Aortic Symposium New York 2012 „Pseudoaneurysm After Endovascular Stent Graft Placement for Treatment of Type B Aortic Dissection“ R.A. Jánosi, M. Bettin,

Slides:

Advertisements

Similar presentations

ONE STAGE REPAIR IN COMPLEX AORTIC DISEASE : SURGERY COMBINED WITH OPEN DISTAL STENT GRAFTING REQUIRES A NEW STENT GRAFT DESIGN U. Herold, M. Kamler, I.

Advertisements

Aortic dissection: current percutaneous options Advanced Angioplasty BSET Jan 2008.

Management of acute type b aortic dissection

Endovascular Treatment of Acute Aortic Emergencies: Early Results Badr Aljabri, MD, FRCSC King Khalid University Hospital Riyadh, Saudi Arabia.

Menaka Nadar, MD University of Virginia. CC: Acute onset abdominal pain HPI: 43 year old male with a history of Marfan’s syndrome presented to outside.

Aortic Pathology Angioclub Case Alex Copelan M.D. William Beaumont Hospital October 24, 2013.

KAREN L. WALKER MS JONATHAN J. SHUSTER PHD THOMAS M. BEAVER MD, MPH DIVISION OF THORACIC AND CARDIOVASCULAR SURGERY DIVISION OF BIOSTATISTICS UNIVERSITY.

THE FUTURE PA Gaines Sheffield Vascular Institute.

Antegrade Stent Grafting of Descending Thoracic Aorta During Acute Debakey I Dissection: Early and Midterm Outcomes Prashanth Vallabhajosyula MD, Joseph.

Angioclub Case Series: Aortic Pathology Candace L. White MA, MD Mount Sinai Medical Center of Florida.

Division of Cardiovascular Surgery Xijing Hospital, Xi’an, China

Results of “Type II” Hybrid Arch Repair with Zone 0 Stent Graft Deployment Jehangir Appoo, William Kent, Eric Herget, Jason Wong, Alberto Pochettino and.

Epidemiology, Risk Factors, Diagnosis and Intervention of Abdominal Aortic Aneurysms By, Sultan O Al-Sheikh.

Stent Assisted Balloon Induced Intimal Disruption and Relamination in Aortic Dissection Repair: The STABILISE Concept Sophie C. Hofferberth 1, Andrew E.

A Comparison Of Endovascular And Open Approaches To The Treatment Of Aneurysms Of The Descending Aorta: Outcomes Differ By Severity Of Co-morbid Diseases.

New York Aortic Surgery Symposium 2010 Mohamad Bashir, Aaron Ranasinghe, David Quin, Ben Holloway, Jorge Mascaro, Robert Bonser The limited potential for.

Aneurysms & Aneurysm Screening

SIR-RFS AngioClub Ethan M. Dobrow, PGY-4 Maine Medical Center, Portland, Maine (The Freeman Hospital, Newcastle-Upon-Tyne, UK)

P Narayan, A Wong, I Davies, A J Bryan, P Wilde, G J Murphy Does TEVAR provide a financial benefit for management of descending thoracic aortic pathologies?

Cardiac Case 9/15/07. Coarctation of the Aorta Congenital narrowing of the thoracic aorta; typically distal to the left subclavian artery. M:F – 2:1.

What Is Being Done Where

The Use of Thoracic Endovascular Stent Grafting in Acute Aortic Tragedies as Compared to Open Surgical Repair Tyler J. Wallen, BA, Wilson Y. Szeto, MD,

The assessment of the new hybrid procedure for extensive aortic aneurysms compared with the conventional open surgery Department of Cardiovascular surgery,

Usefulness of fenestrated stent graft for thoracic aortic aneurysms

Osaka University Department of Cardiovascular Surgery Osaka University Department of Cardiovascular Surgery The efficacy of debranching TEVAR for arch.

One-stage repair for Stanford Type B Aortic Dissection concomitant with cardiac diseases Open stented elephant trunk technique combined with cardiac operation.

