Jason Zakko, BA, Salvatore Scali, MD, Adam W. Beck, MD, Charles T

Slides:

Advertisements

Similar presentations

Professionalism and the work-life balance Thomas S. Huber, MD, PhD Journal of Vascular Surgery Volume 60, Issue 4, Pages (October 2014) DOI:

Advertisements

Intravascular ultrasound is a critical tool for accurate endograft sizing in the management of blunt thoracic aortic injury Gabriel A. Wallace, MD, Benjamin.

Protocol implementation of selective postoperative lumbar spinal drainage after thoracic aortic endograft Charles J. Keith, BA, Marc A. Passman, MD,

Susanna L. Matsen, MD, Bruce A. Perler, MD, MBA, David C

Vascular distribution of stroke and its relationship to perioperative mortality and neurologic outcome after thoracic endovascular aortic repair Brant.

Ultrasound-determined diameter measurements are more accurate than axial computed tomography after endovascular aortic aneurysm repair Sukgu M. Han,

Duplex criteria for determination of in-stent stenosis after angioplasty and stenting of the superficial femoral artery Donald T. Baril, MD, Robert Y.

Vascular distribution of stroke and its relationship to perioperative mortality and neurologic outcome after thoracic endovascular aortic repair Brant.

Outcomes of total percutaneous endovascular aortic repair for thoracic, fenestrated, and branched endografts Leonardo R. de Souza, MD, Gustavo S. Oderich,

Diameter change of common femoral arteries after percutaneous endovascular aortic repair with the use of the preclose technique Yang-Yu Lin, MD, Ren-Fu.

Benjamin S. Brooke, MD, PhD, Randall R

Age-related trends in utilization and outcome of open and endovascular repair for abdominal aortic aneurysm in the United States, Margaret.

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

Femoral artery calcification as a determinant of success for percutaneous access for endovascular abdominal aortic aneurysm repair Jesse M. Manunga,

The impact of body mass index on perioperative outcomes of open and endovascular abdominal aortic aneurysm repair from the National Surgical Quality Improvement.

Visceral vessel relocation techniques

A percutaneous arterial closure protocol can decrease complications after endovascular interventions in vascular surgery patients Philip P. Goodney,

Extent of Aortic Coverage and Incidence of Spinal Cord Ischemia After Thoracic Endovascular Aneurysm Repair Robert J. Feezor, MD, Tomas D. Martin, MD,

Thoracic endovascular aortic repair with the chimney graft technique

Salvatore T. Scali, MD, Adam W. Beck, MD, Khayree Butler, MD, Robert J

National trends and regional variation of open and endovascular repair of thoracic and thoracoabdominal aneurysms in contemporary practice Salvatore.

Ashkan Karimi, MD, Karen L. Walker, MD, MHS, Tomas D

Financial implications of coding inaccuracies in patients undergoing elective endovascular abdominal aortic aneurysm repair Suniah Ayub, MD, MPH, Salvatore.

Treatment of acute visceral aortic pathology with fenestrated/branched endovascular repair in high-surgical-risk patients Salvatore T. Scali, MD, Alyson.

Infectious complications after elective vascular surgical procedures

Salvatore T. Scali, MD, Diego Ayo, MD, Kristina A

Endovascular native vessel recanalization to maintain limb perfusion after infected prosthetic vascular graft excision Victor Z. Erzurum, MD, Dan Clair,

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

Thoracic endovascular aortic repair of aortobronchial fistulas

Efficacy of thoracic endovascular stent repair for chronic type B aortic dissection with aneurysmal degeneration Salvatore T. Scali, MD, Robert J. Feezor,

Defining risk and identifying predictors of mortality for open conversion after endovascular aortic aneurysm repair Salvatore T. Scali, MD, Adam W. Beck,

Implications of Secondary Aortic Intervention After Thoracic Endovascular Aortic Repair for Acute and Chronic Type B Dissection Salvatore T. Scali, Kristina.

Ultrasound-guided percutaneous endovascular aneurysm repair success is predicted by access vessel diameter Rodney P. Bensley, MD, Rob Hurks, MD, Zhen.

