Catheter-less angiography for endovascular aortic aneurysm repair: A new application of carbon dioxide as a contrast agent Enrique Criado, MD, Loay Kabbani,

Slides:

Advertisements

Similar presentations

Early experience with the snorkel technique for juxtarenal aneurysms

Advertisements

Modular component separation and reperfusion of abdominal aortic aneurysm sac after endovascular repair of the abdominal aortic aneurysm: A case report

Gregory J. Nadolski, MD, S. William Stavropoulos, MD

Custom-made versus off-the-shelf multibranched endografts for endovascular repair of thoracoabdominal aortic aneurysms Theodosios Bisdas, MD, Konstantinos.

Use of custom Dacron branch grafts for “hybrid” aortic debranching during endovascular repair of thoracic and thoracoabdominal aortic aneurysms G. Chad.

Christopher K. Zarins, MD, Rodney A. White, MD, Thomas J. Fogarty, MD

Lee J. Goldstein, MD, Combiz Rezayat, MD, Gautam V

Staged endovascular repair of an abdominal aortic aneurysm adjacent to a chronic high- flow iliocaval traumatic arteriovenous fistula S. Keisin Wang,

Preloaded guidewires to facilitate endovascular repair of thoracoabdominal aortic aneurysm using a physician-modified branched stent graft Gustavo S.

Intraprocedural imaging: Thoracic aortography techniques, intravascular ultrasound, and special equipment Rodney A. White, MD, Carlos E. Donayre, MD,

The chimney procedure is an emergently available endovascular solution for visceral aortic aneurysm rupture Felix J.V. Schlösser, MD, PhD, John E. Aruny,

Surgeon-modified fenestrated-branched stent grafts to treat emergently ruptured and symptomatic complex aortic aneurysms in high-risk patients Joseph.

Acute bilateral renal artery chimney stent thrombosis after endovascular repair of a juxtarenal abdominal aortic aneurysm Salvatore T. Scali, MD, Robert.

Outcome of visceral chimney grafts after urgent endovascular repair of complex aortic lesions Adel Bin Jabr, MD, PhD, Bengt Lindblad, MD, PhD, Thorarinn.

Technical aspects, current indications, and results of chimney grafts for juxtarenal aortic aneurysms Raphael Coscas, MD, Hicham Kobeiter, MD, Pascal.

Daniel F. Leotta, PhD, Benjamin W. Starnes, MD

Novel technique for endovascular salvage of a folded aortic endograft

Intraoperative contrast-enhanced cone beam computed tomography to assess technical success during endovascular aneurysm repair Christof Johannes Schulz,

The use of dynamic volumetric CT angiography (DV-CTA) for the characterization of endoleaks following fenestrated endovascular aortic aneurysm repair.

Impact of transrenal aortic endograft placement on endovascular graft repair of abdominal aortic aneurysms Michael L. Marin, MD, Richard E. Parsons,

A technique for increased accuracy in the placement of the “giant” Palmaz stent for treatment of type IA endoleak after endovascular abdominal aneurysm.

Endovascular repair of thoracoabdominal aortic aneurysm using the off-the-shelf multibranched t-Branch stent graft Bernardo C. Mendes, MD, Gustavo S.

Christopher K. Zarins, MD, Rodney A. White, MD, Thomas J. Fogarty, MD

Gregory J. Nadolski, MD, S. William Stavropoulos, MD

Early versus late experience in fenestrated endovascular repair for abdominal aortic aneurysm Magnus Sveinsson, MD, Jonathan Sobocinski, MD, PhD, Timothy.

Initial results of wireless pressure sensing for endovascular aneurysm repair: The APEX Trial—Acute Pressure Measurement to Confirm Aneurysm Sac EXclusion

Initial experience with the Ventana fenestrated system for endovascular repair of juxtarenal and pararenal aortic aneurysms Andrew Holden, MD, Renato.

Melanie K. Rose, MD, Benjamin J. Pearce, MD, Thomas C

Direct sonographic-guided superior gluteal artery access for treatment of a previously treated expanding internal iliac artery aneurysm Michael M. Herskowitz,

Endovascular aortic aneurysm repair with carbon dioxide-guided angiography in patients with renal insufficiency Enrique Criado, MD, Gilbert R. Upchurch,

Physician modification of Gore C3 excluder endograft for treatment of abdominal aortic aneurysms anatomically unsuitable for conventional endovascular.

Kevin J. Bruen, MD, Robert J. Feezor, MD, Michael J

Techniques in occluding the aorta during endovascular repair of ruptured abdominal aortic aneurysms Mark Edward O’Donnell, DSEM, MRCS, Stephen A. Badger,

Niyant V. Patel, MD, Graham W. Long, MD, Zulfiqar F

Results of a double-barrel technique with commercially available devices for hypogastric preservation during aortoilac endovascular abdominal aortic aneurysm.

Endovascular abdominal aortic aneurysm repair in patients with common iliac artery aneurysms – Initial experience with the Zenith bifurcated iliac side.

