Early Outcome of Endovascular Treatment of Acute Traumatic Aortic Injuries: The Talent Thoracic Retrospective Registry

Size: px
Start display at page:

Download "Early Outcome of Endovascular Treatment of Acute Traumatic Aortic Injuries: The Talent Thoracic Retrospective Registry"

Transcription

1 Early Outcome of Endovascular Treatment of Acute Traumatic Aortic Injuries: The Talent Thoracic Retrospective Registry Marek P. Ehrlich, MD, Hervé Rousseau, MD, Robin Heijman, MD, Philippe Piquet, MD, Jean-Paul Beregi, MD, Christoph A. Nienaber, MD, Gottfried Sodeck, MD, and Rossella Fattori, MD Departments of Cardiothoracic Surgery and Emergency Medicine, University of Vienna, Vienna, Austria; Department of Radiology, Centre Hospitalier Universitaire, Hopital de Rangueil, Toulouse, France; Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands; Centre Hospitalier Universitaire, Hopital Sainte Marguerite, Marseille, Radiologie Vasculaire, Hopital Cardiologique CHRU de Lille, Lille, France; Department of Cardiology, University Hospital Rostock, Rostock, Germany; Cardiovascular Radiology, University Hospital S. Orsola, Bologna, Italy Background. Acute traumatic injury of the thoracic aorta (TAI) is a life-threatening complication in patients who sustain deceleration or crush injuries. This study was conducted to examine the results in patients who underwent endovascular repair with the Talent (Medtronic/AVE, Santa Rosa, CA) thoracic stent graft for acute traumatic injury. Methods. Out of 457 consecutive endograft patients, 41 (9%) were treated for traumatic aortic conditions. There were 36 males with a mean age of years. Mean aortic diameter at the time of intervention was 34 mm 9 (range, 20 to 70 mm). The mean length of covered aorta was 106 mm (range, 5 to 130 mm ) with only one stent graft used in 98% (40) of all cases. Median follow-up period for hospital survivors was 13 months (1.0 to 69.0 months). Results. Stent graft implantation was technically successful in all cases (100%). One patient died during hospitalization, yielding an overall in-hospital mortality rate of 2.4%. Procedural-related paraplegia was zero and a primary endoleak was observed in 1 patient. Postoperative complications occurred in 4 patients (3 respiratory failures, 1 multiorgan failure). No patient required conversion to open surgical repair. Conclusions. The treatment of acute traumatic injuries of the descending thoracic aorta with the Talent stent graft is a feasible and safe technique; it provides low morbidity and mortality rates in the early postoperative period, and early results are encouraging. However, longterm studies are worthwhile to evaluate the effectiveness and the durability of this procedure. (Ann Thorac Surg 2009;88: ) 2009 by The Society of Thoracic Surgeons Blunt trauma with thoracic aortic involvement remains a leading cause of mortality. Most of these patients arrive in the emergency room with multiple concomitant injuries and makes them, therefore, poor candidates for open surgery on the injured descending aorta. Reported mortality rates for conventional repair of traumatic aortic rupture reaches up to 50%, pulmonary complication, renal insufficiency, and especially postoperative paraplegia may occur in 15% to 45% of patients [1 5]. Since the first endovascular stent graft experience in an abdominal aortic aneurysm [6], many groups have started to investigate the feasibility of thoracic aortic aneurysmal repair with endovascular stent grafts (ESG) for various aortic pathologic conditions [7 10]. Over the last decade, endovascular techniques have revolutionized the management of descending thoracic aortic disease, with the benefit of exclusion of the pathologically altered aorta without Accepted for publication June 10, Presented at the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26 28, Address correspondence to Dr Ehrlich, Dept. of Cardio-Thoracic Surgery, University of Vienna, Währinger Gürtel 18-20, Vienna, A-1090, Austria; marek.ehrlich@meduniwien.ac.at. direct surgical exposure. Especially in patients with acute traumatic aortic injuries considered unsuitable candidates for open surgery due to severe comorbid conditions, ESG may offer an attractive and safe alternative approach for treating such aortic pathologic conditions [11, 12]. The Talent Thoracic Retrospective Registry (TTR) was designed to collect outcome data from patients who underwent endoluminal treatment with the Talent thoracic stent graft (Medtronic/AVE, Santa Rosa, CA) in seven European referral centers [13]. The present subanalysis of the TTR registry comprises only data on patients subjected to endovascular stent graft placement for acute traumatic aortic injuries. Patients and Methods Enrollment The current analysis from the TTR registry is focused on 41 consecutive patients who underwent endovascular repair Dr Heijman discloses a financial relationship with Medtronic by The Society of Thoracic Surgeons /09/$36.00 Published by Elsevier Inc doi: /j.athoracsur

2 Ann Thorac Surg EHRLICH ET AL 2009;88: ENDOVASCULAR TREATMENT OF ATI: THE TTR 1259 Table 1. Demographics and Clinical Characteristics (n 41) Characteristics No. % Male Age, y (median) 34 (22 82) ASA score Comorbidity: Hypertension 4 10 Marfan syndrome 0 0 Renal insufficiency 0 0 COPD 4 10 Smoking 7 17 Maximum aortic diameter (mean SD, range ) ( mm) ASA American Society of Anesthesiologists; obstructive pulmonary disease. COPD chronic with the Talent thoracic stent graft for acute traumatic aortic injuries between November 1996 and March This subgroup represents 9% from a total of 457 patients with thoracic aortic pathology collected for the TTR registry. Seven European referral centers (Bologna, Lille, Marseille, Nieuwegein, Rostock, Toulouse, and Vienna) provided data from patients treated consecutively, with a minimum of 1-year follow-up. The TTR registry was approved by the local ethical committee of each participant center. Follow-up analysis was formed on clinical and imaging findings until the last visit and includes all adverse events. Data were collected on case report forms and checked for inconsistencies. In case of discrepancies, the attending investigator was queried to ensure appropriate interpretation of events. Table 2. Procedural Detail and 30-day Outcome Variable No. (%) Procedural success 41 (100) Length of covered aorta, mm (mean SD) Number of stent grafts deployed 42 One per person 40 (98) Two per person 2 (2) Occlusion of left subclavian artery 8 (19) Early mortality: 30-day mortality 1 (2) Procedural failure and redo intervention: Conversion to open surgery 0 (0) Primary endoleak 1 (2) Early complications: Neurological 0 (0) Stroke 0 (0) Spinal cord ischemia 0 (0) Respiratory failure 3 (7) Multiorgan failure 1 (2) Length of hospital stay (days) median, IQR (days) 15 (8 27) IQR interquartile range. Patient Characteristics The traumatic subgroup of TTR comprises 36 male and 5 female patients with an age of years, ranging from 18 to 71 years (Table 1). The American Society of Anesthesiologists (ASA) classification greater than class III was present in all cases (100%). None of the patients had undergone previous aortic surgery or endovascular repair. Comorbid medical conditions comprised hypertension (n 4, 10%) and chronic obstructive pulmonary disease (n 4, 10%). None of the treated patients had Fig 1. Postoperative computed tomographic scan of a patient after traumatic aortic injury.

