How Did We Get To The? CT Scan Granularity & Development of TAVER. Multi & Single Center Reports Getting Us Closer to Answer
|
|
|
- Toby Harris
- 6 years ago
- Views:
Transcription
1 How Did We Get To The? CT Scan Granularity & Development of TAVER Multi & Single Center Reports Getting Us Closer to Answer
2 # Patients Dying That anyone survives complete transection of this artery is almost unbelievable Parmley,LF Circ,June DOA 24 ALIVE Isthmus Rupture <1H 1<6 H 6-<24H 1-2D 3-4D 5-7D 8-14D 15D-3M 4-12M 2-3Y
3 Patients 3 Eras
4 AAST II Level 1 Trauma Ctrs. ISS: 35.6 v 42.4 TAVER V. OPEN 453 BTAI Pts. Mediastinial Treatment Hematoma: Non-Random 26 v 51% NOM(91),TAVER(198), OPEN(61) prbc : 0 v 3 units Hosp Mortality: 8.6 v. 19.7%(all cause) 2.5 v. 13.1%(aortic) DuBose,JTraumaAcute Care Surg 2015;78:
5 CT Replaces Angiography AATS 1 (1998) vs. AATS 2 (2008) 8.3% vs. 84.4%
6 Lesions Grades Azizzadeh,J Vas Surg.2009;49: (24.6%) 68(17.8%) 192(50.3%) 28(7.4%) DuBose,JTraumaAcute Care Surg 2015;78:
7 Treatment BTAI ASST II % TAVER vs 23.5% Open vs 32.2% Non Op DuBose,JTraumaAcute Care Surg 2015;78:
8 Early Technology Challenging
9 Improving Technology Conformational Endograft ASSTS I 2008 vs ASSTS II 2015 Endo Complication 18.4% (13.6 e-leak) vs 5.5% DuBose,JTraumaAcute Care Surg 2015;78:
10 Predictors Aortic Mortality BTAI Pts Variable Odds Ratio p ISS Lesion Grade TEVAR Chest AIS Score DuBose,JTraumaAcute Care Surg 2015;78:
11 TEVAR vs. OPEN REPAIR Time to Treatment, Open vs. TEVAR Mean Time to Rx Open 34hr TAVER 74 hr! Open Cases TAVR Cases Column1 Admission 6 Hours 24 Hours 48 Hours DuBose,JTraumaAcute Care Surg 2015;78:
12 LEE,WA J Vasc Surg 2011;53:187-92
13 Non-operative Management of Blunt Traumatic Aortic Injury (BTAI) Joseph Rabin MD, Joe DuBose MD, Clint W. Sliker MD, James V. O Connor MD, Thomas M. Scalea MD, and Bartley P. Griffith MD. Disclosures: None
14 Excluded: in extremis low grade lesions repair < 48 hrs non-aortic death < 48h 284 BTAI UMD patients Stable + high grade lesion 18 Rupture: Contrast extravasation Surgery or autopsy 31 Stable: No repair within 48 hrs HarrisDG,TaylorB, J Vasc Surg 2015;61:332-8
15 Model Construction Factors dichotomized for univariate analysis Strongest factor from each data group included for multivariate analysis Factors weighted according to β coefficient A priori goal of 100% sensitivity HarrisDG, J Vasc Surg 2015;61:332-8
16 Factor mm Lactate > 4 mm Diameter ratio > 1.4 DTA hematoma > 10 mm Lactate β coefficient Multivariate P Odds Ratio Weig ht ( ) ( ) 0.53 < ( ) Model Components 2 2 3
17 Points 7 Sensitivity: 100% Specificity: 84% Accuracy: 90% AUROC Rupture, n=18 Stable, n=31 Mean: 6 ± 1 2 ± 2 P <
18 Operational Use High risk for aortic rupture when any 2 are present: Lactate > 4 mm Mediastinal hematoma > 10 mm Lesion: normal aortic ratio > 1.4 mm HarrisDG, J Vasc Surg 2015;61:332-8
19 What Happens to the 20 yo trauma patient with a 20mm device who is going to live 50 years? What is the durability of the device? Now 15 year data. Discussion AATS, JTCVS 2010;140: Anthony Caffarelli AATS
20 Standford Led TAVER but... CT indicative of Stable Aorta but, 70% Small Pseudo Aneurysms <3cm Caffarelli: The Journal of Thoracic and Cardiovascular Surgery, Volume 140, 2010,
21 Bart s Recommendations Grade I & II Watch with Med Rx Grade III <4 cms can watch if needed but prefer treating Model Seems Reasonable Guide 2 of 3 Lactate>4, Hematoma>10, Lesion/Aorta>1.4
22
23 Delayed Repair May Reduce TBI EARLY REPAIR DELAYED REPAIR # Patients P Value Days to Repair GCS & BAIS 7 & 4 9 & 4 ns Progressive TBI 34% 0 % Mortality 7 (24 %) 4 (17%) ns Rabin, AnnThoracSurg 2014;98:46-52
24 Model Performance Sensitivity AUROC: 0.98 ( ) Specificity
25 Outcome Outcomes Rupture, n = 18 Stable, n = 31 Inpatient mortality 89% 23% Aortic mortality 83% 0% CT to decompensation, med (IQR) 64hr (44 124) n/a
