Thoracic endovascular aortic repair: The basics

Slides:

Advertisements

Similar presentations

Periprosthetic leak and rupture after endovascular repair of abdominal aortic aneurysm: The significance of device design for long-term results Kirsten.

Advertisements

Celiac artery coverage after occlusion test during endovascular stent grafting for thoracoabdominal aortic aneurysm Taro Shimazaki, MD, Satoshi Kawaguchi,

Ravi K. Ghanta, MD, John A. Kern, MD

Complicated acute type B aortic dissection involving the arch: Treatment by simultaneous hybrid approach under local anesthesia Gabriele Iannelli, MD,

PP-355 Endovascular Stenting Extension of Elephant Trunk Surgical Graft to Lower Descending Thoracic Aorta in a Patient with Aortic Arch and Descending.

Directional tip control technique for optimal stent graft alignment in angulated proximal aortic landing zones Toshio Takayama, MD, PhD, Patrick J. Phelan,

Giant thrombus in ascending aorta and aortic arch

Endovascular treatment of thoracic aortic aneurysms with a short proximal landing zone using scalloped endografts Ali Alsafi, MBBS, BSc (Hons), Colin.

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

Percutaneous aortic valves: Effective in inoperable patients, what price in high-risk patients? Lars G. Svensson, MD, PhD The Journal of Thoracic and.

Hybrid repair of complex thoracoabdominal aortic aneurysms using applied endovascular strategies combined with visceral and renal revascularization Lukla.

Homemade proximal scalloped stent graft for thoracic endovascular aortic repair of zone 2 acute aortic syndrome Ludovic Canaud, MD, PhD, Thomas Gandet,

Ravi K. Ghanta, MD, John A. Kern, MD

Acute blunt traumatic injury to the descending thoracic aorta

Branched Endovascular Therapy of the Distal Aortic Arch: Preliminary Results of the Feasibility Multicenter Trial of the Gore Thoracic Branch Endoprosthesis

Jacques Kpodonu, MD, Venkatesh G. Ramaiah, MD, Edward B. Diethrich, MD

Proximal thoracic aortic aneurysm mimicking a mediastinal neoplasm

Initial clinical experience with a new low-profile thoracic endograft

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

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

Elective transfer from cardiopulmonary bypass to centrifugal blood pump support in very high-risk cardiac surgery Stephen Westaby, BSc, FRCS, MS, PhD,

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

Staged hybrid approach for an acute-on-chronic aortic dissection with rupture in a Jehovah's Witness patient: Case report Sarah T. Ward, MD, Minhaj S.

Surgery for acute type A aortic dissection

Distal aortic arch aneurysm after endovascular stent graft repair for type B chronic aortic dissection Claudio F. Russo, MD, Andrea Garatti, MD, Maurizio.

Stent-Grafting of the Thoracic Aorta by the Cardiothoracic Surgeon

New technique for passage of endograft through problematic arch anatomy Hitoshi Matsuda, MD, Tetsuya Fukuda, MD, Hiroshi Tanaka, MD, Kenji Minatoya, MD

Bitubular graft as an adjunct for laparoscopic hybrid repair of an abdominal aortic aneurysm Raphaël Coscas, MD, Clément Capdevila, MD, Olivier Goeau-Brissonniere,

Shane S. Parmer, MD, Jeffrey P. Carpenter, MD

Preservation of internal iliac arteries during endovascular aneurysm repair using “eye of the tiger” technique Tariq Almerey, MD, W. Andrew Oldenburg,

An option for intraoperative placement of an intra-aortic balloon pump in patients with occlusive peripheral vascular disease Domenico Calcaterra, MD,

Transposition of the supra-aortic vessels before stent grafting the aortic arch and descending aorta Martin Czerny, MD, Martin Funovics, MD, Maria Schoder,

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

Advantage of a precurved fenestrated endograft for aortic arch disease: Simplified arch aneurysm treatment in Japan 2010 and 2011 Yoshihiko Yokoi, MD,

Surgical management after stent-graft failure during the frozen elephant trunk technique for acute type A aortic dissection Maximilian Luehr, MD, Christian.

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

Experience with a novel custom-made fenestrated stent graft in the repair of juxtarenal and type IV thoracoabdominal aneurysms Alexander E. Rolls, MRCS,

Management of acute type B aortic dissection

Periprosthetic leak and rupture after endovascular repair of abdominal aortic aneurysm: The significance of device design for long-term results Kirsten.

Total aortic arch reconstruction with open placement of triple-branched stent graft for acute type A dissection Liang-Wan Chen, MD, Xiao-Fu Dai, MD,

Aortic cannulation with a single purse-string suture

Coarctation of aorta aneurysm with aberrant right subclavian artery and single carotid artery: Surgical and perfusion strategies Balasubramoniam Kavumkal.

Complicated acute type B aortic dissection involving the arch: Treatment by simultaneous hybrid approach under local anesthesia Gabriele Iannelli, MD,

Intra-operative DynaCT improves technical success of endovascular repair of abdominal aortic aneurysms Lukla Biasi, MD, Tahir Ali, MBChB, MRCS, Lakshmi.

Aneurysm expansion caused by an intercostal type II endoleak after thoracic endovascular aortic repair for secondary elephant trunk graft fixation Atsushi.

Conduits and endoconduits, percutaneous access

Giant pseudoaneurysm after proximal aortic surgery treated by means of redo axillary artery cannulation and use of an Endoclamp device Francois Dagenais,

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

Richard E. Parsons, MD, Michael L. Marin, MD, Frank J

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

Open thoracoabdominal aortic repair for chronic type B dissection

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

A novel technique of antegrade transapical arch and thoracic aortic endovascular repair with a triple-barrel graft Robert Shahverdyan, MD, Navid Madershahian,

Use of carotid–subclavian arterial bypass and thoracic endovascular aortic repair to minimize cerebral ischemia in total aortic arch reconstruction Steve.

Proximal aortic perforation after endovascular repair of a type B dissection in a patient with Marfan syndrome Jasper W. van Keulen, MD, Frans L. Moll,

Endovascular management of thoracic aortic aneurysms

Advantages of the continuous telescopic inversion technique do not overcome the disadvantages of the “turn-up” technique of aortic anastomosis Takeshi.

Usefulness of bridging thoracic endovascular aortic repair and sac irrigation followed by open repair in patients with mycotic thoracic aortic aneurysms

Commentary: It's all about the distal

A fenestrated stent graft for surgical resection of lung cancer invading the aortic arch Toshiyuki Nagata, MD, Yoshihiro Nakamura, MD, PhD, Hiroyuki Yamamoto,

Open repair of a new aneurysm of the thoracoabdominal aorta after endovascular stent placement Siyamek Neragi-Miandoab, MD, James Tuchak, MD, Mamdouh.

Shane S. Parmer, MD, Jeffrey P. Carpenter, MD

Endovascular repair of abdominal aortic aneurysms in patients with congenital renal vascular anomalies David B. Kaplan, MD, Christopher C. Kwon, MD,

Management of acute type B aortic dissection; ADSORB trial

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

Eric E. Roselli, MD, Jahanzaib Idrees, MD, Roy K

Grant T. Fankhauser, MD, Abe DeAnda, MD, Patrick T. Roughneen, MD

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

Zone zero thoracic endovascular aortic repair is all about “location, location, location” Kevin L. Greason, MD The Journal of Thoracic and Cardiovascular.

Phlegmasia cerulea dolens secondary to an aortoiliac aneurysm

Presentation transcript:

Thoracic endovascular aortic repair: The basics Nick Cheshire, MD, FRCS, Colin Bicknell, MD, FRCS The Journal of Thoracic and Cardiovascular Surgery Volume 145, Issue 3, Pages S149-S153 (March 2013) DOI: 10.1016/j.jtcvs.2012.11.069 Copyright © 2013 Terms and Conditions

Figure 1 Multiplanar reconstruction of computed tomographic data showing tortuous anatomy in the thoracic aorta distal to a postdissection aneurysm. This kind of problem can be difficult to negotiate with a large-caliber stent-graft delivery system. Knowledge of individual thoracic endovascular aortic repair device characteristics, as well as adjuncts such as dual (“buddy”) stiff wire passage and large sheath use, can be invaluable in overcoming such problems. Rupture is always a possibility. The Journal of Thoracic and Cardiovascular Surgery 2013 145, S149-S153DOI: (10.1016/j.jtcvs.2012.11.069) Copyright © 2013 Terms and Conditions

Figure 2 High angulation at the proximal landing zone in a case of thoracic aneurysm. In this case, the shape of the aortic arch dictates the landing zone. A minimum of 10 mm of relatively straight, nonaneurysmal aortic wall with limited mural thrombus is required for sealing with most devices. Angulation requires relatively greater length to secure a seal. The device in this case can be seen to be sitting away from the inferior arch wall, reducing the length of the seal. The Journal of Thoracic and Cardiovascular Surgery 2013 145, S149-S153DOI: (10.1016/j.jtcvs.2012.11.069) Copyright © 2013 Terms and Conditions

Figure 3 Use of a 10-mm diameter Dacron polyester fabric access conduit in the case of a small-caliber, calcified external iliac artery in a female patient. The conduit was sutured end to side to the common iliac artery, accessed through a muscle-splitting incision in the iliac fossa, and brought out in a straight line through a stab incision in the body wall. It is simplest to clamp the end of the graft and use needle access through the Dacron fabric to maintain hemostasis. The Journal of Thoracic and Cardiovascular Surgery 2013 145, S149-S153DOI: (10.1016/j.jtcvs.2012.11.069) Copyright © 2013 Terms and Conditions

Figure 4 Angiogram showing extravasation of contrast from iliac artery rupture. This complication should be suspected whenever small-caliber iliac arteries have been cannulated or when intraoperative device passage difficulties are encountered. On-table angiography before removal of the delivery system can be used for diagnosis. Never remove the device until control has been achieved, usually with an occlusion balloon passed into the lower aorta from the contralateral femoral artery. The Journal of Thoracic and Cardiovascular Surgery 2013 145, S149-S153DOI: (10.1016/j.jtcvs.2012.11.069) Copyright © 2013 Terms and Conditions