3 1260 EHRLICH ET AL Ann Thorac Surg ENDOVASCULAR TREATMENT OF ATI: THE TTR 2009;88: Definitions Procedural success was defined as successful deployment of the stent graft device. Primary success was defined as complete exclusion of the injured side without any additional intervention. Secondary success was defined as complete exclusion of the aneurysm after secondary intervention. Endoleak was defined as radiologic evidence of blood flow outside the stent graft and was classified as primary (diagnosed within 30 days of endovascular repair) or secondary (diagnosed more than 30 days after intervention). Statistical Analysis Continuous data are presented as the median and interquartile range (range from the 25th to the 75th percentile) or the median and the 95% confidence interval [CI] as appropriate. Discrete data are given as counts and percentages. Univariate comparisons of continuous data were performed by Mann-Whitney U tests. Groups of categoric data were compared by Fisher exact tests with Yates correction. Mantel-Cox regression analysis for survival was performed according to standard procedures. A two-sided p value below 0.05 was considered statistically significant. Calculations were performed with SPSS for Mac version 16.0 (SPSS Inc, Chicago, IL). Fig 2. Kaplan-Meier survival curve. Marfan syndrome. All patients were treated within 14 days of traumatic injury. Cause of traumatic injury was traffic accident in 32 patients (78%) followed by occupational accident in 5 patients (12%) and high elevation fall in the remaining 4 patients (10%). Device Description The Talent Thoracic stent graft is composed of Dacron graft fabric supported by self-expanding nitinol springs. The springs are sewn to the graft material with polyester sutures. The graft material is a sheet of monofilament polyester with a seam joining the edges to create a cylindrical tube. The connecting bar provides columnar strength to the device and facilitates deployment. All Talent stent grafts in that study had uncovered springs proximally and the smallest graft size was 22 mm. Preintervention Imaging Before endovascular treatment, all patients were examined by at least one tomographic imaging modality. Computed tomography (CT) (Fig 1) or magnetic resonance imaging (MRI) was preferred. In some specific cases angiography or transesophageal echocardiography (TEE) were performed additionally. Contrast enhanced CT was the most frequently used diagnostic method (95%), followed by angiography (37%), TEE (17%), and MRI (5%). All operations were performed under general anesthesia in the radiology suite under fluoroscopy control by a C-arm image intensifier. The technique of stent graft insertion has been described before [13]. Results There was no intraprocedural death and success deployment of the stent graft was obtained in all cases (100%) (Table 2). Furthermore, there were no access complications. Median length of covered aorta was 102 mm (100 to 115 mm) with only one stent graft used in 40 patients (98%). Mean aortic diameter at the time of intervention was measured 34 mm (range, 20 to 70 mm). In 8 patients (19%), the stent graft was positioned in the distal arch with coverage of the left subclavian artery to extend the proximal landing zone. In none of these 8 patients was a carotidsubclavian bypass performed prior to stent graft placement. One patient died during hospitalization due to multiorgan failure, yielding an overall in-hospital mortality rate of 2.4%. Procedural related paraplegia was zero and none of the patients experienced stroke or other major stent graft-related complications. Incomplete exclusion of the thoracic aortic pathology after the stent graft procedure was only observed in 1 case. This patient had a type Ia endoleak and an additional stent graft was positioned at the proximal landing zone right during the same procedure with complete sealing of the leak. Postoperative complications occurred in 4 patients (3 respiratory failures, 1 multiorgan failure). No patient required early conversion to open surgical repair. Follow-Up Mean follow-up period for hospital survivors was 13 months (range, 1 to 69 month). A reduction of the involved aortic segment was detected in 77% of all patients ( mm for follow-up mean diameter versus mm for preoperative mean diameter) and in the remaining 9 patients (23%) the aortic diameter remained stable during follow-up. There was no late death related to the stent graft procedure and no late complications or endoleaks. Kaplan-Meier overall survival rate was 100% at 12, 24, and 36 months (Fig 2). Comment Acute thoracic aortic injury (TAI) may be a life threatening complication after blunt chest trauma and a leading

4 Ann Thorac Surg EHRLICH ET AL 2009;88: ENDOVASCULAR TREATMENT OF ATI: THE TTR 1261 cause of mortality. Recent investigations have shown that TAI occurs in 10% to 30% of adults sustaining fatal blunt trauma [14, 15]. It therefore represents one of the most common causes of death at the scene of vehicular accidents, accounting for 8,000 victims per year in the United States. The more sophisticated prehospital care and the proliferation of rapid transport for patients have resulted in an average increase in the number of patients treated. The lesion may be generated by many different types of sudden-deceleration injury, including car and motorcycle collisions, falls from a height or blast injuries, airplane and train crashes, skiing, and equestrian accidents. The region subjected to the greatest strain is put upon the isthmus, where the relatively mobile thoracic aorta joins the fixed arch and the insertion of the ligamentum arteriosum. Aortic ruptures occur at this site in 80% of the pathologic series and in 90% to 95% of the clinical series [1, 14 16]. Up to 80% of these patients die at the scene of the accident and for those who reach the hospital the estimated rate of mortality is around 30% [17]. In most of these cases, a complete transection of the aorta at the isthmus site occurs, which leads to sudden death due to exsanguination. In those who survive the initial period, antihypertensive medication is imperative to reduce wall stress and the risk of aortic rupture. Surgical repair of these aortic lesions has been the gold standard for many decades but was and still is associated with significant morbidity as well as mortality rates. Several studies have reported operative mortalities from 10% to 54% with spinal cord injuries in up to 35% of all patients [2, 3]. During the last two decades, treatment of the descending aorta with a stent graft device for a variety of pathologic conditions (such as aneurysmal dilatations, acute type B dissections, or penetrating ulcers) has become a viable option and an alternative treatment modality to open surgical repair [13]. Especially patients after blunt trauma presenting with associated thoracic aortic injury are excellent candidates for such a less invasive procedure for a number of reasons. Pulmonary complications associated with thoracotomy can be prevented; cardiopulmonary bypass necessitating the use of heparin for surgical aortic reconstruction can be completely avoided. Furthermore, this procedure can be performed in the acute phase without physiologic stress on the unstable patient. This analysis focuses on 41 patients with acute traumatic aortic injuries extracted from the TTR registry and demonstrates that endovascular repair using the Talent stent graft is feasible and has low incidence of associated complications. All these patients arrived in the hospital with signs of hemodynamic instability, uncontrolled blood pressure, and signs of other vital organ dysfunctions. Imaging findings showed clear signs of impending rupture, periaortic hematoma, hemothorax, or rapid growth of the pseudoaneurysm. They received the stent graft within 14 days after the traumatic incidence. Technical success was obtained in all patients who underwent this approach and hospital mortality was as low as 2% in this series. This finding is consistent with previous series of similar size [18 20]. Extrapolating this small group of 41 patients from the whole TTR, which was comprised of 457 patients who have been treated with this device for a variety of other pathologic conditions, this type of aortic lesion resulted in the lowest mortality and morbidity rate [21]. Furthermore, although the number of patients was small, midterm results were excellent. These findings can be explained by the fact that most of these patients are of younger age and have no other comorbidities that might influence short as well as midterm outcome. Not surprisingly, a very low rate of primary and secondary endoleaks could be observed in this series. This can be explained by the good wall condition at the deployment site with no atherosclerotic changes. Furthermore, none of the patients needed early as well as late conversion to conventional open surgery due to stent graft procedural failure. With regard to spinal cord injury, none of our patients developed paraplegia after the stent graft procedure and this observation is consistent with several other studies [19, 22]. This phenomenon can be explained due to the short length of covered aortic segment. It has been shown that the threshold for increased risk of paraplegia appears to be at around 200 mm [23]. Forty out of the 41 patients treated in this study (98%) received only one stent graft, with a mean length of aortic coverage of 106 mm. With regard to a short proximal neck for placing the stent graft in the descending aorta, a number of different approaches have been described in the literature including intentional left subclavian overstenting, coil embolization, or preoperative subclavian-carotid bypass surgery [24]. In this series, the left subclavian origin was covered in 8 of the 41 patients (19%) and there was no incidence of postoperative neurologic sequelae such as stroke or left arm ischemia. In spite of many benefits on the short-term and midterm outcomes, the long-term results of endovascular repair remain a major issue in relatively young patients and some particular anatomic conditions need to be present to perform this kind of procedure. First of all, a proper peripheral vascular access of at least 7 to 8 mm of diameter is necessary, but this condition is not always present, particularly in younger patients. Second, the most important anatomic characteristic of any lesion allowing endovascular treatment is the presence of an adequate proximal neck. The aortic isthmus is usually very close to the left subclavian artery and sometimes the lesion in contiguity or with a limited distance from the vessel. Proximal apposition is also an important issue for long-term stability, because individual case reports of stent graft collapse resulting in major morbidity and mortality and the need for reintervention have been reported with several different devices. In this study, the stent graft had proximal uncovered springs proximally insuring a better apposition of the proximal seal zone to the inner curvature of a tight aortic arch. Another issue is the need for smaller diameter devices in these younger patients whose aortas have not begun to dilate.