26 Can a Aortic Injury Score Guide Early vs Delayed Treatment of BTAI Donald G. Harris, Joseph Rabin, Robert S. Crawford
27 J Vasc Surg 2011;53:187-92
28 J Vasc Surg 2011;53:187-92
29 Admission Lactate Rupture Stable mm
30 Admission Characteristic Derivation Rupture, Groups n = 18 Stable, n = 31 Age, yrs 48 ± ± Male, n (%) 14 (78) 21 (68) 0.53 Mean Art. Pressure, mmhg 84 ± ± Heart Rate, bpm 108 ± ± Glasgow coma scale 9 ± 5 11 ± Non-chest injury severity score 26 ± ± Revised trauma score 5.67 ± ± Hemoglobin, g/dl 12 ± 2 12 ± Lactate, mm 7 ± 3 4 ± P
31 Diameter Ratio
32 Periaortic Hematoma
33 High Grade Aortic Injury
34
35 High Grade Aortic Injury
36 Traumatic Aortic Injury Second most common cause of death due to blunt trauma Annual incidence in U.S. - 7,500-8,000 1,000-1,500 arrive to hospital alive Fabian TC, Richardson JD, Croce MA, Smith JS, Jr., Rodman G, Jr., Kearney PA, Flynn W, et al. Prospective study of blunt aortic injury: Multicenter Trial of the American Association for the Surgery of Trauma. J Trauma. 42: ; discussion 380-3, 1997.
37 Methods Retrospective study (7/2005-7/2007) 26 consecutive patients with TAI treated with aortic endograft Comparison Group 26 consecutive patients treated with open surgery (7/03-12/05) Left heart bypass (heparinized circuit)
38
39 Aortic Injury Morphology and Location Non-operative Survivors INJURY LOCATION INJURY TYPE Arch Isthmus Descending Intraluminal thrombus/intimal injury 2 4 Mural hematoma 1 1 Pseudoaneurysm <½ aortic circumference Pseudoaneurysm >½ aortic circumference Caffarelli et al. J Thorac Cardiovasc Surg :
40
41
42
43 Evolution in BTAI AATS 1 (1998) vs. AATS 2 (2008) Diagnosis by CT: 8.3 vs. 84.4% Endographic Repair now: 65% Reduced Mortality : 22 vs. 13% Procedural Paraplegia: 8.7 vs. 1.6 % Time to Rx: 16 vs. 54 Hrs.
44
45 Lactate: 2.6 mm Ratio: 1.7 Hematoma: 0 mm
46 Lactate: 4.4 mm Ratio: 1.6 Hematoma: 16 mm
47 Lactate: 4.4 mm Ratio: 1.6 Hematoma: 16 mm
48 Clinical Assessment Test 9 blinded vascular surgeon reviewers Vitals, labs & representative CT slices Performance compared to model
49 Model vs Clinical Assessment Clinical Test Risk Model P Sensitivity 0.7 ± < 0.05 Specificity 0.6 ± < 0.05 Accuracy 0.6 ± < 0.01
50 Discussion High grade BTAI Aortic risk score Negative Positive Delayed repair Immediate repair
51 Summary Risk score reliably identifies high-risk BTAI Improves patient selection Opportunity to optimize management of patients with high-grade aortic lesions
52 # Patients Dying ISTHUMUS RUPTURE <1H 1<6 H 6-<24H 1-2D 3-4D 5-7D 8-14D 15D-3M 4-12M 2-3Y
53
54
55 % TREATED Mean: 34Hr Mean:75Hr. OPEN vs TEVAR Admission 6 Hours 24 Hours 48 Hours HOURS to TREATMENT TEVAR Open Non-Op: 122pts(30%) Grade I & II 91 pts. vs TEVAR 61pts. Open: 61pts(16%) higher ISS, HemotomaComprssion, RBC tx TEVAR: 198 pts(54%)
56
57 Can an Aortic Injury Score Guide Early vs Delayed Treatment of BTAI
58
TEVAR for trauma is here to stay: Advances in the Treatment of Blunt Thoracic Aortic Injury
TEVAR for trauma is here to stay: Advances in the Treatment of Blunt Thoracic Aortic Injury Megan Brenner MD MS RPVI FACS Associate Professor of Surgery Division of Trauma/Surgical Critical Care, RA Cowley
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
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
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
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
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
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
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
Follow-up of Aortic Dissection: How, How Often, Which Consequences Euro Echo 2011
Follow-up of Aortic Dissection: How, How Often, Which Consequences Euro Echo 2011 Susan E. Wiegers, MD, FASE Director of Clinical Echocardiography Hospital of the University of Pennsylvania Disclosure