AORTIC ANEURYSM Prepared by: Dr. Hanan Said Ali. Objectives Define aortic aneurysm. Enumerate causes. Classify aortic aneurysm. Enumerate clinical manifestation.

Aneurysm. It is a blood sac that communicates with the lumen of an artery They are classified according to –Etiology congenital Acquired –pathological,

TOTAL AORTIC ARCH REPLACEMENT WITH THORAFLEX HYBRID FROZEN ELEPHANT TRUNK PROSTHESIS: RESULTS OF FIRST 100 PATIENTS Malakh Shrestha, Heike Krueger, Tim.

Imaging Experience of Type II Hybrid Aortic Arch Repair: Lessons learned from Zone 0 Debranching & Evolution to Zone 2 Arch Repair Vamshi Kotha, Eric J.

Osaka University Graduate School of Medicine Division of Cardiovascular Surgery Strategy of TEVAR for acute aortic dissection Osaka University Graduate.

Long-term Result of Acute Type B Aortic Dissection Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji, Hyogo Brain and Heart.

Aortic Disease. Aortic Aneurysm Defined asDefined as an abnormal dilatation of the aortic lumen; a true aneurysm involves all the layers of the wall,

UNIVERSITY OF KENTUCKY Department of Radiology. HPI  57 yo man presented to the ER with sudden onset severe chest pain.  On arrival, patient was pale,

Hybrid Arch for Acute Type A Aortic Dissection

Hybrid Arch for Acute Type A Aortic Dissection

Challenging Case Presentation For Structural Heart Disease Program

Figure 1 Initial management of a patient with acute heart failure

Illustration of a hybrid arch repair. A

EVAR Planning: Keys to Success

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

Endovascular repair of proximal endograft collapse after treatment for thoracic aortic disease Markus G.M. Steinbauer, MD, Alexander Stehr, MD, Karin.

Total aortic arch replacement with a novel 4-branched frozen elephant trunk prosthesis: Single-center results of the first 100 patients Malakh Shrestha,

Open Distal Fenestration of Chronic Dissection Facilitates Endovascular Elephant Trunk Completion: Late Outcomes Muhammad Aftab, MD, Jay J. Idrees, MD,

The challenge of associated intramural hematoma with endovascular repair for penetrating ulcers of the descending thoracic aorta Himanshu J. Patel, MD,

Endovascular Treatment of Acute Descending Thoracic Aortic Dissections

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

Combined proximal stent grafting plus distal bare metal stenting for management of aortic dissection: Superior to standard endovascular repair? Sophie.

Randall R. De Martino, MD, MS, Jill Johnstone, MD, Elizabeth A

Comparison of thoracic aortic diameter changes after endograft placement in patients with traumatic and aneurysmal disease Hillary B. Alberta, MSPP,

Seminars in Thoracic and Cardiovascular Surgery

Stent graft–induced new entry tear (SINE): Intentional and NOT

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

Outcomes of endovascular treatment for aortic pseudoaneurysm in Behcet's disease Sung Won Kim, MD, Do Yun Lee, MD, Man Deuk Kim, MD, Jong Yun Won, MD,

Thoracic endovascular aortic repair: The basics

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

CASE PRESENTAION DR.ANJU CHAUDHARY BJMC.

Ruptured Aneurysm Caused by an Endoleak 29 Months After Transluminal Endovascular Grafting for a Dissecting Aortic Aneurysm S. Suzuki, K. Imoto, K. Uchida,

Efficacy and durability of the chimney graft technique in urgent and complex thoracic endovascular aortic repair Adel Bin Jabr, MD, Bengt Lindblad, MD,

Stent graft-induced new entry after endovascular repair for Stanford type B aortic dissection Zhihui Dong, MD, Weiguo Fu, MD, Yuqi Wang, MD, Chunsheng.

Anatomic factors associated with acute endograft collapse after Gore TAG treatment of thoracic aortic dissection or traumatic rupture Bart E. Muhs, MD,

Computed tomography evaluation of aortic remodeling after endovascular treatment for complicated ulcer-like projection in patients with type B aortic.