5 1262 EHRLICH ET AL Ann Thorac Surg ENDOVASCULAR TREATMENT OF ATI: THE TTR 2009;88: In conclusion, the treatment of acute traumatic injuries of the descending thoracic aorta with the Talent stent graft is a feasible and safe technique and provides low morbidity and mortality rates in the early postoperative period. Early outcome results are encouraging; however, long-term studies with larger number of cases are needed to evaluate the effectiveness and the durability of this procedure. The major limitation of the present study was that all data was analyzed retrospectively, a process which mandates caution in the interpretation of the results. For example, there is a lack of endograft-exclusion criteria as well as a lack of number of patients who had been treated within the same time interval conventionally. Furthermore, a number of variables, such as proximal and distal neck diameter, access of conduit diameters were not available in this registry. In addition, the specific details on other related injuries which resulted from the trauma are unknown due to the fact that this study was performed retrospectively. However, it is known that all patients had an ASA greater than 3. References 1. Hunt JP, Baker CC, Lentz CW, et al. Thoracic aorta injuries: management and outcome of 144 patients. J Trauma 1996;40: Fabian TC, Richardson JD, Croce MA, et al. Prospective study of blunt aortic injury: multicenter trial of the American Association for the Surgery of Trauma. J Trauma 1997;42: von Oppell UO, Dunne TT, De Groot MK, Zilla P. Traumatic aortic rupture: twenty-year meta-analysis of mortality and risk of paraplegia. Ann Thorac Surg 1994;58: Rousseau H, Dambrin C, Marcheix B, et al. Acute traumatic aortic rupture: a comparison of surgical and stent-graft repair. J Thorac Cardiovasc Surg 2005;129: Buz S, Zipfel B, Mulahasanovic S, Pasic M, Weng Y, Hetzer R. Conventional surgical repair and endovascular treatment of acute traumatic aortic rupture. Eur J Cardiothorac Surg 2008;33: Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 1991;5: Dake MD, Miller DC, Semba CP, Mitchell RS, Walker PJ, Liddell RP. Transluminal placement of endovascular stentgrafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med 1994;331: Inoue KI, Iwase T, Sato M, et al. Clinical application of transluminal endovascular graft placement for aortic aneurysms. Ann Thorac Surg 1997;63: Mitchell RS, Miller DC, Dake MD, Semba CP, Moore KA, Sakai T. Thoracic aortic aneurysm repair with an endovascular stent graft: the first generation. Ann Thorac Surg 1999;67: Mitchell RD, Dake MD, Semba CP, et al. Endovascular stent graft repair of thoracic aortic aneurysms. J Thoracic Cardiovasc Surg 1996;111: Amabile P, Collart F, Gariboldi V, Rollet G, Bartoli JM, Piquet P. Surgical versus endovascular treatment of traumatic thoracic aortic rupture. J Vasc Surg 2004;40: Czermak BV, Waldenberger P, Perkmann R, et al. Placement of endovascular stent grafts for emergency treatment of acute disease of the descending thoracic aorta. AJR Am J Roentgenol 2002;179: Fattori R, Nienaber CA, Rousseau H, et al. Results of endovascular repair of the thoracic aorta with the Talent Thoracic stent graft: the Talent Thoracic Retrospective Registry. J Thorac Cardiovasc Surg 2006;132: Richens D, Kotidis K, Neale M, Oakley C, Fails A. Rupture of the aorta following road traffic accidents in the United Kingdom The results of the co-operative crash injury study. Eur J Cardiothoracic Surg 2003;23: Bertrand S, Cuny S, Petit P, et al. Traumatic rupture of thoracic aorta in real-world motor vehicle crashes: Traffic Inj Prev 2008;9: Arajärvi E, Santavirta S, Tolonen J. Aortic ruptures in seat belt wearers; J Thorac Cardiovasc Surg 1989;98: Avery JE, Hall DP, Adams JE, Headrick JR, Nipp RN. Traumatic rupture of the aorta. South Med J 1979;72: Fattori R, Russo V, Lovato L, Di Bartolomeo R. Optimal management of traumatic aortic injury. Eur J Vasc Endovasc Surg 2009;37: Lachat M, Pfammatter T, Witzke H, et al. Acute traumatic aortic rupture: early stent-graft repair: Eur J Cardiothorac Surg 2002;21: Peterson BG, Matsumara JS, Morasch MD, West MA, Eskandari MK. Percutaneous endovascular repair of blunt thoracic transaction. J Trauma 2005;59: Kische S, Ehrlich MP, Nienaber CA, et al. Endovascular treatment of acute and chronic aortic dissection: midterm results from the Talent Thoracic Retrospective Registry. J Thorac Cardiovasc Surg 2009;138: Day CP, Buckenham TM. Outcomes of endovascular repair of acute thoracic Aortic injury: interrogation of the New Zealand thoracic aortic stent database (NZ TAS). Eur J Vasc Endovasc Surg 2008;36: Amabile P, Grisold D, Giorgi R, Bartoli JM, Piquet P. Incidence and determinants of spinal cord ischemia in stentgraft repair of the thoracic aorta, Eur J Vasc Endovasc Surg 2008;35: Weigang E, Luehe M, Harloff A, et al. Incidence of neurological complications following overstenting of the left subclavian artery. Eur J Cardiothorac Surg 2007;31: DISCUSSION DR JEHANGIR APPOO (Calgary, Canada): Thank you for your nice presentation. What we ve noticed in these young patients, when we see them afterwards in the clinic, is for some reason we find these patients are hypertensive and all these twenty- and thirty-year-olds are on medications to control their blood pressure. And I was wondering if you ve seen this postoperatively, if this has to do with compliance of the aorta and the pressure wave bouncing off the stent grafts. But we ve seen patients do well, who are healthy, but now you have twenty- and thirtyyear-olds on antihypertensive medication. DR EHRLICH: I cannot speak for all of the centers, but generally speaking, in Vienna we did not see the phenomenon of these young patients developing hypertension after the stent graft procedure. DR APPOO: Sorry, I think maybe you didn t understand my question. Once the cases do well and they go home, and in ongoing follow-up, we find that these patients are still hypertensive. And these are patients you would not otherwise expect to have hypertension because they re generally otherwise

