The journey of a graft

When standard, off-the-shelf Zenith endograft technology cannot address a patient’s specific anatomy and condition, Cook offers a service to a number of centers around the world to provide a uniquely created device to meet the clinical need.

Meet the Asia-Pacific Endovascular Planning team

Have you ever wondered how a customized graft makes the journey from concept to a full graft plan ready to be signed off and ordered by the doctor? The Asia-Pacific (APAC) Endovascular Planning team, based at Cook Australia in Brisbane, provides the link between the doctor, the patients’ anatomy, and a manufacturable graft design.

The APAC team consists of four planning specialists based in Australia, and they are part of a global team of 18, with planning offices in Brisbane, London, Bloomington, and Atlanta.

Background and experience

The planning team has extensive experience in medical imaging analysis and graft design, and their day usually consists of communicating complex ideas about graft configuration for endovascular repair to surgeons. To be able to do this, planners are generally qualified radiographers with strong computed tomography (CT) and advanced imaging skills.

If a planner is a qualified radiographer, or radiologic technologist, they are an allied health professional who has specialized in imaging the body for the diagnosis and treatment of pathology. As part of this specialization, strong CT skills and advanced imaging skills are gained by having clinical work experience in complex cases utilizing  advanced scanning technology (CT and MRI) or in interventional radiology labs.

All in a day’s work

After receiving a planning request from a surgeon along with a patient’s CT scan, the planning specialists use this information to create all the documentation and files necessary for planning and processing the order. Firstly, an E-Number is created; this is a unique electronic number assigned to that order and it will stay with the device for its lifecycle. Then files with all relevant data are created in the case tracking and secure data storage systems, MPower and Livelink. Finally, the imaging is uploaded to our advanced 3D imaging software, TeraRecon.

In conjunction with the case information provided by the surgeon, the planning specialists then use the advanced 3D imaging tools to highlight any anatomical issues and help identify the type of graft that can be designed to suit the patient’s unique anatomy and disease state.

Case triage meetings are held regularly so the whole team can discuss ideas and come up with solutions for more difficult anatomy and advanced technology cases. These meetings are held to review and assess received cases for sustainability for endovascular graft planning and manufacturability. The cases are also reviewed to check if there is sufficient information to proceed with planning, or if further information from the doctor is needed.

Throughout the process, discussions are held with the surgeon on the best solution for the patient before a final concept is settled upon. The surgeon’s input is vital so the graft can be tailored to their patients’ needs and the surgeon’s treatment plan. Should the graft design require advanced technology, then the case is taken to Cook’s Advanced Technology team and presented to them for approval.

Once the concept is settled, the planning specialist designs the graft to best match the patient’s anatomy while ensuring the design is manufacturable. This step typically takes a few hours. Along with the graft plan, an anatomy sketch (a visual representation of how the graft is predicted to sit in the anatomy), a letter, and an image worksheet are produced by the planner and sent to the surgeon for final approval and ordering.

The graft design solution is dependent on the quality of information received throughout the planning process. To ensure we obtain the right information, we provide workshops with planning and sizing presentations and training to surgeons, vascular trainees, and territory managers around the APAC region. This not only empowers the surgeons to become fully involved with the planning process but also enables the territory managers to have more effective case discussions with them. This in turn flows into high-quality information gathered early in the planning process, which helps reduce planning time overall.

The video below demonstrates the imaging software mentioned above, TeraRcon, as a planner takes measurements of the left common iliac artery diameter in order to choose the graft leg diameter needed to seal in this location.

Putting the patient first

As with all Cook Medical teams, the patient is at the center of everything we do and our goal is to design the best solution for the patient in the shortest possible time. For suitable patients, endovascular surgery can offer many benefits, including a shorter hospital stay and recovery time compared to open surgery.¹

Meet the team!

1. Brewster, David C. et al. Guidelines for the treatment of abdominal aortic aneurysms: Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery. Journal of Vascular Surgery. 2003; 37(5):1106 – 1117.

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Written by Denise Elliott, an Endovascular Planning specialist on the Asia-Pacific (APAC) Endovascular Planning team at Cook Australia. 

You can click, “Thank you, Tom, for everything,” to learn about Cook’s first hired on employee. You can also click, Remembering James Yang to learn more about the first and the longest-tenured employee at Cook China who passed away earlier this year.