Spinal cord protection segmental artery embolization. Christian D. Etz, MD, PhD Heisenberg Professor for Aortic Surgery

Size: px
Start display at page:

Download "Spinal cord protection segmental artery embolization. Christian D. Etz, MD, PhD Heisenberg Professor for Aortic Surgery"

Transcription

1 Spinal cord protection segmental artery embolization Christian D. Etz, MD, PhD Heisenberg Professor for Aortic Surgery

2 Ischemic Spinal Cord Injury No definite prevention strategy essential for safe open and endovascular repair 1,2 1 Coselli, LeMaire. Descending and Thoracoabdominal Aortic Aneurysms. In: Lh C, ed. Cardiac Surgery in the Adult. New York: McGraw-Hill; 2008: Etz CD et al. Spinal cord perfusion after extensive segmental artery sacrifice: can paraplegia be prevented? Eur J Cardiothorac Surg 2007;31(4):643-8.

3 If the theory does not fit the facts too bad for the facts Kurt Biedenkopf (former Ministerpräsident of Saxony) quoting a frustrated UC Berkley student

4

5

6 If the theory does not fit the facts, change the facts Albert Einstein

7 Segmental Artery Occlusion Yorkshire pigs (N = 20)

8 Direct blood pressure measurement

9 MAP SCPP

10 POSTOPERATIVE SCPP 80 Paraparetic Animals Recovered Animals SCPP (mmhg) ~ 95% > 60% 0 1h 5h 24h 48h 3d 4d 5d 1h 5h 24h 2d 3d 4d 5d after ALL clamped

11 Collateral Network recovers blood flow within 72h!

12

13 HUMAN vs PIG

14

15

16

17

18 UNDERSTANDING THE IMPLICATIONS

19 Etz et al., J Thorac Cardiovasc Surg Apr;141(4): Etz et al., J Thorac Cardiovasc Surg Apr;149(4):1074-9

20 Enlargement of lower thoracic and lumbar collaterals significant changes!

21 DEVELOPING A NEW STRATEGY THE STAGED REPAIR

22 Experimental solution: the staged repair

23 conventional repair paraplegia rate: 20-30%

24 staged repair 100% recovery!

25 After total SA Occlusion: regeneration of arterial perfusion in 5 days with staged occlusion zero paraplegia Etz et al. J Thorac Cardiovasc Surg Dec;140(6 Suppl):S125-30

26 Patient Number Hours ONSET TIME OF POSTOPERATIVE PARAPLEGIA Concept: Delayed Paraplegia, timing of delayed paraplegia, and clinical support of the Griepp/Etz Observation Emergence Emergence Emergence 2nd Episode Mean: 36.8 ± 38.9 hrs (1st Episode) Median: 21.6 hrs (1st Episode) 7.3 Days or 176 hrs (2nd episode) COURTESY OF JOE BAVARIA 2nd Episode Days (0) (2.1) (4.2) (6.3) (8.3) (10.4) Department of Surgery, University of Pennsylvania Health System

27 Retrospective clinical data: significant lower incidence of SCI with staged repair (= staged occlusion of SAs) Etz et al. J Thorac Cardiovasc Surg Jun;139(6):

28

29 EXPERIMENTAL PRIMING OF THE COLLATERAL NETWORK

30 Hypothesis: Preemptive Conditionig with Minimally Invasive Segmental Artery Coilembolisation (MISACE) may help to prevent SCI

31 no histologic damage in coiled areas

32 zero paraplegia after coil embolization

33

34 FIRST-IN-MAN EXPERIENCE

35 Etz et al. J Thorac Cardiovasc Surg Apr;149(4):1074-9

36 MISACE Minimally invasive coil deployment - schematically Coil-occluded (right) / patent SA (left)

37

38 MISACE pt #1 Conventional open repair left common femoral access (6F braided sheath, Flexor, Cook Medical, Bjaeverskov, Denmark) as 2 nd -stage 31-month rd an 4 interval lumbar SA catheterized conventional repair deployment of microcoils (0.018 VortX-Diamond, Boston Scientific) into proximal SA Intra op course uneventful no significant back bleeding short cross clamp time discharged home w/o neurological impairment

39 MISACE pt #2 Endovascular repair right common femoral access (6F braided sheath, 2 nd -stage Flexor, Cook Medical, Bjaeverskov, Denmark) 4th SA catheterized (5F, 65cm C2-catheter, Cook Medical, 8 week interval Bjaeverskov, Denmark and 2.7F Progreat microcatheter, Terumo Europe, Leuven, Belgium) Endo repair with a four-branched stent- Deployment of microcoils in the proximal SA graft (T-branch, CE-marked, Cook Medical, Bjaeverskov, Denmark) in general anesthesia with adjunctive CSF-drainage all remaining open SAs between the T7 and the infrarenal aorta occluded w/o endoleakage discharged home w/o neurologic deficit on POD #8

40

41 There are several important breakthroughs relating to managing and preventing spinal cord injury that have been simultaneously brought together with the MISACE technique. The first is that optimal perioperative management [ ] is not enough to prevent cord ischemia. The second breakthrough represented by the MISACE technique is the capacity to selectively coil-embolize segmental arteries.

42 CREATING EVIDENCE RCT PAPAartis starting in 2017

43 Paraplegia Prevention in Aortic Aneurysm Repair by Thoracoabdominal Staging with Minimally-Invasive Segmental Artery Coil-Embolization (MISACE) : A Randomized Controlled Multicentre Trial (PAPA_ARTiS)

44 PAPA_ARTiS EUROPE Horizon 2020 funded with 6.3M starting in 2017

45 PAPA_ARTiS EUROPE

46 PAPA_ARTiS EUROPE spin labeled 4D MRI

47 DISCUSSION

48

49 INCIDENCE

50 Inzidenz der Paraplegie Endo / Stentgraft endo Year N DTA Type I Type II Type III Type IV Greenberg et al. 3 ** Gravereau x et al. 4 1% 10% 19% 5% 3% 5.7% # # # # Conrad et al % # # # # Bavaria et al. 5 3% # # # # ** The severity of the SCI (paraplegia versus paraparesis) and the potential for recovery did not differ between treatment modalities SCI was more commonly noted immediately after OPEN REPAIR (29% versus 13%) and in a delayed presentation (up to 6 days) after ER

51 Inzidenz der Paraplegie offene Chirurgie Open Surgery year N DT A Type I Type II Type III Type IV Greenberg et al % 14% 22% 10% 2% Conrad et al % 24% 20% 13% 2% Fehrenbacher % 4.3% 5.4% 3.1% 0% Coselli et al # 3.3% 6.3% 2.6% 1.4% Bavaria et al % # # # # Zoli et al % 2.5% 11.5% 3.9% 2.2% Sundt et al % 0% 0% 0% 0% Schepens et al Paraplegia 5.3%, paraparesis 3%