Influence of Hospital Volume on Patient Selection, Risk of Complications, and Mortality From Failure to Rescue After Open Abdominal Aortic Aneurysm Repair

Total percutaneous access for endovascular aortic aneurysm repair (“Preclose” technique) W. Anthony Lee, MD, Michael P. Brown, DO, Peter R. Nelson, MD,

Outcomes after endovascular aneurysm repair conversion and primary aortic repair for urgent and emergency indications in the Society for Vascular Surgery.

National Incidence, Mortality Outcomes, and Predictors of Spinal Cord Ischemia After Thoracic Endovascular Aortic Repair Salvatore T. Scali, Kristina.

Robert J. Feezor, MD, Thomas S. Huber, MD, PhD, Tomas D

Karen L. Walker, MHS, Jonathan J. Shuster, PhD, Tomas D

Robert J. Feezor, MD, Thomas S. Huber, MD, PhD, Scott A

Nonoperative management of grade III blunt thoracic aortic injuries

Paul J. Riesenman, MD, MS, Mark A. Farber, MD, Robert R

Paraplegia after coronary artery bypass surgery: An uncommon complication in a patient with history of thoracic endovascular aortic repair Aurélien Vallée,

Conduits and endoconduits, percutaneous access

Reporting standards for thoracic endovascular aortic repair (TEVAR)

Critical analysis of results after chimney endovascular aortic aneurysm repair raises cause for concern Salvatore T. Scali, MD, Robert J. Feezor, MD,

Completion duplex ultrasound predicts early graft thrombosis after crural bypass in patients with critical limb ischemia Salvatore T. Scali, MD, Adam.

Karthikeshwar Kasirajan, MD, Mark D. Morasch, MD, Michel S

W. Anthony Lee, MD, Tomas D. Martin, MD, Philip J. Hess, MD, Thomas M

Timothy A. M. Chuter, MD, Bo Risberg, MD, PhD, Brian R

Subclavian revascularization in the age of thoracic endovascular aortic repair and comparison of outcomes in patients with occlusive disease Salvatore.

The Correlation Between Computed Tomography (CT) and Duplex Evaluation of Vein Bypass Grafts and Their Relationship to Graft Failure Jonathan Rehfuss,

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

Regarding “Endovascular repair of ruptured abdominal aortic aneurysms”

Philip P. Goodney, MD, MS, Adam W. Beck, MD, Jan Nagle, MS, RPh, H

Comparative Outcomes of Open, Hybrid, and Fenestrated Branched Endovascular Repair of Extent II and III Thoracoabdominal Aortic Aneurysms Dean J. Arnaoutakis,

Trends of 30-day mortality and morbidities in endovascular repair of intact abdominal aortic aneurysm during the last decade Kanhua Yin, MD, Satinderjit.

Mark A. Farber, MD, Robert R. Mendes, MD Journal of Vascular Surgery

Daniel J. Martin, MD, Tomas D. Martin, MD, Philip J

Journal of Vascular Surgery

Intravascular ultrasound is a critical tool for accurate endograft sizing in the management of blunt thoracic aortic injury Gabriel A. Wallace, MD, Benjamin.

Optimizing infrainguinal arm vein bypass patency with duplex ultrasound surveillance and endovascular therapy Paul A. Armstrong, DO, Dennis F. Bandyk,

Lower extremity artery stenosis distribution in an unselected elderly population and its relation to a reduced ankle-brachial index Johan Wikström, MD,

Outcomes after endovascular aneurysm repair conversion and primary aortic repair for urgent and emergency indications in the Society for Vascular Surgery.

Contrast-enhanced Duplex surveillance after endovascular abdominal aortic aneurysm repair: Improved efficacy using a continuous infusion technique Esteban.

The advent of thoracic endovascular aortic repair is associated with broadened treatment eligibility and decreased overall mortality in traumatic thoracic.

Defining utility and predicting outcome of cadaveric lower extremity bypass grafts in patients with critical limb ischemia Catherine K. Chang, MD, Salvatore.