6 Ann Thorac Surg EHRLICH ET AL 2009;88: ENDOVASCULAR TREATMENT OF ATI: THE TTR 1263 healthy twenty- or thirty-year-olds who have been in car accidents. Have you seen that? Because I find that a lot of these patients I see postoperatively now have to be treated with antihypertensive medication. DR EHRLICH: Are you saying that there is a sort of coarctation situation occurring? DR APPOO: Well, you know, yes. We CT [computed tomography] them and you worry about that, and there are absolutely no coarct at all and they have good peripheral perfusion. There is a theory out there that maybe the stent grafts proximally, the pressure wave and the dynamics of the blood flow changes. Any comments. DR EHRLICH: Well, we haven t seen that, so I cannot comment. DR JOSEPH BAVARIA (Philadelphia, PA): You have a great deal of experience with the Talent graft for transections and it s being used more and more. Would you like to make a comment on technique, ballooning, not ballooning, risk of antegrade dissection, et cetera. DR EHRLICH: Well, first of all, the right timing for the stent graft approach is crucial, some centers balloon, some don t, and in none of these patients a dissection was observed after the procedure. DR BAVARIA: Do you have long-term follow-up? DR EHRLICH: No, unfortunately not and this is the major pitfall of this multicenter study, that it s actually only a retrospective observational one. DR BAVARIA: So these patients are not being followed long term, right? DR EHRLICH: Well, some of them are. But, not in the registry anymore. DR BAVARIA: Do you have the average diameter of the stent you used? DR EHRLICH: It s 24 mm.

Thoracic aortic trauma A.T.O.ABDOOL-CARRIM ACADEMIC HEAD VASCULAR SURGERY DEPARTMENT OF SURGERY UNIVERSITY OF WITWATERSRAND

Thoracic aortic trauma A.T.O.ABDOOL-CARRIM ACADEMIC HEAD VASCULAR SURGERY DEPARTMENT OF SURGERY UNIVERSITY OF WITWATERSRAND Thoracic aortic trauma A.T.O.ABDOOL-CARRIM ACADEMIC HEAD VASCULAR SURGERY DEPARTMENT OF SURGERY UNIVERSITY OF WITWATERSRAND Thoracic Aortic Trauma In USA and CANADA 7500-8000 die of blunt thoracic aortic

More information

Midterm results after endovascular treatment of acute, complicated type B aortic dissection: The Talent Thoracic Registry

Midterm results after endovascular treatment of acute, complicated type B aortic dissection: The Talent Thoracic Registry Midterm results after endovascular treatment of acute, complicated type B aortic dissection: The Talent Thoracic Registry Marek P. Ehrlich, MD, a Herve Rousseau, MD, b Robin Heijmen, MD, c Philippe Piquet,

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

account for 10% to 15% of all traffic fatalities majority fatal at the scene 50% who survive the initial injury die in the first 24 hours 90% die

account for 10% to 15% of all traffic fatalities majority fatal at the scene 50% who survive the initial injury die in the first 24 hours 90% die account for 10% to 15% of all traffic fatalities majority fatal at the scene 50% who survive the initial injury die in the first 24 hours 90% die within the first month if aorta not repaired 30-90% overall

More information

Midterm Results After Endovascular Treatment of Acute, Complicated Type B Aortic Dissection

Midterm Results After Endovascular Treatment of Acute, Complicated Type B Aortic Dissection Midterm Results After Endovascular Treatment of Acute, Complicated Type B Aortic Dissection Marek P. Ehrlich, MD, Julia Dumfarth, MD, Maria Schoder, MD, Roman Gottardi, MD, Johannes Holfeld, MD, Andrzej

More information

Dissection of descending aorta treated by stent-graft implantation in a patient with Marfan syndrome

Dissection of descending aorta treated by stent-graft implantation in a patient with Marfan syndrome Case Report 1 Dissection of descending aorta treated by stent-graft implantation in a patient with Marfan syndrome Marat. ripov, Ildar Z. bdyldaev, Semen D. Chevgun, ektur S. Daniyarov, Dinara. Toktosunova,

More information

Thoracic aortic aneurysms are life threatening and

Thoracic aortic aneurysms are life threatening and Thoracic Aortic Aneurysms: Treatment With Endovascular Self-Expandable Stent Grafts Martin Grabenwöger, MD, Doris Hutschala, MD, Marek P. Ehrlich, MD, Fabiola Cartes-Zumelzu, MD, Siegfried Thurnher, MD,

More information

I-Hui Wu, M.D. Ph.D. Clinical Assistant Professor Cardiovascular Surgical Department National Taiwan University Hospital

I-Hui Wu, M.D. Ph.D. Clinical Assistant Professor Cardiovascular Surgical Department National Taiwan University Hospital Comparisons of Aortic Remodeling and Outcomes after Endovascular Repair of Acute and Chronic Complicated Type B Aortic Dissections I-Hui Wu, M.D. Ph.D. Clinical Assistant Professor Cardiovascular Surgical

More information

Indications for stent grafts in type B aortic dissection

Indications for stent grafts in type B aortic dissection expert opinion I Akin C A Nienaber Indications for stent grafts in type B aortic dissection ibrahim akin christoph a nienaber Department of Medicine, Divisions of Cardiology, Pulmology and Intensive Care

More information

TEVAR FOR! THORACIC AORTIC TRAUMA"

TEVAR FOR! THORACIC AORTIC TRAUMA 10th HKL Vascular Surgery Conference and Workshop" TEVAR FOR! THORACIC AORTIC TRAUMA" Dr Hanif Hussein" Vascular and General Surgeon" Department of Surgery" Hospital Kuala Lumpur" Source: MIROS! Thoracic

More information

Transluminal Stent-graft Placement endovascular surgery

Transluminal Stent-graft Placement endovascular surgery 13 545 551 2004 Transluminal Stent-graft Placement endovascular surgery 1 1 2 2 1 1 1 3 2 1 1996 11Transluminal Stent-graft Placement TSGP 6 82 TSGP T42 O TSGP Th10 T 26 O 5 T 3 O 23T 6 O 2 T 47 A15B17B15O

