Vessel Navigator e altre tecniche di incannulamento dei vasi viscerali

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1 Alma Mater Studiorum Bologna University S.Orsola-Malpighi, Bologna, Italy Vascular Surgery Vessel Navigator e altre tecniche di incannulamento dei vasi viscerali E. Gallitto

2 Visceral Vessel Cannulation in endovascular aortic procedures Standard EVAR in challenging anatomies Iliac Branch FB-EVAR Parallel Graft Alma Mater Studiorum University of Bologna

3 Visceral Vessel Cannulation in endovascular aortic procedures Avoid coverage of visceral vessels + optimize standard endograft sealing Re-vascularize visceral vessels in case of FB-EVAR or Parallel Graft Alma Mater Studiorum University of Bologna

4 Preoperative Planning Crucial Moment Dedicated Team/Technologies Time Consuming Alma Mater Studiorum University of Bologna

5 Preoperative Imaging CTA Dedicated Software Alma Mater Studiorum University of Bologna

6 3Mensio TM Multi Planar Reconstruction Coronal Sagittal Axial Alma Mater Studiorum University of Bologna

7 3Mensio TM Volume Rendering Alma Mater Studiorum University of Bologna

8 3Mensio TM Center Lumen Line R L Alma Mater Studiorum University of Bologna

9 3Mensio TM Angiography Simulation L1 L2 LAO 30 L4 Alma Mater Studiorum University of Bologna

10 Visceral Vessel Cannulation in endovascular aortic procedures Techniques Vertebral Bone Marks Fusion Imaging / Vessel Navigator Alma Mater Studiorum University of Bologna

11 Visceral Vessel Cannulation in endovascular aortic procedures Techniques Vertebral Bone Marks Fusion Imaging / Vessel Navigator Alma Mater Studiorum University of Bologna

12 Vertebral Bone Marks T12 Renal Arteries Carrefour Hypogastric L5 Alma Mater Studiorum University of Bologna

13 Vertebral Bone Marks Alma Mater Studiorum University of Bologna

14 Inter-vertebral Spaces Alma Mater Studiorum University of Bologna

15 Alma Mater Studiorum University of Bologna Vertebral Borders

16 Transvere Process Alma Mater Studiorum University of Bologna

17 Vertebral Bone Marks Standard EVAR Alma Mater Studiorum University of Bologna

18 L1

19 L1

20 L1

21 L1

22

23

24 L1 Avoid the first procedural Aortography

25

26 Vertebral Bone Marks Standard EVAR AAA-sac embolization during EVAR Alma Mater Studiorum University of Bologna

27 L1 L2 L3 L4 3 4 L5

28 L1 L2 L3 L4 3 4 L5

29 L2 L3 L4

30 L2 L3 L4

31 Vertebral Bone Marks Standard EVAR AAA-sac embolization during EVAR TEVAR Alma Mater Studiorum University of Bologna

32 Alma Mater Studiorum University of Bologna

33 T12 L1

34 T12 L1 LAO 90 Alma Mater Studiorum University of Bologna

35 Alma Mater Studiorum University of Bologna

36

37 Vertebral Bone Marks Standard EVAR AAA-sac embolization during EVAR TEVAR FB-EVAR Alma Mater Studiorum University of Bologna

38 j/p-aaa

39 Alma Mater Studiorum University of Bologna L1

40 L1

41 Alma Mater Studiorum University of Bologna

42 L1

43 L1

44 L1

45 L1 RAO 90

46 L1

47 LRA fenestration

48 LRA fenestration

49 Visceral Vessel Cannulation in endovascular aortic procedures Techniques Vertebral Bone Marks Fusion Imaging / Vessel Navigator Alma Mater Studiorum University of Bologna

50 Hybrid Room Alma Mater Studiorum Università di Bologna

51 Technological Evolution Alma Mater Studiorum Università di Bologna

52 Visceral Vessels Cannulation Vessel Navigator Alma Mater Studiorum Università di Bologna

53 AP LAO 90 Alma Mater Studiorum Università di Bologna

54 Bone Marks Alma Mater Studiorum Università di Bologna

55 Alma Mater Studiorum Università di Bologna

56 Alma Mater Studiorum Università di Bologna

57 Male, 85 yrs CAD COPD GFR 40 mg/dl EVAR RLT PLC ASA IV Back pain Alma Mater Studiorum Università di Bologna

58 TEVAR Cook Zenith Alfa 40 x 167mm CT Viabhan 11 x100mm Luminex 12 x 100mm SMA Viabhan 9 x100mm Protégé 9 x 100mm RRA Viabhan 7 x100mm Viabhan 7 x 50mm Protégé 8 x 120mm Sac embolization Alma Mater Studiorum Università di Bologna

59 12 F 8 F 9 F

60 Zenith Cook Alfa 40 x 167 mm

61 Time Fluoroscopy Contrast 240 min 40 min 60 cc

62 Alma Mater Studiorum Università di Bologna GFR 39 mg/dl

63 Alma Mater Studiorum Università di Bologna

64 Alma Mater Studiorum Università di Bologna

65 C-Arm Hybrid Room Alma Mater Studiorum Università di Bologna Hertault, EJVS 2014

66 C-Arm Hybrid Room Hybrid Room is associated with lower Radiation exposure Contrast medium amount Alma Mater Studiorum Università di Bologna Hertault, EJVS 2014

67 Visceral Vessel Cannulation in endovascular aortic procedures Conclusion Vertebral Bone Marks & Vessels Navigator important tools in advanced endovascular aortic procedures Reduction of Radiation & Contrast Medium Alma Mater Studiorum University of Bologna

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