Rebranching of renals at CX


Gore’s Satellite Symposium, chaired by Jan Brunkwall (Cologne, Germany), at the Charing Cross International Symposium was a chance for the company to showcase its aortic technologies, and it did not disappoint. The Gore Viabahn endoprosthesis was the star of the show, with Mario Lachat (Zurich, Switzerland) showing how easy it is to use when re-branching the renal arteries in situations with difficult access.

He talked the audience through the process: “Puncture the renal artery, insert the guidewire, deploy the Viabahn prosthesis, dilate the balloon, fix the Viabahn to the renal artery with two stitches and then attach the Viabahn to the graft.” Lachat called this ‘the G-VORTEX’ – Gore Viabahn Open Rebranching Technique Experience. “I hope I’ve convinced you that this technique has very high potential in difficult situations,” he concluded.

One attendee who was convinced was Frank Veith, who commented that this was “a very clever technique. I was interested when I first heard about it, and seeing it now I’m even more keen”, and he pressed Lachat for more details about the fixation of the prosthesis. An advantage of the simple double transfixing stitch arrangement is that there is no need for anastomoses. “We do anastomoses daily, we are very good at them, but sometimes in the renals, especially on the right hand side, there can be problems,” added Lachat.5-year Excluder results

Also in the Satellite were data on the Gore Excluder bifurcated endoprosthesis. Michael Makaroun (Pittsburgh, PA) highlighted the five-year follow-up data from the US PIVOTAL trial, using the original graft. There were zero ruptures, one post-procedure migration, one fracture, no graft tears, a 10% total endoleak rate, a low post-procedure conversion rate and 100% cumulative patency “The current device in use is a modified version that reduces ultrafiltration,” he added.

Elaborating on the ultrafiltration theme was Mark Morasch (Chicago, IL), who said that the Excluder “is the device of choice for us at Northwestern University because of its low profile”. He reported that a trial of the low-permeability Excluder showed that more than half of patients experience significant sac regression (>5mm) at six and 12 months, while no patient experienced significant sac growth. He concluded: “Longer follow-up is needed as reversed trends have been seen before and could be seen again. Nonetheless, this is encouraging data and it suggests that device modifications may have altered the concerning sac growth noted in earlier reports.”