52 open repair endovascular =! Aortic X-clamping vs. Segmental Artery Occlusion

53 MISACE side effects and Cx

54 CONCLUSIONS staged preconditioning to significantly reduce iatrogenic SCI after TAAA-repair now clinically available much safer treatment with only 1-2 sessions in the cath lab reduction of backbleeding through SAs during open repair reducing steal and shortening OR times reduction of type II endoleakage after endo repair

55 X-clamping

56 ischemic Spinal Cord Injury Aortic X- clamping Segmental Artery Occlusion 1 2

57 Aortic X-clamping open TAA/A repair x

58 SPINAL CORD BLOOD FLOW prior to, during and after 28ºC baseline flow desc X-clamp: NO flow below T 8

59 UNKNOWN open questions to be clarified

60 2 Bestimmung des optimalen Okklusionsmusters Hypothese: alternierend schnellere Arteriogenese (besser als regional) Okklusion alternierend vs. regional (N=10) (N=10) 2 Perfusionsdruck Blutfluß Ultrastruktur im Verlauf

61 Etz et al. J Thorac Cardiovasc Surg Feb;135(2): Etz et al., J Thorac Cardiovasc Surg Apr;141(4): Etz et al., J Thorac Cardiovasc Surg Apr;149(4): Optimales Timing / Intervall? 2. Stufe nach 5, 10 oder 20 Tagen (je N=10)

62 4 Optimales Monitoringverfahren / Validierung Tiermodell Hypothese: Regionale Nahinfrarot Spektroskopie (NIRS) korreliert mit Kollateral Perfusion / spinaler Oxigenierung in Echtzeit Etz et al., Eur J Vasc Endovasc Surg Dec;46(6):651-6 Etz et al., Eur J Cardiothorac Surg Jun;47(6):943-57

63 DIRECT SCPP MONITORING

64

65 SCPP-CATH PLACEMENT

66 SCPP = CN pressure CSF pressure

67 SCPP SCPP = CN = CNP pressure - CSF pressure: CSF pressure Five patients 9 ± 3 SA sacrificed SCPP (mmhg) p=.016 paraparesis normal recovery hours postoperatively

68 CN NIRS

69 Detection of ischemic spinal cord injury during and after extensive open or endovascular TAA/A repair utilizing SSEP and/or MEP monitoring: invasive and expensive Etz CD et al. Spinal cord perfusion after extensive segmental artery sacrifice: can paraplegia be prevented? Eur J Cardiothorac Surg 2007;31(4):643-8.

70 Spinal cord monitoring SSEP= Somatosensory evoked potentials; MEP=Motor evoked potentials SCPP=Spinal cord perfusion pressure; cnnirs=near-infrared spectroscopy of the collateral network

71 Near Infrared Spectroscopy = LIGHT (!)?

72 Collateral Network cnnirs cnnirs Image from J Thorac Cardiovasc Surg. 2011, The Collateral Network Concept: A Reassessment of the Anatomy of Spinal Cord Perfusion

73

74 FIRST IN-MAN SERIES 1 Lumbar cnnirs sensitive to X-clamping & distal perfusion 1 Diminished lumbar cnnirs = postoperative SCI* Eur J Vasc Endovasc Surg. 2013; * comparing patients with and without postoperative spinal cord injury

75 HYPOTHESIS Perfusion & oxygenation of the collateral network directly reflects spinal cord microcirculation? Can cnnirs depict spinal cord oxygenation?

76 Experimental setup Seven juvenile male pigs Subcutaneous cnnirs T5/6 and L2/3 Direct muscle and spinal cord oxygenation + flow by LDF Laser Doppler (LDF) (bottom left) Image from PlosONE Optical Monitoring and Detection of Spinal Cord Ischemia

77 Baseline Experimental Sequence X-clamping (ischemia: 8 min.) Clamp release (recovery) MAP consecutively 4 times LDF - OXYGENATION LDF cnnirs LDF - FLOW

78 Direct Invasive Laser Doppler (LDF) Collateral Network Spinal Cord Oxygenation Flo w X-clamp Clamp release

79 Direct Invasive Laser Doppler (LDF) Collateral Network Spinal Cord Oxygenation X-clamp Flo Clamp release w HYPOTHESIS: oxygenation of the CN = spinal cord?

80 Collateral Network vs. Spinal Cord CN oxygenation Spinal cord oxygenation Paraspinous CN oxygenation directly reflects spinal cord tissue oxygenation

81 Non-invasive cnnirs Lumbar cnnirs Lumbar spinal cord oxygenation Question: lumbar cnnirs = Spinal cord oxygenation?

82 cnnirs vs. Spinal Cord Oxygenation cnnirs Spinal cord oxygenation lumbar cnnirs directly reflects spinal cord tissue oxygenation

83 Conclusions 1 CN oxygenation reflects spinal cord oxygenation 1 Lumbar cnnirs reflects spinal cord oxygenation Lumbar cnnirs is an effective tool to noninvasively monitor spinal cord oxygenation

84 BP MANAGEMENT

85

86 Ultimate goal: Translation of the staged repair concept into clinical practice for ZERO PARAPLEGIA

Paraplegia in endovascular repair of TAA and in TEVAR: Incidence, prevention and therapy. Johannes Lammer Medical University Vienna, Austria

Paraplegia in endovascular repair of TAA and in TEVAR: Incidence, prevention and therapy. Johannes Lammer Medical University Vienna, Austria Paraplegia in endovascular repair of TAA and in TEVAR: Incidence, prevention and therapy Johannes Lammer Medical University Vienna, Austria Conflict of interests: none 68y, male, PAU in coral reef aorta,

More information

What is the benefit. of MEP s in BEVAR for TAAA. in preventing paraplegia?

What is the benefit. of MEP s in BEVAR for TAAA. in preventing paraplegia? What is the benefit of MEP s in BEVAR for TAAA in preventing paraplegia? P M Kasprzak Department of Vascular Surgery, Endovascular Surgery University Hospital Regensburg, Germany Disclosures Dr. Kasprzak

More information

Daniela Branzan MD, Department of Vascular Surgery and Department of Interventional Angiology University Hospital Leipzig

Daniela Branzan MD, Department of Vascular Surgery and Department of Interventional Angiology University Hospital Leipzig Ischemic Preconditioning with Minimally Invasive Segmental Artery Coil Embolization (MISACE) prior to Endovascular TAAA Repair: Clinical Experience in 50+ Patients Daniela Branzan MD, Department of Vascular

More information

Neurological Complications of TEVAR. Frank J Criado, MD. Union Memorial-MedStar Health Baltimore, MD USA

Neurological Complications of TEVAR. Frank J Criado, MD. Union Memorial-MedStar Health Baltimore, MD USA ISES Online Neurological Complications of Frank J Criado, MD TEVAR Union Memorial-MedStar Health Baltimore, MD USA frank.criado@medstar.net Paraplegia Incidence is 0-4% after surgical Rx of TAAs confined

More information

Kopp R, Puippe G, Rancic Z, Hofmann M, Pecoraro F, Pfammatter T, Lachat M.. University Hospital Zurich, Switzerland

