The PERTINI Method (Physician Gore Excluder Re-Sheathing Technique IN emergency Indications)

A simple technique for re-sheathing a physician-modified Gore C3 endograft Two small sheaths with funnel-shaped ends, represent an original endograft re-sheathing system (ERS) for the Gore Excluder endoprosthesis. “Step by step” description: 1) both sheaths are cut to a desired length (leaving a funnel-shaped side intact), to obtain two endograft re-sheathing systems (proximal and distal ERS) 2) the distal ERS is preloaded on the delivery system with the funnel-shaped side facing towards the tip of the prosthesis 3) the main body of the Endograft is partially deployed in the main trunk portion; the contralateral gate is kept constrained by the distal ERS 4) Fenestrations are made by sharply incising the ePTFE, followed by a circumferential reinforcement suture with a cut gooseneck wire 5) the deployed portion of the Endograft is partially re-sheathed into the distal ERS by pushing it forward. The nitinol barbs are left free 6) the Endograft re-sheathing is completed by introducing the proximal ERS from the tip until the “funnel-shaped ends” touch each other 7) both ERS are moved distally. The proximal ERS profile allows the introduction of the graft into the DrySeal sheath.