polyester graft. There are two main components: a tubular component which contains the fenestrations and a bifurcate component which is similar to the standard Zenith device, with a variety of limb extensions (Figure 52.2). The device comes loaded in the familiar H&L-B introducer system (Figure 52.3) with some significant modifications. On initial unsheathing of the stentgraft it remains constrained by posterior diameter-reducing ties (Figure 52.4), which allows the device to be manipulated partially deployed in the aorta so that the fenestrations can be accurately placed and cannulated. There are also anterior and posterior gold markers as well as gold markers around the fenestrations and scallops to aid in orientation of the device (Figure 52.5).