Kopp R, Puippe G, Rancic Z, Hofmann M, Pecoraro F, Pfammatter T, Lachat M.. University Hospital Zurich, Switzerland Low risk of spinal cord ischemia after endovascular repair for suprarenal and thoracoabdominal aortic aneurysms using parallel stent graft implantation. Kopp R, Puippe G, Rancic Z, Hofmann M, Pecoraro

More information

Hybrid Repair of a Complex Thoracoabdominal Aortic Aneurysm

Hybrid Repair of a Complex Thoracoabdominal Aortic Aneurysm Hybrid Repair of a Complex Thoracoabdominal Aortic Aneurysm Virendra I. Patel MD MPH Assistant Professor of Surgery Massachusetts General Hospital Division of Vascular and Endovascular Surgery Disclosure

More information

Thoracoabdominal Aorta: Advances and Novel Therapies

Thoracoabdominal Aorta: Advances and Novel Therapies Thoracoabdominal Aorta: Advances and Novel Therapies Robert Meisner, MD FACS Sidney Kimmel Medical Center Assistant Professor of Surgery Vascular / Endovascular Surgeon at Lankenau Medical Center November

More information

Current strategies to prevent spinal cord ischemia in TAAA repair

Current strategies to prevent spinal cord ischemia in TAAA repair Current strategies to prevent spinal cord ischemia in TAAA repair Geert Willem Schurink Barend Mees Noud Peppelenbosch Michiel de Haan Michael Jacobs Maastricht University Medical Center, the Netherlands

More information

Intravascular Ultrasound in the Treatment of Complex Aortic Pathologies. Naixin Kang, M.D. Vascular Surgery Fellow April 26 th, 2018

Intravascular Ultrasound in the Treatment of Complex Aortic Pathologies. Naixin Kang, M.D. Vascular Surgery Fellow April 26 th, 2018 Intravascular Ultrasound in the Treatment of Complex Aortic Pathologies Naixin Kang, M.D. Vascular Surgery Fellow April 26 th, 2018 DISCLOSURES Nothing To Disclose 2 ENDOVASCULAR AORTIC INTERVENTION Improved

More information

Reinhard Kopp, Karin Pfister, Beatrix Cucuruz, Konstantinos Gallis, Piotr M Kasprzak

Reinhard Kopp, Karin Pfister, Beatrix Cucuruz, Konstantinos Gallis, Piotr M Kasprzak Immediate, delayed and late spinal cord ischemia after extended endovascular thoracoabdominal aortic repair Reinhard Kopp, Karin Pfister, Beatrix Cucuruz, Konstantinos Gallis, Piotr M Kasprzak Disclosure

More information

Accepted Manuscript. Perioperative renal function and thoracoabdominal aneurysm repair: Where do we go from here? Leonard N. Girardi, M.D.

Accepted Manuscript. Perioperative renal function and thoracoabdominal aneurysm repair: Where do we go from here? Leonard N. Girardi, M.D. Accepted Manuscript Perioperative renal function and thoracoabdominal aneurysm repair: Where do we go from here? Leonard N. Girardi, M.D. PII: S0022-5223(18)31804-X DOI: 10.1016/j.jtcvs.2018.06.057 Reference:

More information

Retrograde Embolization of a Symptomatic Hypogastric Artery Aneurysm

Retrograde Embolization of a Symptomatic Hypogastric Artery Aneurysm Retrograde Embolization of a Symptomatic Hypogastric Artery Aneurysm Andrew Unzeitig MD Piedmont Atlanta Hospital Georgia Vascular Society 2017 Annual Meeting Lake Oconee, Georgia Disclosures None Case

More information

Aortic Arch/ Thoracoabdominal Aortic Replacement

Aortic Arch/ Thoracoabdominal Aortic Replacement Aortic Arch/ Thoracoabdominal Aortic Replacement Joseph S. Coselli, M.D. Vice Chair, Department of Surgery Professor, Chief, and Cullen Foundation Endowed Chair Division of Cardiothoracic Surgery Baylor

More information

THORACOABDOMINAL AORTIC ANEURYSMS HYBRID REPAIR

THORACOABDOMINAL AORTIC ANEURYSMS HYBRID REPAIR Update on Open and Endovascular Therapeutic Option for Aortic Repair CENTRE CARDIO-TORACIQUE DE MONACO Friday November 7 th, 2014 THORACOABDOMINAL AORTIC ANEURYSMS HYBRID REPAIR Roberto Chiesa Vascular

More information

Lumbar Drain Management Thoracic Aortic Aneurysm Surgery

Lumbar Drain Management Thoracic Aortic Aneurysm Surgery Lumbar Drain Management Thoracic Aortic Aneurysm Surgery Presented By Tonya L. Page MSN, APRN, ACNP-BC What is a Lumbar drain? A small, flexible, soft plastic tube placed in the lower back (lumbar area)

More information

Percutaneous Axillary Artery Access For Branch Grafting for complex TAAAs and pararenal AAAs: How to do it safely

Percutaneous Axillary Artery Access For Branch Grafting for complex TAAAs and pararenal AAAs: How to do it safely Percutaneous Axillary Artery Access For Branch Grafting for complex TAAAs and pararenal AAAs: How to do it safely Daniela Branzan, MD, Department of Vascular Surgery University Hospital Leipzig Disclosure

More information

POSITION STATEMENT. Abstract BACKGROUND

POSITION STATEMENT. Abstract BACKGROUND European Journal of Cardio-Thoracic Surgery 47 (2015) 943 957 doi:10.1093/ejcts/ezv142 POSITION STATEMENT Cite this article as: Etz CD, Weigang E, Hartert M, Lonn L, Mestres CA, Di Bartolomeo R et al.

More information

Influence of Perioperative Hemodynamics on Spinal Cord Ischemia in Thoracoabdominal Aortic Repair

Influence of Perioperative Hemodynamics on Spinal Cord Ischemia in Thoracoabdominal Aortic Repair Influence of Perioperative Hemodynamics on Spinal Cord Ischemia in Thoracoabdominal Aortic Repair Yujiro Kawanishi, MD, Kenji Okada, MD, Masamichi Matsumori, MD, Hiroshi Tanaka, MD, Teruo Yamashita, MD,

More information

Chungbuk Regional Cardiovascular Center, Division of Cardiology, Departments of Internal Medicine, Chungbuk National University Hospital Sangmin Kim

Chungbuk Regional Cardiovascular Center, Division of Cardiology, Departments of Internal Medicine, Chungbuk National University Hospital Sangmin Kim Endovascular Procedures for Isolated Common Iliac and Internal Iliac Aneurysm Chungbuk Regional Cardiovascular Center, Division of Cardiology, Departments of Internal Medicine, Chungbuk National University

More information

2012 What is New in Aortic Surgery: Monitoring and Preventing Spinal Cord Injuries - Teamwork

2012 What is New in Aortic Surgery: Monitoring and Preventing Spinal Cord Injuries - Teamwork 2012 What is New in Aortic Surgery: Monitoring and Preventing Spinal Cord Injuries - Teamwork George Silvay, MD, PhD Professor of Anesthesiology The Mount Sinai Medical Center New York, NY I would like