Successful off-label use of the GORE EXCLUDER Iliac Branch Endoprosthesis to preserve gluteal perfusion during staged endovascular repair of bilateral.

Technical aspects of repair of juxtarenal abdominal aortic aneurysms using the Zenith fenestrated endovascular stent graft Gustavo S. Oderich, MD, Mateus.

Endovascular repair of an iliac artery aneurysm in a patient with Ehlers-Danlos syndrome type IV Britt H. Tonnessen, MD, W. Charles Sternbergh, MD, Krishna.

Prediction of altered endograft path during endovascular abdominal aortic aneurysm repair with the Gore Excluder David R. Whittaker, MD, Jeff Dwyer,

Carbon dioxide digital subtraction angiography as an option for detection of endoleaks in endovascular abdominal aortic aneurysm repair procedure Eijun.

Georgios Vourliotakis, MD, PhD, Montse Blanch, MD, Clark J

The effect of endograft relining on sac expansion after endovascular aneurysm repair with the original-permeability Gore Excluder abdominal aortic aneurysm.

Combined endovascular and surgical approach (CESA) to thoracoabdominal aortic pathology: A 10-year experience William Quinones-Baldrich, MD, Juan Carlos.

Repair of recurrent visceral aortic patch aneurysm after thoracoabdominal aortic aneurysm repair with a branched endovascular stent graft Donald J. Adam,

Alternative access techniques with thoracic endovascular aortic repair, open iliac conduit versus endoconduit technique Guido H.W. van Bogerijen, MD,

Endovascular treatment of ruptured axillary and large internal mammary artery aneurysms in a patient with Marfan syndrome Jessica F. Rose, DO, Layla.

Peter L Faries, MD, Hadley Cadot, MD, Gautam Agarwal, MD, K

First experience using intraoperative contrast-enhanced ultrasound during endovascular aneurysm repair for infrarenal aortic aneurysms Reinhard Kopp,

Anthony Carnicelli, BA, Adam Doyle, MD, Michael Singh, MD

Endovascular aneurysm repair for ruptured abdominal aortic aneurysm: The Albany Vascular Group approach Manish Mehta, MD, MPH Journal of Vascular Surgery

Treatment of an early type II endoleak causing hemorrhage after endovascular aneurysm repair for ruptured abdominal aortic aneurysm Olivier Hartung,

Endovascular abdominal aortic aneurysm repair in patients with common iliac artery aneurysms – Initial experience with the Zenith bifurcated iliac side.

Hybrid management of ruptured isolated superior mesenteric artery dissecting aneurysm Yoshikatsu Nomura, MD, Masato Yamaguchi, MD, Atsushi Kitagawa,

Three-dimensional fusion computed tomography decreases radiation exposure, procedure time, and contrast use during fenestrated endovascular aortic repair

Endovascular treatment of thoracoabdominal aortic aneurysms

One-year follow-up after total endovascular repair of a contained-ruptured thoracoabdominal aortic aneurysm with the sandwich technique Theodosios Bisdas,

A hybrid approach using a composite endovascular and open graft procedure for a symptomatic common femoral aneurysm extending well above the inguinal.

Jade S. Hiramoto, MD, Catherine K. Chang, MD, Linda M

Outcome after celiac artery coverage during endovascular thoracic aortic aneurysm repair: Preliminary results Sarat K. Vaddineni, MD, Steve M. Taylor,

Type B aortic dissection after endovascular abdominal aortic aneurysm repair causing endograft collapse and severe malperfusion Vikram Iyer, MD, Mark.

Sukgu M. Han, MD, Warren J. Gasper, MD, Timothy A.M. Chuter, MD

Endovascular repair of stent graft collapse by stent-protected angioplasty using a femoral-brachial guidewire Drosos Kotelis, MD, Ruben Lopez-Benitez,

Endovascular repair of an actively hemorrhaging gunshot injury to the abdominal aorta Michael W. Yeh, MD, Jan K. Horn, MD, William P. Schecter, MD, Timothy.

John L. Anderson, Donald J. Adam, MD, Michael Berce, David E. Hartley

Fenestrated endograft for recurrent paravisceral aortic pseudoaneurysm after thoracoabdominal aortic aneurysm open repair Mauro Gargiulo, MD, PhD, Enrico.

A staged replacement of the entire aorta from the ascending arch to the hypogastric arteries using a hybrid approach Juan Carlos Jimenez, MD, Wesley.

Mesenteric vascular insufficiency and claudication following acute dissecting thoracic aortic aneurysm Thomas H. Cogbill, M.D., A.Erik Gundersen, M.D.,

William J. Quiñones-Baldrich, MD, Thomas F. Panetta, MD, Candace L

Combined transbrachial and transfemoral strategy to deploy an iliac branch endoprosthesis in the setting of a pre-existing endovascular aortic aneurysm.