More information

Santi Trimarchi, MD, PhD Vascular Surgeon Thoracic Aortic Research Center, Director IRCCS Policlinico San Donato University of Milan

Santi Trimarchi, MD, PhD Vascular Surgeon Thoracic Aortic Research Center, Director IRCCS Policlinico San Donato University of Milan The Gore GREAT Registry: Update about a real life data collection Santi Trimarchi, MD, PhD Vascular Surgeon Thoracic Aortic Research Center, Director IRCCS Policlinico San Donato University of Milan Disclosures

More information

Performance of the conformable GORE TAG device in Type B aortic dissection from the GORE GREAT real world registry

Performance of the conformable GORE TAG device in Type B aortic dissection from the GORE GREAT real world registry University of Milan Thoracic Aortic Research Center Performance of the conformable GORE TAG device in Type B aortic dissection from the GORE GREAT real world registry Santi Trimarchi, MD, PhD Associate

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

How to achieve a successful proximal sealing in TEVAR? Pr L Canaud

How to achieve a successful proximal sealing in TEVAR? Pr L Canaud How to achieve a successful proximal sealing in TEVAR? Pr L Canaud CHU de Montpellier France Disclosure I have the following potential conflicts of interest to report: Consulting: Medtronic. Proximal neck

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

Haemodynamically unstable patient with chest trauma

Haemodynamically unstable patient with chest trauma HR J Clinical Case - Test Yourself Interventional Haemodynamically unstable patient with chest trauma Dimitrios Tomais, Theodoros Kratimenos, Dimosthenis Farsaris Interventional Radiology Unit, Radiology

More information

Clinical trial and real-world outcomes of an endovascular iliac aneurysm repair with the GORE Iliac Branch Endoprosthesis (IBE)

Clinical trial and real-world outcomes of an endovascular iliac aneurysm repair with the GORE Iliac Branch Endoprosthesis (IBE) Clinical trial and real-world outcomes of an endovascular iliac aneurysm repair with the GORE Iliac Branch Endoprosthesis (IBE) Jan MM Heyligers, PhD, FEBVS Consultant Vascular Surgeon The Netherlands

More information

Subject: Endovascular Stent Grafts for Disorders of the Thoracic Aorta

Subject: Endovascular Stent Grafts for Disorders of the Thoracic Aorta 02-33000-29 Original Effective Date: 04/15/03 Reviewed: 07/26/18 Revised: 08/15/18 Subject: Endovascular Stent Grafts for Disorders of the Thoracic Aorta THIS MEDICAL COVERAGE GUIDELINE IS NOT AN AUTHORIZATION,

More information

Management of Acute Aortic Syndromes. M. Grabenwoger, MD Dept. of Cardiovascular Surgery Hospital Hietzing, Vienna, Austria

Management of Acute Aortic Syndromes. M. Grabenwoger, MD Dept. of Cardiovascular Surgery Hospital Hietzing, Vienna, Austria Management of Acute Aortic Syndromes M. Grabenwoger, MD Dept. of Cardiovascular Surgery Hospital Hietzing, Vienna, Austria I have nothing to disclose. Acute Aortic Syndromes Acute Aortic Dissection Type

More information

Development of a Branched LSA Endograft & Ascending Aorta Endograft

Development of a Branched LSA Endograft & Ascending Aorta Endograft Development of a Branched LSA Endograft & Ascending Aorta Endograft Frank R. Arko III, MD Sanger Heart & Vascular Institute Carolinas Medical Center Charlotte, North Carolina, USA Disclosures Proximal

More information

Fate of Aneurysms of the Distal Arch and Proximal Descending Thoracic Aorta After Transaortic Endovascular Stent-Grafting

Fate of Aneurysms of the Distal Arch and Proximal Descending Thoracic Aorta After Transaortic Endovascular Stent-Grafting CARDIOVASCULAR Fate of Aneurysms of the Distal Arch and Proximal Descending Thoracic Aorta After Transaortic Endovascular Stent-Grafting Taijiro Sueda, MD, Kazumasa Orihashi, MD, Kenji Okada, MD, Yuji

More information

Increased Flexibility of AneuRx Stent-Graft Reduces Need for Secondary Intervention Following Endovascular Aneurysm Repair

Increased Flexibility of AneuRx Stent-Graft Reduces Need for Secondary Intervention Following Endovascular Aneurysm Repair 583 Increased Flexibility of AneuRx Stent-Graft Reduces Need for Secondary Intervention Following Endovascular Aneurysm Repair Frank R. Arko, MD; W. Anthony Lee, MD; Bradley B. Hill, MD; Paul Cipriano,

More information

Advances in Treatment of Traumatic Aortic Transection

Advances in Treatment of Traumatic Aortic Transection Advances in Treatment of Traumatic Aortic Transection Himanshu J. Patel MD University of Michigan Medical Center Author Disclosures Consulting fees from WL Gore Inc. There is no disease more conducive

More information

Patient Information Booklet

Patient Information Booklet Patient Information Booklet Endovascular Stent Grafts: A Treatment for Thoracic Aortic Aneurysms Table of Contents Table of Contents Introduction 1 Anatomy of the Thoracic Aorta 2 What Is an Aneurysm?

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 surgery in Marfan syndrome: CON

Endovascular surgery in Marfan syndrome: CON Perspective Endovascular surgery in Marfan syndrome: CON Nicholas T. Kouchoukos Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, BJC Healthcare, St. Louis, Missouri, USA

More information

Are stent-grafts for acute type B dissection durable? Est-ce que les stents graft pour la dissection aigue de type B sont efficaces à moyen terme?

Are stent-grafts for acute type B dissection durable? Est-ce que les stents graft pour la dissection aigue de type B sont efficaces à moyen terme? Are stent-grafts for acute type B dissection durable? Est-ce que les stents graft pour la dissection aigue de type B sont efficaces à moyen terme? Martin Björck, Johnny Steuer, Anders Wanhainen Uppsala

More information

ENCORE, a Study to Investigate the Durability of Polymer EVAR with Ovation A Contemporary Review of 1296 Patients

ENCORE, a Study to Investigate the Durability of Polymer EVAR with Ovation A Contemporary Review of 1296 Patients ENCORE, a Study to Investigate the Durability of Polymer EVAR with Ovation A Contemporary Review of 1296 Patients The Ovation System is approved to treat infrarenal abdominal aortic aneurysms and is not

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

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

INL No. A0083 Project Medtronic Thoracic patients guide Description Version 18

INL No. A0083 Project Medtronic Thoracic patients guide Description Version 18 INL No. A0083 Project Medtronic Thoracic patients guide Description Version 18 www.inl-agency.com PATIENT INFORMATION BOOKLET Endovascular Stent Grafts: A treatment for Thoracic Aortic disease Table of

More information

Aortic stents, types, selection, tricks in deployment.