More information

SPINAL CORD ISCHEMIA AFTER THORACIC ANEURYSM REPAIR: RISK STRATIFICATION & PREVENTION DISCLOSURES. INDIVIDUAL None

SPINAL CORD ISCHEMIA AFTER THORACIC ANEURYSM REPAIR: RISK STRATIFICATION & PREVENTION DISCLOSURES. INDIVIDUAL None DISCLOSURES AFTER THORACIC ANEURYSM REPAIR: INDIVIDUAL None RISK STRATIFICATION & PREVENTION INSTITUTIONAL Cook, Inc W. L. Gore, Inc Conrad, J Vasc Surg, 2008 1 Intraoperative Adjuncts Oversew intercostals

More information

Nellix Endovascular System: Clinical Outcomes and Device Overview

Nellix Endovascular System: Clinical Outcomes and Device Overview Nellix Endovascular System: Clinical Outcomes and Device Overview Jeffrey P. Carpenter, MD Professor and Chief, Department of Surgery CAUTION: Investigational device. This product is under clinical investigation

More information

Antegrade Thoracic Stent Grafting during Repair of Acute Debakey I Dissection: Promotes Distal Aortic Remodeling and Reduces Late Open Re-operation

Antegrade Thoracic Stent Grafting during Repair of Acute Debakey I Dissection: Promotes Distal Aortic Remodeling and Reduces Late Open Re-operation Antegrade Thoracic Stent Grafting during Repair of Acute Debakey I Dissection: Promotes Distal Aortic Remodeling and Reduces Late Open Re-operation Vallabhajosyula, P: Szeto, W; Desai, N; Pulsipher, A;

More information

How to manage the left subclavian and left vertebral artery during TEVAR

How to manage the left subclavian and left vertebral artery during TEVAR How to manage the left subclavian and left vertebral artery during TEVAR Jürg Schmidli Chief of Vascular Surgery Inselspital Hamburg 2017 Dept Cardiovascular Surgery, Bern, Switzerland Disclosure No Disclosures

More information

Acute Type B dissection. Closure of the infra diaphragmatic tear: how and when?

Acute Type B dissection. Closure of the infra diaphragmatic tear: how and when? Acute Type B dissection. Closure of the infra diaphragmatic tear: how and when? Prof. Olgierd Rowiński II Department of Clinical Radiology Medical University of Warsaw Disclosure Speaker name: Olgierd

More information

The SPIDER-Graft for Thoracoabdominal Aortic Repair a feasability study in pigs

The SPIDER-Graft for Thoracoabdominal Aortic Repair a feasability study in pigs The SPIDER-Graft for Thoracoabdominal Aortic Repair a feasability study in pigs Wipper S, Kölbel T, Manzoni D, Duprée A, Sandhu H, Nelis V, Debus ES University Heart Center Hamburg University Heart Center

More information

The Petticoat Technique Managing Type B Dissection with both Early and Long Term Considerations

The Petticoat Technique Managing Type B Dissection with both Early and Long Term Considerations The Petticoat Technique Managing Type B Dissection with both Early and Long Term Considerations Joseph V. Lombardi, MD Professor & Chief, Division of Vascular & Endovascular Surgery Department of Surgery,

More information

Neuromonitor-guided repair of thoracoabdominal aortic aneurysms

Neuromonitor-guided repair of thoracoabdominal aortic aneurysms Neuromonitor-guided repair of thoracoabdominal aortic aneurysms Anthony L. Estrera, MD, a Roy Sheinbaum, MD, a Charles C. Miller III, PhD, b Ryan Harrison, BA, a and Hazim J. Safi, MD a Objective: Monitoring

More information

EVAR and TEVAR: Extending Their Use for Rupture and Traumatic Injury. Conflict of Interest. Hypotensive shock 5/5/2014. none

EVAR and TEVAR: Extending Their Use for Rupture and Traumatic Injury. Conflict of Interest. Hypotensive shock 5/5/2014. none EVAR and TEVAR: Extending Their Use for Rupture and Traumatic Injury Bruce H. Gray, DO MSVM FSCAI Professor of Surgery/Vascular Medicine USC SOM-Greenville Greenville, South Carolina none Conflict of Interest

More information

Experimental Two-Stage Simulated Repair of Extensive Thoracoabdominal Aneurysms Reduces Paraplegia Risk

Experimental Two-Stage Simulated Repair of Extensive Thoracoabdominal Aneurysms Reduces Paraplegia Risk Experimental Two-Stage Simulated Repair of Extensive Thoracoabdominal Aneurysms Reduces Paraplegia Risk Stefano Zoli, MD, Christian D. Etz, MD, PhD, Fabian Roder, MS, Robert M. Brenner, MS, Carol A. Bodian,

More information

Combined Endovascular and Surgical Repair of Thoracoabdominal Aortic Pathology: Hybrid TEVAR

Combined Endovascular and Surgical Repair of Thoracoabdominal Aortic Pathology: Hybrid TEVAR Combined Endovascular and Surgical Repair of Thoracoabdominal Aortic Pathology: Hybrid TEVAR William J. Quinones-Baldrich MD Professor of Surgery Director UCLA Aortic Center UCLA Medical Center Los Angeles,

More information

Combination of Myogenic and Neurogenic Motor Evoked Potential Monitoring During Thoracoabdominal Aortic Surgery

Combination of Myogenic and Neurogenic Motor Evoked Potential Monitoring During Thoracoabdominal Aortic Surgery Hiroshima J. Med. Sci. Vol. 67, No. 4, 117~121, December, 2018 HIMJ 67 18 117 Combination of Myogenic and Neurogenic Motor Evoked Potential Monitoring During Thoracoabdominal Aortic Surgery Shinya TAKAHASHI

More information

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

Paraplegia prevention branches: A new adjunct for preventing or treating spinal cord injury after endovascular repair of thoracoabdominal aneurysms 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, a Marc Michel

More information

TAAA / Spinal Cord Protection

TAAA / Spinal Cord Protection TAAA / Spinal Cord Protection Hazim J. Safi, MD Professor and Chair Department of Cardiothoracic and Vascular Surgery McGovern Medical School The University of Texas Science Center at Houston Memorial

More information

Thoracic and Thoracoabdominal Aneurysm Repair: Is Reimplantation of Spinal Cord Arteries a Waste of Time?