Presentation transcript:

Catheter-less angiography for endovascular aortic aneurysm repair: A new application of carbon dioxide as a contrast agent Enrique Criado, MD, Loay Kabbani, MD, Kyung Cho, MD Journal of Vascular Surgery Volume 48, Issue 3, Pages 527-534 (September 2008) DOI: 10.1016/j.jvs.2008.04.061 Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 1 The carbon dioxide (CO2) delivery system. The system includes a 1500 cc plastic bag (pb) with a one-way stopcock and gas fitting (Angioflush 111 fluid collection bag, AngioDynamics, Inc., Queensbury, NY), three one-way check valves and an O-ring gas fitting (arrowhead), which connects the bag and the delivery system (AngioFlush 111 fluid management system, AngioDynamics, Inc), and a luer-lock syringe connected to the delivery port with a check-valve (white arrow). The delivery system is connected to the connecting tube (black arrow) of the CAPTOR hemostatic valve (hv) of the main body delivery system of Zenith Flex AAA Endovascular Graft (Cook Inc., Bloomington, Ind). Journal of Vascular Surgery 2008 48, 527-534DOI: (10.1016/j.jvs.2008.04.061) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 2 Deploying the first two covered stents of the main body. A, After advancing the main body delivery system just proximal to the left renal artery, digital subtraction angiographic (DSA) is obtained with the injection of 30-cc of carbon dioxide (CO2) through the connecting tube of the hemostatic valve (the patient's left side was elevated to 8°). There is excellent filling of the celiac (CA) and superior mesenteric (SMA) arteries and left renal artery (arrow). The level of the left renal artery is marked on the fluoroscopy monitor by a marker pencil. Right renal artery is absent from a nephrectomy. B, Using the landmark, the system is retracted until the four gold radiopaque markers of the proximal graft material is at least 2 mm from the renal artery. The first two covered stents are deployed by withdrawing the sheath, and repeat CO2 digital subtraction angiographic (DSA) demonstrates the position of the gold markers (longer arrow) inferior to the left renal artery (shorter arrow). Then deployment is proceeded until the contralateral limb is fully deployed. Journal of Vascular Surgery 2008 48, 527-534DOI: (10.1016/j.jvs.2008.04.061) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 3 Deploying the iliac leg graft. After cannulation of the contralateral limb, the suprarenal stent is deployed and the contralateral guidewire is advanced into the thoracic aorta. The contralateral iliac leg that was prepped with saline solution and primed with carbon dioxide (CO2), is introduced into the external iliac artery. A, Digital subtraction angiographic (DSA) is performed in the right anterior oblique projection with the injection of 20-cc of CO2 through the connecting tube of the hemostatic valve. There is excellent filling of the common iliac (CI) and external iliac (EI) arteries, and the origin of the hypogastric artery (arrow). The level of the hypogastric artery is identified on the fluoroscopy monitor by a marker pencil. B, After deploying the iliac leg graft, repeat CO2 DSA confirmed the position of the graft (arrow) above the origin of the hypogastric artery. Journal of Vascular Surgery 2008 48, 527-534DOI: (10.1016/j.jvs.2008.04.061) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 4 Deploying the ipsilateral iliac leg. After deploying the ipsilateral limb of the main body, the ipsilateral iliac leg graft that has been prepped with normal saline and primed with carbon dioxide (CO2), is introduced into the external iliac artery. A, Digital subtraction angiographic (DSA) is performed in the left anterior oblique projection with the injection of 20-cc of CO2 through the connecting tube of the hemostatic valve. There is excellent filling of the common and external iliac arteries and the origin of the hypogastric artery (arrow). B, After deployment of the iliac graft, repeat CO2 DSA confirmed the position of the iliac limb (arrow) seen above the hypogastric artery. Journal of Vascular Surgery 2008 48, 527-534DOI: (10.1016/j.jvs.2008.04.061) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 5 Completion CO2 digital subtraction angiographic (DSA). After expansion of the molding balloon with dilute contrast along the aortic graft, a 5F cobra catheter is advanced from the left femoral sheath to the proximal end of the graft. A, DSA with the injection of 30-cc of CO2 confirmed the position of the main graft and patency of the renal artery (arrow). There is no endoleak from the proximal fixation site. B, After placing the catheter within the main body, repeat CO2 DSA is obtained. The graft and both iliac limbs are visualized. The middle colic artery of the superior mesenteric artery provides the primary collateral pathway to the excluded inferior mesenteric artery (arrow). There are no endoleaks or kinks. The renal and bilateral hypogastric arteries are filled by this injection. Journal of Vascular Surgery 2008 48, 527-534DOI: (10.1016/j.jvs.2008.04.061) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 6 Sac perfusion after endograft placement. Intraprocedural digital subtraction angiography was performed in the left anterior oblique projection with the injection of 30-cc of carbon dioxide (CO2) into the main body. The main body and left iliac limb are filled with CO2. The aneurysm sac (arrow) is filled partially through left internal iliac-inferior mesenteric collateral channels. A CT scan one month after endograft placement showed no endoleak. Journal of Vascular Surgery 2008 48, 527-534DOI: (10.1016/j.jvs.2008.04.061) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions