Paraplegia prevention branches: A new adjunct for preventing or treating spinal cord injury after endovascular repair of thoracoabdominal aneurysms Christos.

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Presentation transcript:

Paraplegia prevention branches: A new adjunct for preventing or treating spinal cord injury after endovascular repair of thoracoabdominal aneurysms Christos Lioupis, BSc, MSc, EBSQ-Vasc, Marc Michel Corriveau, BSc, MD, FRCSC, Kent S. MacKenzie, BSc, MD, FRCSC, Daniel I. Obrand, BSc, MD, FRCSC, Oren K. Steinmetz, BSc, MD, FRCSC, Krassi Ivancev, MD, PhD, Cherrie Z. Abraham, BSc, BA, MD, FRCSC Journal of Vascular Surgery Volume 54, Issue 1, Pages 252-257 (July 2011) DOI: 10.1016/j.jvs.2010.11.131 Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 1 a, Type II thoracoabdominal aneurysm. b, The maximum diameter of the infrarenal aorta was 7.5 cm. There was increased burden of clot throughout the descending thoracic and abdominal aorta. Journal of Vascular Surgery 2011 54, 252-257DOI: (10.1016/j.jvs.2010.11.131) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 2 a, A prominent intercostal artery of 3.4-mm diameter at the T5 level. b and c, A pair of large lumbar arteries perfused from the aneurysmal sac (yellow arrows). Journal of Vascular Surgery 2011 54, 252-257DOI: (10.1016/j.jvs.2010.11.131) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 3 Postoperative computed tomographic angiography (CTA) showing the extent of aortic coverage. Journal of Vascular Surgery 2011 54, 252-257DOI: (10.1016/j.jvs.2010.11.131) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 4 a, Paravisceral component with four downward-facing side branches for the celiac, superior mesenteric, and two renal arteries. b, Infrarenal custom-made bifurcated graft, designed with two upward-facing side branches paraplegia prevention branches (PPBs). Journal of Vascular Surgery 2011 54, 252-257DOI: (10.1016/j.jvs.2010.11.131) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 5 Computed tomographic angiography (CTA) 3 days after repair of the aneurysm. a, Paravisceral stent graft with stents placed in both renal arteries and the superior mesenteric artery (SMA) without endoleak. b, Flow into the aneurysm at the level of the paraplegia prevention branches (PPBs; yellow arrows). c, Perfusion of one pair of distal lumbar arteries from the aneurysmal sac (yellow arrows). Journal of Vascular Surgery 2011 54, 252-257DOI: (10.1016/j.jvs.2010.11.131) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 6 Occlusion of paraplegia prevention branches (PPBs) 3 weeks after the initial placement of stent grafts. The 8-mm vascular plugs delivered inside the PPBs (not yet deployed). Journal of Vascular Surgery 2011 54, 252-257DOI: (10.1016/j.jvs.2010.11.131) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 7 Computed tomographic angiography (CTA) 2 days after occlusion of paraplegia prevention branches (PPBs). a, No flow into the aneurysm at the level of the PPBs. b, No lumbar arteries are perfused from the aneurysmal sac. Journal of Vascular Surgery 2011 54, 252-257DOI: (10.1016/j.jvs.2010.11.131) Copyright © 2011 Society for Vascular Surgery Terms and Conditions