Thoracic and Thoracoabdominal Aneurysm Repair: Is Reimplantation of Spinal Cord Arteries a Waste of Time? CARDIOVASCULAR Thoracic and Thoracoabdominal Aneurysm Repair: Is Reimplantation of Spinal Cord Arteries a Waste of Time? Christian D. Etz, MD, James C. Halstead, MA (Cantab), MRCS, David Spielvogel, MD,

More information

Assessment of Spinal Cord Circulation and Function in Endovascular Treatment of Thoracic Aortic Aneurysms

Assessment of Spinal Cord Circulation and Function in Endovascular Treatment of Thoracic Aortic Aneurysms Assessment of Spinal Cord Circulation and Function in Endovascular Treatment of Thoracic Aortic Aneurysms Geert Willem H. Schurink, MD, PhD, Robbert J. Nijenhuis, MD, Walter H. Backes, PhD, Werner Mess,

More information

Strategies to Manage Paraplegia Risk After Endovascular Stent Repair of Descending Thoracic Aortic Aneurysms

Strategies to Manage Paraplegia Risk After Endovascular Stent Repair of Descending Thoracic Aortic Aneurysms ORIGINAL ARTICLES: Strategies to Manage Paraplegia Risk After Endovascular Stent Repair of Descending Thoracic Aortic Aneurysms Albert T. Cheung, MD, Alberto Pochettino, MD, Michael L. McGarvey, MD, Jehangir

More information

Challenges. 1. Sizing. 2. Proximal landing zone 3. Distal landing zone 4. Access vessels 5. Spinal cord ischemia 6. Endoleak

Challenges. 1. Sizing. 2. Proximal landing zone 3. Distal landing zone 4. Access vessels 5. Spinal cord ischemia 6. Endoleak Disclosure I have the following potential conflicts of interest to report: Consulting: Medtronic, Gore Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s)

More information

Intra-operative neurologic injuries: Avoidance and prompt response

Intra-operative neurologic injuries: Avoidance and prompt response Intra-operative neurologic injuries: Avoidance and prompt response James S. Harrop MD, FACS Professor Neurological and Orthopedic Surgery Director, Division of Spine and Peripheral Nerve Surgery Nsurg

More information

Lumbar CSF Drains for Thoracic Aortic Surgery

Lumbar CSF Drains for Thoracic Aortic Surgery Lumbar CSF Drains for Thoracic Aortic Surgery John C. Klick, MD CASE CAG Why do them? Open descending thoracic aortic aneurysm repair (still the gold standard) has an incidence of postoperative paraplegia

More information

An Overview of Post-EVAR Endoleaks: Imaging Findings and Management. Ravi Shergill BSc Sean A. Kennedy MD Mark O. Baerlocher MD FRCPC

An Overview of Post-EVAR Endoleaks: Imaging Findings and Management. Ravi Shergill BSc Sean A. Kennedy MD Mark O. Baerlocher MD FRCPC An Overview of Post-EVAR Endoleaks: Imaging Findings and Management Ravi Shergill BSc Sean A. Kennedy MD Mark O. Baerlocher MD FRCPC Disclosure Slide Mark O. Baerlocher: Current: Consultant for Boston

More information

Preoperative and operative predictors of delayed neurologic deficit following repair of thoracoabdominal aortic aneurysm

Preoperative and operative predictors of delayed neurologic deficit following repair of thoracoabdominal aortic aneurysm Preoperative and operative predictors of delayed neurologic deficit following repair of thoracoabdominal aortic aneurysm Anthony L. Estrera, MD a Charles C. Miller III, PhD a Tam T. T. Huynh, MD a Ali

More information

Early- and medium-term results after aortic arch replacement with frozen elephant trunk techniques a single center study

Early- and medium-term results after aortic arch replacement with frozen elephant trunk techniques a single center study Featured Article Early- and medium-term results after aortic arch replacement with frozen elephant trunk techniques a single center study Sergey Leontyev*, Martin Misfeld*, Piroze Daviewala, Michael A.

More information

Modified candy-plug technique for chronic type B aortic dissection with aneurysmal dilatation: a case report

Modified candy-plug technique for chronic type B aortic dissection with aneurysmal dilatation: a case report Kotani et al. Journal of Cardiothoracic Surgery (2017) 12:77 DOI 10.1186/s13019-017-0647-8 CASE REPORT Modified candy-plug technique for chronic type B aortic dissection with aneurysmal dilatation: a case

More information

Open surgical repair of thoracoabdominal aneurysms - the Massachusetts General Hospital experience

Open surgical repair of thoracoabdominal aneurysms - the Massachusetts General Hospital experience Research Highlight Open surgical repair of thoracoabdominal aneurysms - the Massachusetts General Hospital experience Virendra I. Patel, Robert T. Lancaster, Mark F. Conrad, Richard P. Cambria Division

More information

COMPLICATIONS OF TEVAR

COMPLICATIONS OF TEVAR COMPLICATIONS OF TEVAR P. Bergeron, A.Petrosyan, F.Markatis, T.Abdulamit, J.-C. Trastour IMAD CONGRESS 2010 Liège Belgium BACKGROUND Stentgrafting is a recognized treatment for TAA & TAD and has been proposed

More information

Evolving Strategy and Results of Spinal Cord Protection in Type I and II Thoracoabdominal Aortic Aneurysm Repair

Evolving Strategy and Results of Spinal Cord Protection in Type I and II Thoracoabdominal Aortic Aneurysm Repair Original Article Evolving Strategy and Results of Spinal Cord Protection in Type I and II Thoracoabdominal Aortic Aneurysm Repair Norihiko Shiiya, MD, Takashi Kunihara, MD, Kenji Matsuzaki, MD, and Keishu

More information

Dr Brigitta Brandner UCLH

Dr Brigitta Brandner UCLH Dr Brigitta Brandner UCLH 2.5% paraplegia/paraparesis (EUROSTAR) Some studies up to 8% Immediate, recurrent and delayed 37% deficits are delayed: present 13 hours 91 days post op >50% will resolve with

More information

Jean M Panneton, MD Professor of Surgery Program Director Vascular Surgery Chief EVMS. Arch Pathology: The Endovascular Era is here

Jean M Panneton, MD Professor of Surgery Program Director Vascular Surgery Chief EVMS. Arch Pathology: The Endovascular Era is here Jean M Panneton, MD Professor of Surgery Program Director Vascular Surgery Chief EVMS Arch Pathology: The Endovascular Era is here Disclosures Consultant: Cook Medical, Bolton Medical, Medtronic Inc, Volcano,

More information

Percutaneous Approaches to Aortic Disease in 2018

Percutaneous Approaches to Aortic Disease in 2018 Percutaneous Approaches to Aortic Disease in 2018 Wendy Tsang, MD, SM Assistant Professor, University of Toronto Toronto General Hospital, University Health Network Case 78 year old F Lower CP and upper

More information

Endovascular Treatment of the Aorta with Fenestrated and Branched Grafts

Endovascular Treatment of the Aorta with Fenestrated and Branched Grafts Endovascular Treatment of the Aorta with Fenestrated and Branched Grafts Eric LG Verhoeven,MD, PhD, A. Katsargyris, MD Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany

More information

Treatment of Thoracoabdominal Aneurysms Is there a need for custom-made devices?