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

Salvatore T. Scali, MD, S. Keisin Wang, MD, Robert J

Matthew Thompson, MD, Peter Holt, PhD, Ian Loftus, MD, Thomas L

Presentation transcript:

Percutaneous thoracic endovascular aortic repair is not contraindicated in obese patients Jason Zakko, BA, Salvatore Scali, MD, Adam W. Beck, MD, Charles T. Klodell, MD, Thomas M. Beaver, MD, MS, Tomas D. Martin, MD, Thomas S. Huber, MD, PhD, Robert J. Feezor, MD Journal of Vascular Surgery Volume 60, Issue 4, Pages 921-928 (October 2014) DOI: 10.1016/j.jvs.2014.04.051 Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 1 Method of femoral access vessel assessment. The common femoral artery (CFA) was located at the mid–femoral head, and a measurement from the skin to the anterior vessel wall was obtained to determine access vessel depth (A). The left-right (B) and anterior-posterior (C) inner vessel diameters as well as plaque morphology and calcium score were obtained for each vessel accessed with a sheath that was 20F outer diameter or larger. Journal of Vascular Surgery 2014 60, 921-928DOI: (10.1016/j.jvs.2014.04.051) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 2 Patient and access vessel selection for percutaneous thoracic endovascular aortic repair (TEVAR). A total of 536 patients were available at the time of analysis, with 365 arteries from 355 patients accessed with a sheath that was ≥20F outer diameter. Of these, 336 were successfully closed percutaneously by the preclose technique, with 29 failures. When body mass index (BMI) ≥30 was used as a definition of obesity, it was not associated with a higher rate of failure (P = NS vs nonobese patients). Journal of Vascular Surgery 2014 60, 921-928DOI: (10.1016/j.jvs.2014.04.051) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 3 Body mass index (BMI) and access vessel morphology trends. These scatter plots demonstrate that as expected, the access vessel depth is greater as the patient's BMI increases (A). Of note, the inner vessel diameter also tended to be larger with increasing BMI (B). Journal of Vascular Surgery 2014 60, 921-928DOI: (10.1016/j.jvs.2014.04.051) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 4 Preclose failure management during thoracic endovascular aortic repair (TEVAR). Preclose failure was defined as the inability to achieve hemostasis and to maintain limb perfusion without the need for common femoral artery (CFA) exposure or obligate surgical repair of the vessel within a 30-day postoperative period (see Methods section for further details). Three hematomas were documented clinically and confirmed with duplex ultrasound and managed expectantly (no transfusion or evacuation). All of these hematomas resolved during postoperative follow-up. Of the other 26 failures, four required an iliofemoral bypass, 10 required an endarterectomy and patch angioplasty, and 12 arteriotomies were repaired primarily. Journal of Vascular Surgery 2014 60, 921-928DOI: (10.1016/j.jvs.2014.04.051) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 5 Probability of preclose failure during percutaneous thoracic endovascular aortic repair (P-TEVAR). This graph demonstrates some of the univariate associations with preclose failure during P-TEVAR. Notably, factors such as age and sheath diameter were linearly correlated with failure; however, body mass index (BMI) had an inverse relationship (eg, ↓BMI ∝ ↑failure rate). Of the three demonstrated variables in this graph, only sheath diameter independently predicted failure in multivariable analysis. The optimal prediction model was obtained in accounting for the interaction of sheath size and access vessel inner diameter. Journal of Vascular Surgery 2014 60, 921-928DOI: (10.1016/j.jvs.2014.04.051) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 6 Interaction between access vessel diameter and sheath size. This plot demonstrates the interaction between the femoral access vessel diameter and sheath size ratio as a function of the patient's body mass index (BMI). A decreasing access vessel diameter to sheath size ratio (eg, smaller vessel and larger sheaths) was an independent predictor of preclose failure during percutaneous thoracic endovascular aortic repair (P-TEVAR). Journal of Vascular Surgery 2014 60, 921-928DOI: (10.1016/j.jvs.2014.04.051) Copyright © 2014 Society for Vascular Surgery Terms and Conditions