Aortic Center of Excellence at Sentara
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1 Gordon K. Stokes, MD, FACS Eastern Virginia Medical School Sentara Vascular Specialists Norfolk, VA Aortic Center of Excellence at Sentara April 25, 2014
2 Disclosures I have no disclosures relevant to this presentation.
3 It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has. William Osler,
4 Aortic Dissection
5 Intramural Hematoma
6 Penetrating Aortic Ulcer
7 Blunt Aortic Injury
8 Thoracic Aneurysm
9 TAD Incidence is Directly Related to Age 34,835,000 70,319,000 Increasing prevalence of thoracic aortic disease Year U.S. population 65 yr old (millions)
10 Abdominal Aortic Aneurysm
11 AAA Rupture is the 15th leading cause of death in Men AAA Death rate by age
12 AAA Rupture is the 15th leading cause of death in Men % of the population > 50 yr 6.3% men > 65 yr AAA Death rate by age
13 Endo-Vascular Aneurysm Repair EVAR
14 Abdominal Aortic Aneurysm Repair
15 Thoracoabdominal Aneurysm Surgery
16 Complex Aortic Aneurysm Repair Aortic aneurysms were the primary cause of 10,597 deaths and a contributing cause in more than 17,215 deaths in the United States in 2009.
17 Spinal Cord Protection Anesthesiology Expertise in Spinal Drainage Vascular Intensive Care Unit Spinal drain management
18 TEVAR with Visceral De-branching
19 TEVAR with Visceral De-branching
20 Complex Hybrid TEVAR/EVAR
21 Thoracic Endovascular Aorta Repair (TEVAR) with Great Vessel Snorkel
22 Arch De-branching to Facilitate TEVAR
23 Fenestrated and Branched Stent Grafts TEVAR for Arch
24 Mortality by Hospital Volume after Surgical Repair of Thoraco-abdominal Aneurysms. John A Cowan Jr, Justin B Dimick, Peter K Henke, Thomas S Huber, James C Stanley, Gilbert R Upchurch Jr Journal of Vascular Surgery, Volume 37, Issue 6, 2003,
25 Mortality by Surgeon Volume after Repair of Thoraco-abdominal Aortic Aneurysms John A Cowan Jr, Justin B Dimick, Peter K Henke, Thomas S Huber, James C Stanley, Gilbert R Upchurch Jr Journal of Vascular Surgery, Volume 37, Issue 6, 2003,
26 Aortic Dissection Increasing incidence 5-30/1 million people/year 2-3 times as frequent as Ruptured AAA Male to Female 2:1
27 Aortic Dissection Etiology Atherosclerosis Increased wall stress Aortic Media abnormalities Iatrogenic Other
28 Aortic Dissection Etiology Atherosclerosis Increased wall stress Aortic Media abnormalities Iatrogenic Other
29 Type A Aortic Dissection repair
30 Type A Aortic Dissection repair
31 Type A Aortic Dissection repair
32 Patent false lumen 69.7% Aorta dilated >/= 1 cm 47.5% Shrinkage occurred in 95.8% with thrombosed false lumen Park et. al., Ann Thorac Surg 2009,87:103-8
33 Chronic Complex Arch Dissecting Aneurysm
34 Acute Type A Stented Elephant Trunk Pochettino, Szeto, and Bavaria; AnnThor Surg 2009
35 Chronic Distal Dissecting Aneurysm
36 Does TEVAR Prevent Aneurysmal Degeneration in Acute Uncomplicated Type B Aortic Dissection
37
38 INSTEAD TRIAL Randomized Trial 140 patients Acute un-complicated Type B Dissection TEVAR vs Optimal Medical Treatment Primary End Point All cause Death Secondary End Points Aorta related Death Progression aortic disease Aortic remodeling
39 Five year INSTEAD Data TEVAR Medical All Cause Mortality Aorta Specific Mortality Aortic Disease Progression Aortic Remodeling 11.1% 19.3% P= % 19.3% P= % 46.0% P= % 19.4% P<0.0001
40 Complicated Aortic Dissection Mal-Perfusion
41 Intra Vascular Ultrasound (IVUS)
42 Zenith Dissection Clinical Study STABLE II Prospective nonrandomized study 67 patients 30 Global clinical centers Acute complicated Type B Dissection
43 Aortic Center of Excellence at Sentara High volume center Regionalize care Optimize outcomes Facilitate follow-up Easy access High Volume Quality
44 Aortic Center of Excellence at Sentara Protocols CTA Protocol Patient transfer Protocol Multidisciplinary Team Quality Outcomes Database Chronic Aortic Disease Management
45 Aortic Center of Excellence at Sentara Advanced Imaging CTA Chest Abdomen and Pelvis MRI/MRA TEE IVUS Carotid Duplex Head Neck CTA
46 Aortic Center of Excellence at Sentara Seamless Care Advanced Imaging Expert Evaluation Timely Intervention Long-term follow-up Coordinated and technologically advanced Multidisciplinary Team
47 Aortic Center of Excellence at Sentara 100 mile radius
48
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P Paraplegia abdominal aortic aneurysm repair, 52 paraparesis, 52 pathophysiology, 51 rates and endografts, 51 two-stage approach, 129
A AAA. See Abdominal aortic aneurysm (AAA) Abdominal aortic aneurysm (AAA). See also Abdominal aortic pathologies advantage, IVUS, 20 asymptomatic infrarenal, 154 device selection and treatment, 19 20
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