Educational animated video
“complete removal of an endograft with suprarenal fixation can tear the aorta, injure the renal or visceral artery origins, and prolong suprarenal cross-clamp time, all contributing to poor outcomes.”
“Several techniques for removal of suprarenal stents have been used, such as circumferentially releasing barbs from the main body with a wire cutter or using a 20-mL syringe as a sheath to encircle and collapse the suprarenal component. We used the syringe technique in two cases, but it was of limited help.”*
*Arnaoutakis et al, Journal of Vascular Surgery, Volume 69, Number 1, 80-85
“Some have reported using a 20-mL syringe to “resheath” the bare metal stent and facilitate its removal. This technique was rarely reported in our series, and, when attempted in endografts that had been in place for some time, was often unsuccessful owing to the adherence of the bare metal stent to the endothelium of the aorta. Others have also reported that the technique was of little use”**
**Dubois et al, Journal of Vascular Surgery, Volume 74, Number 3, 720-28
XplantR
The only tool designed and patented, with guidance from Kellie R. Brown, MD, FACS, to aid in open aortic stent graft explant. Surgeons need a simple, atraumatic, fast and effective tool, the Hjarta Care XplantR Explant Tool.
The Hjarta Care XplantR Explant Tool is not yet approved or cleared for commercial distribution by the FDA in the United States or by any other regulatory authorities.
kellie’s mandate: improve Open surgical expLant
Simple: no cut syringe or bulky orthopedic wire cutters
Atraumatic: Bullet nose lead edge and tapered inner cylinder to promote smooth advancement
Fast explant: Limit ischemic/cross-clamp time preventing end organ failure leading to extensive complications and/or readmission
“some authors have attributed the high morbidity and mortality seen with late conversion to extended supravisceral aortic cross-clamp time”*
*Brinster et al, Journal of Vascular Surgery, Volume 54, Number 1, 42-46
Current explant techniques take 3 - 15 minutes or more
The XplantR FDA approval De Novo study
120 explants by 30 Vascular Surgeons averaged 90 seconds per explant
90 seconds included;
size selection
opening the package
inspection of the tool
actual explant
Effective: Intimal inspection of every explant reviled no damage, only visible defect was the puncture marks caused by the suprarenal fixation
Traditional Explant using the Hjarta Care XgraftR Explant Tool
Complicated Explant - STOP and reinspect