Treatment of Thoracoabdominal Aneurysms Is there a need for custom-made devices? : FETURED TECHNOLOGY: JOTEC E-XTR DESIGN ENGINEERING Treatment of Thoracoabdominal neurysms Is there a need for custom-made devices? INTERVIEW ND CSE PRESENTTIONS WITH DNIEL RNZN, MD, ND NDREJ SCHMIDT,

More information

Three year experience with multilayer stent in the treatment of thoracoabdominal aneurysms no evidence for aneurysm stabilization

Three year experience with multilayer stent in the treatment of thoracoabdominal aneurysms no evidence for aneurysm stabilization Three year experience with multilayer stent in the treatment of thoracoabdominal aneurysms no evidence for aneurysm stabilization Thomas Larzon, MD, PhD Head of Vascular Surgery Dept of Cardiothoracic

More information

Conflicts of Interest. Endovascular Repair of Thoracoabdominal Aneurysm. Overview PLANNING ANATOMIC CONSIDERATIONS FOR COMPLEX AORTIC REPAIR

Conflicts of Interest. Endovascular Repair of Thoracoabdominal Aneurysm. Overview PLANNING ANATOMIC CONSIDERATIONS FOR COMPLEX AORTIC REPAIR Endovascular Repair of Thoracoabdominal Aneurysm Tim Resch MD Björn Sonesson MD, Nuno Dias MD Vascular Center Skane University Hospital Conflicts of Interest COOK Medical - Consulting, Speakers Bureau,

More information

Treatment of acute type B aortic dissection: Current status

Treatment of acute type B aortic dissection: Current status MEET Cannes, 18. - 21.06.2009 Treatment of acute type B aortic dissection: Current status Christoph A. Nienaber, MD, FACC University of Rostock Department of Internal Medicine, Cardiology christoph.nienaber@med.uni-rostock.de

More information

Technique and Outcome of Laser Fenestration For Arch Vessels

Technique and Outcome of Laser Fenestration For Arch Vessels Technique and Outcome of Laser Fenestration For Arch Vessels Jean M. Panneton MD, FRCSC, FACS Professor of Surgery Chief & Program Director Division of Vascular Surgery Eastern Virginia Medical School

More information

Residual Dissection and False Lumen Aneurysm After TEVAR

Residual Dissection and False Lumen Aneurysm After TEVAR WHAT WOULD YOU DO? Residual Dissection and False Lumen Aneurysm After MODERATOR: MARK FARBER, MD PANEL: YAZAN DUWAYRI, MD; MATTHEW J. EAGLETON, MD; WILLIAM D. JORDAN Jr, MD; TILO KÖLBEL, MD, PhD; AND ERIC

More information

SANWICH TECHNIQUE TO REDUCE COMPLICATIONS WHEN TREATING BILATERAL INTERNAL ILIAC ARTERY

SANWICH TECHNIQUE TO REDUCE COMPLICATIONS WHEN TREATING BILATERAL INTERNAL ILIAC ARTERY SANWICH TECHNIQUE TO REDUCE COMPLICATIONS WHEN TREATING BILATERAL INTERNAL ILIAC ARTERY TRAN TRA GIANG.MD Interventional cardiovascular department Hanoi Heart Hospital, Hanoi, Viet Nam Nothing to Disclose

More information

Surgical Considerations of TEVAR

Surgical Considerations of TEVAR Surgical Considerations of TEVAR University of Alberta, June 14 th, 2013 Jehangir Appoo Libin Cardiovascular Institute University of Calgary, Today: Lesions/Pathology amenable to TEVAR On label Off label

More information

STS/EACTS LatAm CV Conference 2017

STS/EACTS LatAm CV Conference 2017 STS/EACTS LatAm CV Conference 2017 Joseph E. Bavaria, MD Director, Thoracic Aortic Surgery Program Roberts-Measey Professor and Vice Chair of CV Surgery University of Pennsylvania Immediate-Past President

More information

Useful? Definition of High-risk? Pre-OP/Intra-OP/Post-OP? Complication vs Benefit? Mortality? Morbidity?

Useful? Definition of High-risk? Pre-OP/Intra-OP/Post-OP? Complication vs Benefit? Mortality? Morbidity? Preoperative intraaortic balloon counterpulsation in high-risk CABG Stefan Klotz, M.D. Preoperative IABP in high-risk CABG Questions?? Useful? Definition of High-risk? Pre-OP/Intra-OP/Post-OP? Complication

More information

Experience of endovascular procedures on abdominal and thoracic aorta in CA region

Experience of endovascular procedures on abdominal and thoracic aorta in CA region Experience of endovascular procedures on abdominal and thoracic aorta in CA region May 14-15, 2015, Dubai Dr. Viktor Zemlyanskiy National Research Center of Emergency Care Astana, Kazakhstan Region Characteristics

More information

Presente e futuro negli aneurismi dell arco aortico

Presente e futuro negli aneurismi dell arco aortico Sessione Congiunta SICVE, SEACV, SCVE, SPACV Presente e futuro negli aneurismi dell arco aortico Roberto Chiesa Vascular Surgery, Vita-Salute University Scientific Institute San Raffaele Milano, Italy

More information

Development of Stent Graft. Kato et al. Development of an expandable intra-aortic prothesis for experimental aortic dissection.

Development of Stent Graft. Kato et al. Development of an expandable intra-aortic prothesis for experimental aortic dissection. Development of Stent Graft Kato et al. Development of an expandable intra-aortic prothesis for experimental aortic dissection. ASAIO J 1993 The New England Journal of Medicine Downloaded from nejm.org

More information

Do the Data Support Endovascular Therapy for Descending Thoracic AD? Woong Chol Kang, M.D.

Do the Data Support Endovascular Therapy for Descending Thoracic AD? Woong Chol Kang, M.D. Do the Data Support Endovascular Therapy for Descending Thoracic AD? Woong Chol Kang, M.D. Gil Hospital, Gachon University Incheon, Korea Classification of AD Acute vs. Chronic (2weeks) (IIIa, b) type

More information

Descending Thoracic Aortic Repair: Spinal Cord Protection Strategies Harendra Arora, M.D. University of North Carolina, Chapel Hill, NC

Descending Thoracic Aortic Repair: Spinal Cord Protection Strategies Harendra Arora, M.D. University of North Carolina, Chapel Hill, NC Session: L113 Session: L335 Descending Thoracic Aortic Repair: Spinal Cord Protection Strategies Harendra Arora, M.D. University of North Carolina, Chapel Hill, NC Disclosures: This presenter has no financial

More information

Selective Visceral Perfusion during Thoracoabdominal Aortic Aneurysm Repair

Selective Visceral Perfusion during Thoracoabdominal Aortic Aneurysm Repair Original Article Selective Visceral Perfusion during Thoracoabdominal Aortic Aneurysm Repair Yukio Kuniyoshi, MD, PhD, Kageharu Koja, MD, PhD, Kazufumi Miyagi, MD, Tooru Uezu, MD, Satoshi Yamashiro, MD,

More information

Title. Different arch branched devices are available, is morphology the. main criteria of choice? Ciro Ferrer, MD

Title. Different arch branched devices are available, is morphology the. main criteria of choice? Ciro Ferrer, MD Different arch branched devices are available, is morphology the Title main criteria of choice? Ciro Ferrer, MD Vascular Surgery Unit Sapienza University of Rome Disclosure Speaker name: Ciro Ferrer Proctoring/speaking