Aortic stents, types, selection, tricks in deployment. Aortic stents, types, selection, tricks in deployment. Hamdy Soliman.M.D,FSCAI Consultant of Cardiology&Head of Endovascular Unit National Heart Institute Endovascular Treatment of Thoracic Aortic Aneurysms

More information

Abdominal Aortic Aneurysms. A Surgeons Perspective Dr. Derek D. Muehrcke

Abdominal Aortic Aneurysms. A Surgeons Perspective Dr. Derek D. Muehrcke Abdominal Aortic Aneurysms A Surgeons Perspective Dr. Derek D. Muehrcke Aneurysm Definition The abnormal enlargement or bulging of an artery caused by an injury or weakness in the blood vessel wall A localized

More information

Arch Repair with the Bolton Medical RelayBranch Thoracic Stent-graft system: Multicenter experience

Arch Repair with the Bolton Medical RelayBranch Thoracic Stent-graft system: Multicenter experience Arch Repair with the Bolton Medical RelayBranch Thoracic Stent-graft system: Multicenter experience Joost van Herwaarden, MD, PhD University Medical Center, Utrecht Disclosure I have the following potential

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

Stent-Graft Repair of Penetrating Atherosclerotic Ulcers in the Descending Thoracic Aorta: Mid-Term Results

Stent-Graft Repair of Penetrating Atherosclerotic Ulcers in the Descending Thoracic Aorta: Mid-Term Results Stent-Graft Repair of Penetrating Atherosclerotic Ulcers in the Descending Thoracic Aorta: Mid-Term Results Philippe Demers, MD, MS, D. Craig Miller, MD, R. Scott Mitchell, MD, Stephen T. Kee, MD, Lynn

More information

Ascending Aorta: Is The Endovascular Approach Realistic?

Ascending Aorta: Is The Endovascular Approach Realistic? Ascending Aorta: Is The Endovascular Approach Realistic? Tilo Kölbel, MD, PhD University Heart Center Hamburg University Hospital Eppendorf Disclosures Research-grants, travelling, proctoring speaking-fees,

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

Re-interventions after TEVAR:

Re-interventions after TEVAR: Re-interventions after TEVAR: How often does it occur and what are procedures most commonly utilized to treat these issues? Pacific Northwest Endovascular Conference Seattle, WA June 15, 2018 PENN Surgery

More information

Talent Abdominal Stent Graft

Talent Abdominal Stent Graft Talent Abdominal with THE Xcelerant Hydro Delivery System Expanding the Indications for EVAR Treat More Patients Short Necks The Talent Abdominal is the only FDA-approved device for proximal aortic neck

More information

Aggressive Resection/Reconstruction of the Aortic Arch in Type A Dissection

Aggressive Resection/Reconstruction of the Aortic Arch in Type A Dissection Aggressive Resection/Reconstruction of the Aortic Arch in Type A Dissection M. Grabenwoger Dept. of Cardiovascular Surgery Hospital Hietzing Vienna, Austria Disclosure Statement Consultant of Jotec, Hechingen,

More information

Complex Thoracic and Abdominal Aortic Repair Using Hybrid Techniques

Complex Thoracic and Abdominal Aortic Repair Using Hybrid Techniques Complex Thoracic and Abdominal Aortic Repair Using Hybrid Techniques Tariq Almerey MD, January Moore BA, Houssam Farres MD, Richard Agnew MD, W. Andrew Oldenburg MD, Albert Hakaim MD Department of Vascular

More information

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

Endovascular therapy for Ischemic versus Nonischemic complicated acute type B aortic dissection (catbad).

Endovascular therapy for Ischemic versus Nonischemic complicated acute type B aortic dissection (catbad). Endovascular therapy for Ischemic versus Nonischemic complicated acute type B aortic dissection (catbad). AS. Eleshra, MD 1, T. Kölbel, MD, PhD 1, F. Rohlffs, MD 1, N. Tsilimparis, MD, PhD 1,2 Ahmed Eleshra

More information

MODERN METHODS FOR TREATING ABDOMINAL ANEURYSMS AND THORACIC AORTIC DISEASE

MODERN METHODS FOR TREATING ABDOMINAL ANEURYSMS AND THORACIC AORTIC DISEASE MODERN METHODS FOR TREATING ABDOMINAL ANEURYSMS AND THORACIC AORTIC DISEASE AAA FACTS 200,000 New Cases Each Year Ruptured AAA = 15,000 Deaths per Year in U.S. 13th Leading Cause of Death 80% Chance of

More information

How to select FEVAR versus EVAR + endoanchors in short-necked AAAs

How to select FEVAR versus EVAR + endoanchors in short-necked AAAs How to select FEVAR versus EVAR + endoanchors in short-necked AAAs Jean-Paul P.M. de Vries, Richte C.L. Schuurmann St. Antonius Hospital Nieuwegein, The Netherlands 21st Critical Issues Congress Nuernberg,

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

The Management and Treatment of Ruptured Abdominal Aortic Aneurysm (RAAA)

The Management and Treatment of Ruptured Abdominal Aortic Aneurysm (RAAA) The Management and Treatment of Ruptured Abdominal Aortic Aneurysm (RAAA) Disclosure Speaker name: Ren Wei, Li Zhui, Li Fenghe, Zhao Yu Department of Vascular Surgery, The First Affiliated Hospital of

More information

Challenges with Complex Anatomies Advancing Care in Endovascular Aortic Treatment

Challenges with Complex Anatomies Advancing Care in Endovascular Aortic Treatment Challenges with Complex Anatomies Advancing Care in Endovascular Aortic Treatment Robert Y. Rhee, MD Chief, Vascular and Endovascular Surgery Director, Aortic Center Maimonides Medical Center Brooklyn,

More information

Abdominal and thoracic aneurysm repair

Abdominal and thoracic aneurysm repair Abdominal and thoracic aneurysm repair William A. Gray MD Director, Endovascular Intervention Cardiovascular Research Foundation Columbia University Medical Center Abdominal Aortic Aneurysm Endografts

More information

Recent studies have demonstrated the feasibility of. Survival Benefit of Endovascular Descending Thoracic Aortic Repair for the High-Risk Patient

Recent studies have demonstrated the feasibility of. Survival Benefit of Endovascular Descending Thoracic Aortic Repair for the High-Risk Patient Survival Benefit of Endovascular Descending Thoracic Aortic Repair for the High-Risk Patient Himanshu J. Patel, MD, Michael S. Shillingford, MD, David M. Williams, MD, Gilbert R. Upchurch, Jr, MD, Narasimham

More information

EVAR replaced standard repair in most cases. Why?