Contemporary Management of Blunt Thoracic Aortic Injury: Results of an EAST, AAST and SVS Survey by the Aortic Trauma Foundation
Original Article Vol. 1, No. 1; 2017; pp 4 8 DOI: 10.26676/jevtm.v1i1.8 Contemporary Management of Blunt Thoracic Aortic Injury: Results of an EAST, AAST and SVS Survey by the Aortic Trauma Foundation
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
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
Animesh Rathore, MD 4/21/17. Penetrating atherosclerotic ulcers of aorta
Animesh Rathore, MD 4/21/17 Penetrating atherosclerotic ulcers of aorta Disclosures No financial disclosures Thank You Dr. Panneton for giving this lecture for me. I am stuck at Norfolk with an emergency
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
What Determines Aortic False Lumen Growth Post Dissection?
Aortic Dissections What Determines Aortic False Lumen Growth Post Dissection? UCSF Vascular Symposium April 26, 2012 Most common aortic emergency Incidence of aortic dissections are 2/100,000 person-years
Delayed Surgical Management of Traumatic Pseudoaneurysm of the Ascending Aorta in Multiple Trauma
CASE REPORT J Trauma Inj 2018;31(1):29-33 http://doi.org/10.20408/jti.2018.31.1.29 JOURNAL OF TRAUMA AND INJURY Delayed Surgical Management of Traumatic Pseudoaneurysm of the Ascending Aorta in Multiple
High Risk Uncomplicated Type B Dissection
High Risk Uncomplicated Type B Dissection Ali Azizzadeh, MD, FACS Director, Vascular Surgery Vice Chair, Department of Surgery Associate Director, Heart Institute Cedars-Sinai Medical Center Los Angeles,
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
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
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
Changing Spectrum of Re-Interventions following TEVAR. 31 st Annual Florida Vascular Society. PENN Surgery
Changing Spectrum of Re-Interventions following TEVAR 31 st Annual Florida Vascular Society PENN Surgery No Disclosures Background: Challenges of analyzing TEVAR Outcomes in regard to re-interventions
CT Imaging of Blunt and Penetrating Vascular Trauma DENNIS FOLEY MEDICAL COLLEGE WISCONSIN
CT Imaging of Blunt and Penetrating Vascular Trauma DENNIS FOLEY MEDICAL COLLEGE WISCONSIN THORACO ABDOMINAL TRAUMA 0 10 20 30 40 50 60 5 cc/sec 30 secs 1.25 mm/ 55 mm Z1.375 2.5 mm/ 55 mm Z 1.375 Grade
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
Acute Aortic Dissection: Decision and Outcome
Acute Aortic Dissection: Decision and Outcome Marc R. Moon, M.D. John M. Shoenberg Chair in CV Disease Chief, Cardiac Surgery Director, Center for Diseases of the Thoracic Aorta Washington University School
EAST MULTICENTER STUDY DATA DICTIONARY. Temporary Intravascular Shunt Study Data Dictionary
EAST MULTICENTER STUDY DATA DICTIONARY Temporary Intravascular Shunt Study Data Dictionary Data Entry Points and appropriate definitions / clarifications: Entry space Definition / Instructions 1. Specific
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
Thoracic and Great Vessel Imaging and Intervention
Thoracic and Great Vessel Imaging and Intervention Shelley R. Marder, M.D. The Kaiser Permanente Medical Group Clinical Faculty, SFGH, UCSF Traumatic aortic injury Shearing / shoveling forces at junction
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,
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
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,
Optimal Treatment of Chronic Dissection
Optimal Treatment of Chronic Dissection Chun-Che Shih 施俊哲 MD, Ph.D. Chief, Professor Institute of Clinical Medicine National Yang Ming University Division of Cardiovascular Surgery Taipei Veterans General
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
ACUTE AORTIC SYNDROMES
ACUTE AORTIC SYNDROMES AGNETA FLINCK MD, PhD Dept. of Thoracic Radiology Sahlgrenska University Hospital ACUTE AORTIC SYNDROMES Aortic dissection Intramural hematoma (IMH) 5-20% Penetrating atherosclerotic