More information

State of Art Hybrid Approach

State of Art Hybrid Approach State of Art Hybrid Approach for Complex Aorta Diseases Won Ho Kim, MD Division of Cardiology, Eulji University Hospital Eulji University School of Medicine, Daejeon, Korea Introduction.Hybrid procedure

More information

Lessons learned from Ch-EVAR for the treatment of. Miltos Matsagkas MD, PhD, FEBVS Professor of Vascular Surgery University of Thessaly

Lessons learned from Ch-EVAR for the treatment of. Miltos Matsagkas MD, PhD, FEBVS Professor of Vascular Surgery University of Thessaly Lessons learned from Ch-EVAR for the treatment of pararenal AAAs Miltos Matsagkas MD, PhD, FEBVS Professor of Vascular Surgery University of Thessaly Ch-EVAR Ch-EVAR = Chimney-EVAR Placement of single

More information

Toward Total Endovascular Therapy of the Aorta. Adam W. Beck, MD. Associate Professor of Surgery Division of Vascular Surgery and Endovascular Therapy

Toward Total Endovascular Therapy of the Aorta. Adam W. Beck, MD. Associate Professor of Surgery Division of Vascular Surgery and Endovascular Therapy Toward Total Endovascular Therapy of the Aorta Adam W. Beck, MD Associate Professor of Surgery Division of Vascular Surgery and Endovascular Therapy University of Alabama at Birmingham Disclosures Grant

More information

Postoperative risk factors for delayed neurologic deficit after thoracic and thoracoabdominal aortic aneurysm repair: A case-control study

Postoperative risk factors for delayed neurologic deficit after thoracic and thoracoabdominal aortic aneurysm repair: A case-control study Postoperative risk factors for delayed neurologic deficit after thoracic and thoracoabdominal aortic aneurysm repair: A case-control study Ali Azizzadeh, MD, Tam T. T. Huynh, MD, Charles C. Miller III,

More information

Intraoperative spinal cord monitoring (IOM) during surgery

Intraoperative spinal cord monitoring (IOM) during surgery ORIGINAL ARTICLES Electrophysiologic Monitoring During Surgery to Repair the Thoraco-Abdominal Aorta Tod B. Sloan and Leslie C. Jameson Summary: Prevention of paraplegia during the repair of thoracoabdominal

More information

CUSTOM-MADE SCALLOPED THORACIC ENDOGRAFTS IN DIFFERENT HOSTILE AORTIC ANATOMIES

CUSTOM-MADE SCALLOPED THORACIC ENDOGRAFTS IN DIFFERENT HOSTILE AORTIC ANATOMIES CUSTOM-MADE SCALLOPED THORACIC ENDOGRAFTS IN DIFFERENT HOSTILE AORTIC ANATOMIES A SERIES OF THREE CASE REPORTS Joel Sousa Department of Department of Angiology and Vascular Surgery Hospital S. João, Porto,

More information

Spinal cord blood flow and ischemic injury after experimental sacrifice of thoracic and abdominal segmental arteries

Spinal cord blood flow and ischemic injury after experimental sacrifice of thoracic and abdominal segmental arteries European Journal of Cardio-thoracic Surgery 33 (2008) 1030 1038 www.elsevier.com/locate/ejcts Spinal cord blood flow and ischemic injury after experimental sacrifice of thoracic and abdominal segmental

More information

Cerebrospinal fluid drains reduce risk of spinal cord injury for thoracic/thoracoabdominal aneurysm surgery: A review

Cerebrospinal fluid drains reduce risk of spinal cord injury for thoracic/thoracoabdominal aneurysm surgery: A review SNI: Spine OPEN ACCESS For entire Editorial Board visit : http://www.surgicalneurologyint.com Editor: Nancy E. Epstein, MD Winthrop Hospital, Mineola, NY, USA Review Article Cerebrospinal fluid drains

More information

Treatment options of late failures of EVAS. Michel Reijnen Rijnstate Arnhem The Netherlands

Treatment options of late failures of EVAS. Michel Reijnen Rijnstate Arnhem The Netherlands Treatment options of late failures of EVAS Michel Reijnen Rijnstate Arnhem The Netherlands Disclosure Speaker name: Michel Reijnen I have the following potential conflicts of interest to report: Consulting

More information

Acute dissections of the descending thoracic aorta (Debakey

Acute dissections of the descending thoracic aorta (Debakey Endovascular Treatment of Acute Descending Thoracic Aortic Dissections Nimesh D. Desai, MD, PhD, and Joseph E. Bavaria, MD Acute dissections of the descending thoracic aorta (Debakey type III or Stanford

More information

Thoracoabdominal aortic aneurysms by definition traverse

Thoracoabdominal aortic aneurysms by definition traverse Thoracoabdominal Aortic Aneurysm Repair: Open Technique Joseph Huh, MD, Scott A. LeMaire, MD, Scott A. Weldon, MA, CMI, and Joseph S. Coselli, MD Thoracoabdominal aortic aneurysms by definition traverse

More information

No Disclosure. Aortic Dissection in Japan. This. The Challenge of Acute and Chronic Type B Aortic Dissections with Endovascular Aortic Repair

No Disclosure. Aortic Dissection in Japan. This. The Challenge of Acute and Chronic Type B Aortic Dissections with Endovascular Aortic Repair No Disclosure The Challenge of Acute and Chronic Type B Aortic Dissections with Endovascular Aortic Repair Toru Kuratani Department of Cardiovascular Surgery Osaka University Graduate School of Medicine,

More information

FEVAR FIFTEEN YEARS OF EFFICIENCY E.DUCASSE MD PHD FEBVS CHU DE BORDEAUX

FEVAR FIFTEEN YEARS OF EFFICIENCY E.DUCASSE MD PHD FEBVS CHU DE BORDEAUX FEVAR FIFTEEN YEARS OF EFFICIENCY E.DUCASSE MD PHD FEBVS CHU DE BORDEAUX 2018 A BIT OF HISTORY First use of F-EVAR : 1990s Park et al. J Vasc Interv Radiol. 1996;7:819-823. Faruqi et al. J Endovasc Surg.

More information

NIH Public Access Author Manuscript J Vasc Surg. Author manuscript; available in PMC 2011 January 1.