EVAR replaced standard repair in most cases. Why? EVAR replaced standard repair in most cases. Why? Initial major steps in endograft evolution Papazoglou O. Konstantinos M.D. The story of a major breakthrough in vascular surgery 1991 Parodi introduces

More information

Vascular Intervention

Vascular Intervention 10 : 389-393, 2001 B Vascular Intervention 1 1 2 1 1 1 1 3 2 1 1997 7 2000 4 B 29 19 10 50 84 66.1 stent graft S/G primary entry stenting S/G 12 4 2 1 1 40 mm 8 1 MOF 1 endoleak + 11 91.6% 10 stenting

More information

Dissection de type B: l étude Instead et corollaire stratégique

Dissection de type B: l étude Instead et corollaire stratégique Dissection de type B: l étude Instead et corollaire stratégique Christoph A. Nienaber, MD, FACC University Rostock Heartcenter Med. Clinic I Cardiology christoph.nienaber@med.uni-rostock.de Type B aortic

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

Role of Gender in TEVAR and EVAR results from the GREAT registry

Role of Gender in TEVAR and EVAR results from the GREAT registry Role of Gender in TEVAR and EVAR results from the GREAT registry Mauro Gargiulo Vascular Surgery University of Bologna - DIMES Policlinico S.Orsola-Malpighi Bologna, Italy mauro.gargiulo2@unibo.it Disclosure

More information

Influence of Oversizing on Outcome in Thoracic Endovascular Aortic Repair

Influence of Oversizing on Outcome in Thoracic Endovascular Aortic Repair 738 J ENDOVASC THER 2013;20:738 745 CLINICAL INVESTIGATION Influence of Oversizing on Outcome in Thoracic Endovascular Aortic Repair Jip L. Tolenaar, MD 1,2 ; Frederik H.W. Jonker, MD, PhD 3 ; Frans L.

More information

Description. Section: Surgery Effective Date: October 15, 2016 Subsection: Surgery Original Policy Date: December 7, 2011 Subject:

Description. Section: Surgery Effective Date: October 15, 2016 Subsection: Surgery Original Policy Date: December 7, 2011 Subject: Last Review Status/Date: September 2016 Page: 1 of 30 Description Thoracic endovascular aneurysm repair (TEVAR) involves the percutaneous placement of a stent graft in the descending thoracic or thoracoabdominal

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

How Did We Get To The? CT Scan Granularity & Development of TAVER. Multi & Single Center Reports Getting Us Closer to Answer

How Did We Get To The? CT Scan Granularity & Development of TAVER. Multi & Single Center Reports Getting Us Closer to Answer How Did We Get To The? CT Scan Granularity & Development of TAVER Multi & Single Center Reports Getting Us Closer to Answer # Patients Dying That anyone survives complete transection of this artery is

More information

Blunt aortic injury (BAI) is a life-threatening complication

Blunt aortic injury (BAI) is a life-threatening complication Blunt Traumatic Aortic Transection: The Endovascular Experience Victoria P. Orford, MBBS (Hons), Noel R. Atkinson, FRACS, Ken Thomson, MD, Peter Y. Milne, FRACS, William A. Campbell, FRACS, Andrew Roberts,

More information

Endovascular Management of Thoracic Aortic Pathology Stéphan Haulon, J Sobocinski, B Maurel, T Martin-Gonzalez, R Spear, A Hertault, R Azzaoui

Endovascular Management of Thoracic Aortic Pathology Stéphan Haulon, J Sobocinski, B Maurel, T Martin-Gonzalez, R Spear, A Hertault, R Azzaoui Endovascular Management of Thoracic Aortic Pathology Stéphan Haulon, J Sobocinski, B Maurel, T Martin-Gonzalez, R Spear, A Hertault, R Azzaoui Aortic Center, Lille University Hospital, France Disclosures

More information

Importance of changes in thoracic and abdominal aortic stiffness following stent graft implantation

Importance of changes in thoracic and abdominal aortic stiffness following stent graft implantation 14/9/2018 Importance of changes in thoracic and abdominal aortic stiffness following stent graft implantation Christos D. Liapis, MD, FACS, FRCS, FEBVS Professor (Em) of Vascular Surgery National & Kapodistrian

More information

Accepted Manuscript. Is A More Extensive Operation Justified for Acute Type A Dissection Repair? Dr. Leonard N. Girardi

Accepted Manuscript. Is A More Extensive Operation Justified for Acute Type A Dissection Repair? Dr. Leonard N. Girardi Accepted Manuscript Is A More Extensive Operation Justified for Acute Type A Dissection Repair? Dr. Leonard N. Girardi PII: S0022-5223(18)32552-2 DOI: 10.1016/j.jtcvs.2018.09.048 Reference: YMTC 13502

More information

Anatomical challenges in EVAR

Anatomical challenges in EVAR Anatomical challenges in EVAR M.H. EL DESSOKI, MD,FRCS PROFESSOR OF VASCULAR SURGERY CAIRO UNIVERSITY Disclosure Speaker name:... I have the following potential conflicts of interest to report: Consulting

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

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

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

Combined Open and Endovascular Repair for Aortic Arch Pathology

Combined Open and Endovascular Repair for Aortic Arch Pathology ORIGINAL ARTICLE DOI 10.4070 / kcj.2010.40.8.399 Print ISSN 1738-5520 / On-line ISSN 1738-5555 Copyright 2010 The Korean Society of Cardiology Open Access Combined Open and Endovascular Repair for Aortic

More information

Endovascular Stent Grafts for Disorders of the Thoracic Aorta

Endovascular Stent Grafts for Disorders of the Thoracic Aorta Endovascular Stent Grafts for Disorders of the Thoracic Aorta Policy Number: 7.01.86 Last Review: 9/2018 Origination: 5/2006 Next Review: 9/2019 Policy Blue Cross and Blue Shield of Kansas City (Blue KC)

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

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

I have the following financial relationships to disclose:

I have the following financial relationships to disclose: Novel Approaches to Endovascular Management of Aortic Aneurysms Rodney A White, MD Medical Director, Vascular Services MemorialCare Heart & Vascular Institute Long Beach Memorial Hospital Long Beach, California

More information

Treatment of complex thoracic cases Focus on the new Gore Active Control TAG device

Treatment of complex thoracic cases Focus on the new Gore Active Control TAG device Treatment of complex thoracic cases Focus on the new Gore Active Control TAG device Professor Christoph A. Nienaber The Royal Brompton and Harefield NHS Trust Cardiology and Aortic Centre C.Nienaber@rbht.nhs.uk

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

UC SF An Algorithm to Choose Which Uncomplicated (Asymptomatic) Acute Type B Dissection Patients Should Undergo TEVAR. Disclosures.

UC SF An Algorithm to Choose Which Uncomplicated (Asymptomatic) Acute Type B Dissection Patients Should Undergo TEVAR. Disclosures. An Algorithm to Choose Which Uncomplicated (Asymptomatic) Acute Type B Dissection Patients Should Undergo TEVAR Disclosures Royalties and research grant support from Cook Medical, Inc. Jade S. Hiramoto,

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

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

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

Endovascular Stent Grafts for Disorders of the Thoracic Aorta

Endovascular Stent Grafts for Disorders of the Thoracic Aorta Endovascular Stent Grafts for Disorders of the Thoracic Aorta Policy Number: 7.01.86 Last Review: 9/2017 Origination: 5/2006 Next Review: 9/2018 Policy Blue Cross and Blue Shield of Kansas City (Blue KC)

More information

AORTIC DISSECTIONS Current Management. TOMAS D. MARTIN, MD, LAT Professor, TCV Surgery Director UF Health Aortic Disease Center University of Florida

