Endovascular Repair of a Thoracic Aortic Aneurysm Using the Bolton Relay® Stent-Graft
The Bolton Relay thoracic stent-graft (Bolton Medical, Inc., Sunrise, FL) is a self-expanding stent-graft constructed of nitinol stents and Dacron fabric material. The proximal end of the device has a bare-stent segment for fixation and coaxial alignment. It has a unique dual-stage delivery system, composed of an outer hydrophilic sheath that is advanced to the distal thoracic aorta and a highly flexible inner sheath constructed of a low-friction fabric that allows delivery of the endograft through the tortuosity of the arch to the intended proximal landing zone. The delivery system employs a staged deployment mechanism, which allows controlled release of the endograft. This case study describes an endovascular repair of a descending thoracic aneurysm using the Bolton Medical Relay stent-graft that illustrates some of its unique features.
An 80-year-old woman presented with a 6.6 cm fusiform descending thoracic aortic aneurysm. The proximal landing zone was 20 mm distal to the left subclavian aneurysm, and the distal landing zone extended to the origin of the celiac artery (Figure 1). The patient had a spinal drain placed preoperatively to reduce the risk of spinal cord ischemia. This is routinely performed in all cases in which more than 150 mm of the thoracic aorta will be covered.
The right femoral artery was exposed through a transverse oblique incision. The left femoral artery was percutaneously accessed, and a 5 F sheath was inserted, through which a marked pigtail angiographic catheter was advanced into the aortic arch. After adequate anticoagulation, a 32 mm (proximal diameter) X 28 mm (distal diameter) X 200 mm (length) Bolton Medical Relay device was introduced through the right femoral artery. The proximal covered sealing stent was deployed in zone 4 just distal to the left subclavian artery (Figure 2).
A second Bolton Medical Relay stent-graft measuring 32 X 32 X 200 mm was deployed distal to the first stent-graft with sufficient overlap. The C-arm gantry was rotated 90° to visualize the origin of the celiac artery. The distal end of the stent-graft was deployed just proximal to its origin (Figure 3). A completion angiogram showed no evidence of an endoleak. The right femoral artery and groin were closed routinely, and the left femoral access site was closed using an Angio-Seal closure device (St. Jude Medical, Inc., St. Paul, MN).
Postoperatively, the patient recovered in the cardiovascular intensive care unit. She remained neurologically intact without signs of stroke or spinal cord ischemia. The spinal drain was removed after 24 hours, and the patient was discharged to home on postoperative day 4.
The Bolton Medical Relay thoracic stent-graft is an effective device for endovascular repair of descending thoracic aortic aneurysms that can be deployed in a reliable and accurate manner.
W. Anthony Lee, MD, is Director of Endovascular Program, Lynn Heart and Vascular Institute, Boca Raton, Florida. He has disclosed that he is a consultant and speaker for Bolton Medical, Inc. Dr. Lee may be reached at (561) 395-2626; firstname.lastname@example.org