Preoperative Measurements and Planning Sheet for an Endograft With 3 Inner Branches to Repair Aortic Arch Pathologies

PURPOSE: To present a methodology for aortic arch anatomy measurement to plan and size an arch endograft with 3 inner branches. TECHNIQUE: The arch endograft is custom manufactured with 3 inner side branches. Computed tomography angiography should be used to measure the clock position, the distances between the supra-aortic vessels, and the length and diameter of the proximal and distal landing zones. On the planning sheet, the vertical axis on the grid represents the spiral stabilizing wire at the 12 o'clock position; the horizontal baseline at 0 mm represents the idealized proximal margin of the innominate artery (IA). The first inner branch for the IA would be at 12:30 clock position and -20 mm from the horizontal baseline, while the second inner branch would be at the 11:30 clock position and at 0 mm. The third inner branch would vary among the different potential positions. CONCLUSION: Preoperative measurements of aortic arch anatomy can be made using a standard methodology to plan the size and position of inner branches. Future studies will show the potential applicability of a standard 3-inner-branch arch endograft using the planning sheet.