AORTIC DISSECTIONS Current Management. TOMAS D. MARTIN, MD, LAT Professor, TCV Surgery Director UF Health Aortic Disease Center University of Florida AORTIC DISSECTIONS Current Management TOMAS D. MARTIN, MD, LAT Professor, TCV Surgery Director UF Health Aortic Disease Center University of Florida DISCLOSURES Terumo Medtronic Cook Edwards Cryolife AORTIC

More information

Improving Endograft Durability with EndoAnchors

Improving Endograft Durability with EndoAnchors Improving Endograft Durability with EndoAnchors William D. Jordan, Jr., M.D. John E. Skandalakis Chair in Surgery Professor and Chief Division of Vascular Surgery and Endovascular Therapy Emory University

More information

Taming The Aorta. David Minion, MD Program Director, Vascular Surgery University of Kentucky Medical Center Lexington, Kentucky, USA

Taming The Aorta. David Minion, MD Program Director, Vascular Surgery University of Kentucky Medical Center Lexington, Kentucky, USA Taming The Aorta David Minion, MD Program Director, Vascular Surgery University of Kentucky Medical Center Lexington, Kentucky, USA Faculty Disclosure Consulting: Endologix, Cook 1 Objectives Review the

More information

Understanding the Predictors of Aneurysmal Degeneration in Type B Dissection

Understanding the Predictors of Aneurysmal Degeneration in Type B Dissection Understanding the Predictors of Aneurysmal Degeneration in Type B Dissection A case example illustrating when early endovascular intervention may provide the best outcome. BY DITTMAR BÖCKLER, MD, PhD;

More information

Endovascular Stent Grafts for Disorders of the Thoracic Aorta

Endovascular Stent Grafts for Disorders of the Thoracic Aorta 7.01.86 Endovascular Stent Grafts for Disorders of the Thoracic Aorta Section 7.0 Surgery Subsection Effective Date September 30, 2014 Original Policy Date September 27, 2013 Next Review Date September

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

When to use standard EVAR with EndoAnchors or CHEVAR in short-neck AAAs LINC ASIA 18

When to use standard EVAR with EndoAnchors or CHEVAR in short-neck AAAs LINC ASIA 18 When to use standard EVAR with EndoAnchors or CHEVAR in short-neck AAAs JEAN-PAUL P.M. DE VRIES, DIRECTOR OF VASCULAR SURGERY ST.ANTONIUS HOSPITAL NIEUWEGEIN, THE NETHERLANDS. LINC ASIA-PACIFIC HongKong,

More information

Hostile Neck During EVAR, The Role Of Endoanchores

Hostile Neck During EVAR, The Role Of Endoanchores Hostile Neck During EVAR, The Role Of Endoanchores Samer Koussayer, MD, FACS, RVT Prof, Al Faisal University Section Head and consultant Vascular & Endovascular Surgery Division King Faisal Specialist

More information

The second half of the 20th century produced significant advances in the

The second half of the 20th century produced significant advances in the Midterm results of endovascular treatment of atherosclerotic aneurysms of the descending thoracic aorta Bertrand Marcheix, MD, a Camille Dambrin, MD, PhD, a Jean-Philippe Bolduc, MD, b Catherine Arnaud,

More information

Aortic Arch Treatment Open versus Endo Evidence versus Zeitgeist. M. Grabenwoger Dept. of Cardiovascular Surgery Hospital Hietzing Vienna, Austria

Aortic Arch Treatment Open versus Endo Evidence versus Zeitgeist. M. Grabenwoger Dept. of Cardiovascular Surgery Hospital Hietzing Vienna, Austria Aortic Arch Treatment Open versus Endo Evidence versus Zeitgeist M. Grabenwoger Dept. of Cardiovascular Surgery Hospital Hietzing Vienna, Austria Evidence Surgical aortic arch replacement with a Dacron

More information

Surgery for Acquired Cardiovascular Disease

Surgery for Acquired Cardiovascular Disease Resch et al Changes in aneurysm morphology and stent-graft configuration after endovascular repair of aneurysms of the descending thoracic aorta Timothy Resch, MD, PhD a Bansi Koul, MD, PhD d Nuno V. Dias,

More information

Acute and contained rupture of the descending thoracic aorta: Treatment with endovascular stent grafts

Acute and contained rupture of the descending thoracic aorta: Treatment with endovascular stent grafts Acute and contained of the descending : Treatment with endovascular stent grafts Noriyuki Kato, MD, a Tadanori Hirano, MD, c Masaki Ishida, MD, a Takatsugu Shimono, MD, b Shao Hua Cheng, MD, a Isao Yada,

More information

From 1996 to 1999, a total of 1,193 patients with

From 1996 to 1999, a total of 1,193 patients with THE ANEURX CLINICAL TRIAL AT 8 YEARS Lessons learned following the US AneuRx clinical trial from 1996 to 2004. BY CHRISTOPHER K. ZARINS, MD From 1996 to 1999, a total of 1,193 patients with infrarenal

More information

Analysis of Type IIIb Endoleaks Encountered with Endologix Endografts

Analysis of Type IIIb Endoleaks Encountered with Endologix Endografts Analysis of Type IIIb Endoleaks Encountered with Endologix Endografts Alan R. Wladis, MD, FACS, David Varnagy, MD, FACS, Manuel R. Perez-Izquierdo, MD, Mark Ranson, MD FACS, Delos Clift, MD FACS, Rebecca

More information

Emergency Endovascular Stent-Grafting for Life-Threatening Acute Type B Aortic Dissections

Emergency Endovascular Stent-Grafting for Life-Threatening Acute Type B Aortic Dissections Emergency Endovascular Stent-Grafting for Life-Threatening Acute Type B Aortic Dissections Lennart F. Duebener, MD, Peter Lorenzen, MD, Gert Richardt, MD, Martin Misfeld, MD, Axel Nötzold, MD, Franz Hartmann,

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

Ascending Aorta: The Endovascular Approach

Ascending Aorta: The Endovascular Approach University Heart Center Hamburg GERMAN AORTIC CENTER Ascending Aorta: The Endovascular Approach Tilo Kölbel, MD, PhD University Heart Center Hamburg University Hospital Eppendorf Gold Standard for Ascending

More information

Endovascular Repair Of Traumatic, Degenerative And Mycotic Aortic Aneurysms: A Single Center Experience

Endovascular Repair Of Traumatic, Degenerative And Mycotic Aortic Aneurysms: A Single Center Experience Endovascular Repair Of Traumatic, Degenerative And Mycotic Aortic Aneurysms: A Single Center Experience Poster No.: C-2349 Congress: ECR 2014 Type: Scientific Exhibit Authors: Y. M. H. Al Bulushi, R. ALSukaiti;

More information

How to Categorize the Infrarenal Neck Properly? I Van Herzeele Dept. Thoracic and Vascular Surgery, Ghent University, Belgium

How to Categorize the Infrarenal Neck Properly? I Van Herzeele Dept. Thoracic and Vascular Surgery, Ghent University, Belgium How to Categorize the Infrarenal Neck Properly? I Van Herzeele Dept. Thoracic and Vascular Surgery, Ghent University, Belgium Disclosure Speaker name: Isabelle Van Herzeele I have the following potential

More information