Endovascular Treatment of Malperfusion Syndrome
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1 Endovascular Treatment of Malperfusion Syndrome in Type B Aortic Dissection Department of Cardiology, Pusan National luniveristy i Hospital, Han Cheol Lee
2
3 Endovascular Treatment Indication of Type B Aortic Dissection Acute, Complicated dad 1Rptre 1. Rupture 2. Branch vessel ischemia (Carotid, Celiac, SMA, Renal, Distal aorta, CIA) Chronic, with Aneurysm formation
4 Endovascular Treatment of Type B Aortic Dissection Aortic Stent tgraft Selective e Stenting Fenestration
5 Endovascular Treatment of Type B Aortic Dissection : An IRAD Report JACC 2008;1:
6 Endovascular Treatment of Malperfusion in AcuteType B Aortic Dissection 69 Patients with acute type B dissection with malperfusion were treated with a combination of flap fenestration, true lumen, or branch vessel stenting Malperfusion vessels: spinal cord (n=5), mesenteric (n=40), renal (n=51), and lower extremity (n=47) Major morbidity: dialysis need (n=11), stroke (n=3), Paralysis (n=2) 30-Day mortality 17.4% (n=12) Mean survival 84 months Freedom from aortic rupture or open repair at 1, 5, and 8 years was 80%, 67% and 54% Patel HJ, et al. J Thorac Cardiovasc Surg2009;138(2):300-8
7 Endovascular Treatment of Malperfusion p : Aortic Stent Graft
8 INSTEAD Trial : Nienaber CA et al. : Circulation. 2009;
9 Endovascular Treatment of Malperfusion : Aortic Stent Graft Case 변OM/58 Chief Complaint : back pain, left chest pain, right leg gpain Symtom onset 3 days ago Past History : HT(+), DM(+) Hyperlipidemia(-), CVA(-) Social History : Smoking (+) ABI : 0.2 / 0.9 Hb :
10 CT
11 CT
12 Assessment 1. Aortic Dissection with Malperfusion syndrome Plan? 1. Aortic stent graft 2. Fenestration 3. Femoral femoral bypass operation
13 Aortic Stent Graft
14 Aortic Stent Graft
15 Aortic Stent Graft
16 Aortic Stent Graft
17 Aortic Stent Graft
18 Aortic Stent Graft
19 Aortic Stent Graft
20 Aortic Stent Graft
21 Aortic Stent Graft
22 Aortic Stent Graft
23 Aortic Stent Graft
24 Aortic Stent Graft
25 Aortic Stent Graft
26 Aortic Stent Graft
27 Follow up CT after 1 year
28 Follow up CT after 1 year
29 Endovascular Treatment of Malperfusion : Selective Stents Cases 유 O (M/39)
30 Endovascular Treatment of Malperfusion : Selective Stents Cases
31 Endovascular Treatment of Malperfusion : Selective Stents Cases
32 Endovascular Treatment of Malperfusion : Selective Stents Cases
33 Endovascular Treatment of Malperfusion : Selective Stents Cases
34 Endovascular Treatment of Malperfusion : Selecive Stents Cases
35 Malperfusion : Common Iliac Artery M/46
36 Malperfusion : Left Carotid Artery M/50
37 Malperfusion : Distal aorta, both CIA M/35
38 Endovascular Treatment of Malperfusion : Fenestration Cases
39 Endovascular Treatment of Malperfusion : Fenestration Cases
40 Midterm results of endovascular treatment in patients with complicated type B Aortic Dissection : Data of PNUH AD managed with endovascular treament t : 17 patients t Mean follow up duration : 19.3±11.2 months. 12 cases of Acute aortic dissection 5 cases of Chronic aortic dissection with huge aneurysm 8 cases of malperfusion syndrome 4 cases of aortic stent grafting for ruptured aortic dissection. Mortality of complicated AD managed with endovascular treatment showed 11.8%(2/17). Rate of reintervention was 11.8%(2/17). 2 cases of chronic ( ) aortic dissection with huge aneurysm formation were relapsed aortic dissection in the distal part of aortic stent graft which were managed with additional stent graft.
41 Midterm results of endovascular treatment in patients with complicated type B AD and malperfusion syndrome : Data of PNUH 8 cases of malperfusion syndrome Treated with Aortic stent graft(n=3), Selective branch artery stenting(n=7) renal 4, celiac 3 carotid 1 common iliac 2 Fenestration(n=1), Combined procedure(n=4). Mortality of malperfusion syndrome managed with endovascular treatment was 12.5%(1/8). 1 case of in-hospital mortality. The causes of death was hepatic failure because of compromised celiac trunk.
42 Midterm results of endovascular treatment in patients with complicated type B AD and malperfusion syndrome : Data of PNUH Conclusion: Endovascular treatment for complicated aortic dissection and malperfusion syndrome was a safe procedure with good mid-term clinical outcomes. More clinical data and long term fll follow up are needed. dd
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