Nexus Case Report Form
Form Completed by
*
Please enter your name
Proctor Name (if applicable)
First Name
Last Name
Clinical Specialist Support (if applicable)
First Name
Last Name
Femoral Access
*
Percutaneous
Surgical cut down
Axillary Access
*
Percutaneous
Surgical cut down
NEXUS Arch Stent Graft Used
*
(for example - 14/30/36/180)
NEXUS Ascending Stent Graft Used
*
(for example - 40/55)
Ascending Stent Graft Deployment
*
Double Curved extra stiff guide wire
Extra Stiff guide wire with long floppy tip
Through & Through guide wire loop
TAVI guide wire
Deployment Accuracy Mechanism
*
IVC Balloon
Rapid Pacing
None
Other
Deployment Accuracy BCA
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As planned
Proximal - Sub optimal
Distal - Sub optimal
Unresolved endoleaks at end of procedure
*
Type Ia
Type Ib
Type II
Type III
Type IV
None
Any "None Routine" post modelling ballooning required?
*
No
Ascending Aorta
Dock & Lock
BCT - Brachiocephalic Trunk
Descending Aorta
Parallel Graft
Endoleak resolved post ballooning
Endoleak not resolved post ballooning
Did NEXUS Arch Stent Graft deploy successfully?
*
Yes
No
Other
Did NEXUS Ascending Stent Graft deploy successfully?
*
Yes
No
Other
Was the Dock orientation correct?
*
Yes
No
Did the Dock deploy as it should?
*
Yes
No
Any unplanned NEXUS related additional implantions required?
(for example 2nd ascending stent graft, covered stent extension to BCA)
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Additional Information - Troubleshooting etc.
Physician Comments
Arch Device Angio Upload
*
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Ascending Device Angio Upload
*
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Angio Upload
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Final Angio Upload
*
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