Complications after endovascular repair of acute symptomatic and chronic expanding Stanford type B aortic dissections Dittmar Böckler, MD, Hardy Schumacher,

Rapid enlargement of a distal arch aneurysm after endovascular stent-grafting for pseudoaneurysm: Case report Toshihiro Ohata, MD, Tetsuo Sakakibara,

The frozen elephant trunk: An interesting hybrid endovascular-surgical technique to treat complex pathologies of the thoracic aorta Florian S. Schoenhoff,

G. Chad Hughes, MD, Asvin M. Ganapathi, MD, Jeffrey E

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

Mechanisms of Failure and Outcome of Secondary Surgical Interventions After Thoracic Endovascular Aortic Repair (TEVAR) Julia Dumfarth, MD, Marc Michel,

Presentation transcript:

Aortic Symposium New York 2012 „Pseudoaneurysm After Endovascular Stent Graft Placement for Treatment of Type B Aortic Dissection“ R.A. Jánosi, M. Bettin, T. Konorza, H. Kälsch, H. Eggebrecht, R. Erbel Department of Cardiology West German Heart Center Essen

Patient Characteristics no DPADPAp patients143 (95 %)8 (5 %) male96 (63 %)5 (63 %)0,786 age (y)62,2 ± 12,8 (22-84)60,7 ± 8,7 (48-71)0,746 Time to Treatment (mo)4,3 ± 11,920,3 ± 36,30,251 acute dissection6210,64 stent graft diameter (mm)34,0 ± 5,133,0 ± 1,50,589 stent graft length (mm)153,2 ± 43,1158,1 ± 40,00,753 Angle (°)167,1 ± 12,4148,2 ± 16,5<0,05 reintervention18 (13 %)7 (88 %)*<0,05 Time to reintervention (mo)27,8 ± 24,619,1 ± 15,10,364

Characteristics of 8 patients complicated with DPA after Endografting for Type B Dissection p at ie nt AgeInitial IndicationCoexis ting conditi ons Onset time Intervention >diagnosis DPA (mo) Stent graft extension Duration of follow up (mo) DPA (mm) Stent 170Recurrent pain, impending rupture HTN16yes4515x35Valiant 259Recurrent painHTN3yes2722x34Relay 347Recurrent pain, Malperfusion HTN19yes2710x16Valiant 468Recurrent painHTN50yes8039x44Talent 567Recurrent painHTN, MI 76yes10920x34Talent 665Recurrent painHTN, CHD 14yes1313x25Relay 758Recurrent painHTN115refused115-Talent 849Progredient FL- aneurysm HTN26yes269x28Valiant

Rate of freedom Reintervention years Distal Pseudoaneurysm Yes No Yes-censored No-censored

When passively bent at the arch, the self-expanding stent graft has the inherent tendency to spring back to its initial straight status.

When passively bent at the arch, the self- expanding stent graft has the inherent tendency to spring back to its initial straight status.

Conclusions Endovascular treatment in chronic type B dissection has a high technical success rate and low mortality Pseudoaneurysm of the thoracic aorta is a rare and potentially fatal condition Potential mechanism: Trauma caused by the semi-rigid stent graft Fragility of the aortic wall and disease progression Excessive radial force due to distal oversizing of the stent graft prosthesis to > 20%  Development of dissection-specific, less-rigid endo- prosthesis

Characteristics of 8 patients complicated with DPA after Endografting for Type B Dissection p at ie nt AgeInitial IndicationCoexis ting conditi ons Oversi zing Onset time Intervention >diagnosis DPA (mo) Stent graft extension Duration of follow up (mo) DPA (mm) Stent 170Recurrent pain, impending rupture HTN16yes4515x35Valiant 259Recurrent painHTN3yes2722x34Relay 347Recurrent pain, Malperfusion HTN19yes2710x16Valiant 468Recurrent painHTN50yes8039x44Talent 567Recurrent painHTN, MI 76yes10920x34Talent 665Recurrent painHTN, CHD 14yes1313x25Relay 758Recurrent painHTN115refused115-Talent 849Progredient FL- aneurysm HTN26yes269x28Valiant