NIH Public Access Author Manuscript J Vasc Surg. Author manuscript; available in PMC 2011 January 1. NIH Public Access Author Manuscript Published in final edited form as: J Vasc Surg. 2010 January ; 51(1): 38. doi:10.1016/j.jvs.2009.08.044. Postoperative Renal Function Preservation with Non-Ischemic

More information

Effects of preemptive cerebrospinal fluid drainage on spinal cord protection during thoracic endovascular aortic repair

Effects of preemptive cerebrospinal fluid drainage on spinal cord protection during thoracic endovascular aortic repair Original Article Effects of preemptive cerebrospinal fluid drainage on spinal cord protection during thoracic endovascular aortic repair Seungjun Song 1, Suk-Won Song 2, Tae Hoon Kim 2, Kwang-Hun Lee 3,

More information

I SECTION I. Thoracic aortic aneurysms

I SECTION I. Thoracic aortic aneurysms I SECTION I Thoracic aortic aneurysms 9 10 CASE 1 Endovascular repair of descending thoracic aortic aneurysms using the Gore TAG stent graft Introduction A descending thoracic aneurysm (DTA) is defined

More information

Spinal Cord Protection During Open Repair of Thoracic and Thoracoabdominal Aortic Aneurysms Using Profound Hypothermia and Circulatory Arrest

Spinal Cord Protection During Open Repair of Thoracic and Thoracoabdominal Aortic Aneurysms Using Profound Hypothermia and Circulatory Arrest Spinal Cord Protection During Open Repair of Thoracic and Thoracoabdominal Aortic Aneurysms Using Profound Hypothermia and Circulatory Arrest Thoralf M Sundt, MD, FACS, Mark D Flemming, MD, Gustavo S Oderich,

More information

Originally Posted: November 15, 2014 BRUIT IN THE GROIN

Originally Posted: November 15, 2014 BRUIT IN THE GROIN Originally Posted: November 15, 2014 BRUIT IN THE GROIN Resident(s): Donald ML Tse, MD Attending(s): KT Tan, MD Program/Dept(s): University Health Network/Mount Sinai Hospital, Toronto, ON, Canada CHIEF

More information

Repair of Intracranial Vessel Perforation with Onyx-18 Using an Exovascular Retreating Catheter Technique

Repair of Intracranial Vessel Perforation with Onyx-18 Using an Exovascular Retreating Catheter Technique Repair of Intracranial Vessel Perforation with Onyx-18 Using an Exovascular Retreating Catheter Technique Michael Horowitz M.D. Pittsburgh, Pennsylvania Background Iatrogenic intraprocedural rupture rates

More information

What is the best treatment for False Lumen growth after type B Dissection

What is the best treatment for False Lumen growth after type B Dissection What is the best treatment for False Lumen growth after type B Dissection Nikolaos Tsilimparis, Fiona Rohlffs, Yuk Law, Sebastian Debus, Tilo Kölbel N. Tsilimparis, MD, PhD, FEBVS Deputy Head of German

More information

Total Endovascular Repair Type A Dissection. Eric Herget Interventional Radiology

Total Endovascular Repair Type A Dissection. Eric Herget Interventional Radiology Total Endovascular Repair Type A Dissection Eric Herget Interventional Radiology 65 year old male Acute Type A Dissection Severe Aortic Regurgitation No co-morbidities Management? Part II Evolving Global

More information

for Thoracoabdominal Aneurysms

for Thoracoabdominal Aneurysms Durability of F/BEVAR for Thoracoabdominal Aneurysms Athanasios Katsargyris, MD, Eric Verhoeven MD, PhD Department of Vascular and Endovascular Surgery Paracelsus Medical University, Nuremberg, Germany

More information

Bilateral use of the Gore IBE device for bilateral CIA aneurysms and a first interim analysis of the prospective Iceberg registry

Bilateral use of the Gore IBE device for bilateral CIA aneurysms and a first interim analysis of the prospective Iceberg registry Bilateral use of the Gore IBE device for bilateral CIA aneurysms and a first interim analysis of the prospective Iceberg registry Michel MPJ Reijnen, MD, PhD Department of Vascular Surgery, Rijnstate Hospital

More information

Type II arch hybrid debranching procedure

Type II arch hybrid debranching procedure Safeguards and Pitfalls Type II arch hybrid debranching procedure Prashanth Vallabhajosyula, Wilson Y. Szeto, Nimesh Desai, Caroline Komlo, Joseph E. Bavaria Division of Cardiovascular Surgery, University

More information

Case Report 1. CTA head. (c) Tele3D Advantage, LLC

Case Report 1. CTA head. (c) Tele3D Advantage, LLC Case Report 1 CTA head 1 History 82 YEAR OLD woman with signs and symptoms of increased intra cranial pressure in setting of SAH. CT Brain was performed followed by CT Angiography of head. 2 CT brain Extensive

More information

Emergency endovascular repair of ruptured abdominal aortic aneurysms - our experience

Emergency endovascular repair of ruptured abdominal aortic aneurysms - our experience Emergency endovascular repair of ruptured abdominal aortic aneurysms - our experience Poster No.: C-0837 Congress: ECR 2011 Type: Scientific Paper Authors: D. Kuhelj, M. Baraga, P. Popovi#, T. Klju#evšek,

More information

CEA and cerebral protection Volodymyr labinskyy, MD

CEA and cerebral protection Volodymyr labinskyy, MD CEA and cerebral protection Volodymyr labinskyy, MD VA Hospital 7/26/2012 63 year old male presents for the vascular evaluation s/p TIA in January 2012 PMH: HTN, long term active smoker, Hep C PSH: None

More information

Replacement of the thoracoabdominal aorta for extensive

Replacement of the thoracoabdominal aorta for extensive Anatomy of Spinal Cord Blood Supply in the Pig Justus T. Strauch, MD, Alexander Lauten, MD, Ning Zhang, MD, Thorsten Wahlers, MD, and Randall B. Griepp, MD Department of Cardiothoracic Surgery, The Mount

More information

Postoperative renal function preservation with nonischemic femoral arterial cannulation for thoracoabdominal aortic repair

Postoperative renal function preservation with nonischemic femoral arterial cannulation for thoracoabdominal aortic repair From the Society for Vascular Surgery Postoperative renal function preservation with nonischemic femoral arterial cannulation for thoracoabdominal aortic repair Charles C. Miller III, PhD, a,b Joshua C.

More information

An endoleak is radiographic or ultrasonic evidence

An endoleak is radiographic or ultrasonic evidence Complex Coil Embolization of Multiple Type II Endoleaks Liquid embolics, detachable coils, and plugs to repair an enlarging abdominal aortic aneurysm sac 5 years after EVAR. BY FRANK R. ARKO, MD; ABRAHAM

More information

Thoracoabdominal aortic replacement for Crawford extent II aneurysm after thoracic endovascular aortic repair

Thoracoabdominal aortic replacement for Crawford extent II aneurysm after thoracic endovascular aortic repair Original Article Thoracoabdominal aortic replacement for Crawford extent II aneurysm after thoracic endovascular aortic repair Haiou Hu, Tie Zheng, Junming Zhu, Yongmin Liu, Ruidong Qi, Lizhong Sun Department

More information

History of the Powerlink System Design and Clinical Results. Edward B. Diethrich Arizona Heart Hospital Phoenix, AZ

History of the Powerlink System Design and Clinical Results. Edward B. Diethrich Arizona Heart Hospital Phoenix, AZ History of the Powerlink System Design and Clinical Results Edward B. Diethrich Arizona Heart Hospital Phoenix, AZ Powerlink System: Unibody-Bifurcated Design Long Main Body Low-Porosity Proprietary eptfe

More information