Early outcomes of acute retrograde dissection in the aortic arch and the ascending aorta data from IRAD
Early outcomes of acute retrograde dissection in the aortic arch and the ascending aorta data from IRAD Foeke JH Nauta, MD, PhD Resident Cardiothoracic Surgery, Academic Medical Center, Amsterdam Disclosure
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
Animesh Rathore, MD 4/22/17. The Great Debate 45yo Man With Uncomplicated Acute TBAD: The Case For Medical Management
Animesh Rathore, MD 4/22/17 The Great Debate 45yo Man With Uncomplicated Acute TBAD: The Case For Medical Management Disclosures Just a young vascular surgeon who would like to keep his job My opponent
TEVAR for the Ascending Aorta
TEVAR for the Ascending Aorta Himanshu J. Patel MD Joe D. Morris Collegiate Professor Section Head, Adult Cardiac Surgery University of Michigan Frankel Cardiovascular Center Disclosures Himanshu J. Patel
Determinants of Health: Effects of Funding on Quality of Care for Patients with severe TBI
Determinants of Health: Effects of Funding on Quality of Care for Patients with severe TBI Facts about traumatic brain injury Definitions & Outcomes Methods Results Conclusions Facts about TBI TBI (traumatic
Is there a way to predict the risk in uncomplicated Type B aortic dissections? FRANS MOLL University Medical Centre Utrecht - Netherlands
Is there a way to predict the risk in uncomplicated Type B aortic dissections? FRANS MOLL University Medical Centre Utrecht - Netherlands Disclosures: - Consultant Philips Health Care - Best Doctors Overview
A Validated Practical Risk Score to Predict the Need for RVAD after Continuous-flow LVAD
A Validated Practical Risk Score to Predict the Need for RVAD after Continuous-flow LVAD SK Singh MD MSc, DK Pujara MBBS, J Anand MD, WE Cohn MD, OH Frazier MD, HR Mallidi MD Division of Transplant & Assist
journal ORIGINAL RESEARCH
texas orthopaedic journal ORIGINAL RESEARCH Mortality with Circumferential Pelvic Compression for Pelvic Ring Disruption in Polytraumatized Patients: A Retrospective Analysis of 1,639 Pelvic Ring Injuries
Evolution of Thoracic Aortic Surgery A Rapidly Advancing Paradigm. October 15 th, 2014 Family Practice Evening Course University of Calgary
Evolution of Thoracic Aortic Surgery A Rapidly Advancing Paradigm October 15 th, 2014 Family Practice Evening Course University of Calgary Jehangir Appoo Division of Cardiac Surgery Libin Cardiovascular
Four-year Surgical Results for Traumatic Aortic Injury in China Medical University Hospital, Mid-Taiwan
Four-year Surgical Results for Traumatic Aortic Injury in China Medical University Hospital, Mid-Taiwan Yi-Chun Lin 林怡均 (5 th grade medical student), MingLi Li 李明禮, Chih-Hsiang Hsu, Ching-Feng Wu, Hui-Han
Chapter 2 Triage. Introduction. The Trauma Team
Chapter 2 Triage Chapter 2 Triage Introduction Existing trauma courses focus on a vertical or horizontal approach to the ABCDE assessment of an injured patient: A - Airway B - Breathing C - Circulation
Aortic Center of Excellence at Sentara
Gordon K. Stokes, MD, FACS Eastern Virginia Medical School Sentara Vascular Specialists Norfolk, VA Aortic Center of Excellence at Sentara April 25, 2014 Disclosures I have no disclosures relevant to this
Aortic Neck Issues Associated Clinical Sequelae/Implications for Graft Choice
Aortic Neck Issues Associated Clinical Sequelae/Implications for Graft Choice Eric Verhoeven, MD, PhD, A. Katsargyris, MD Department of Vascular and Endovascular Surgery, Paracelsus Medical University,
Introducing the GORE TAG Conformable Thoracic Stent Graft with ACTIVE CONTROL System
Introducing the GORE TAG Conformable Thoracic Stent Graft with ACTIVE CONTROL System K. Oikonomou Department of Vascular Surgery Regensburg University Disclosures W.L. Gore & Associates Sponsored Presentation
A 14-year experience with blunt thoracic aortic injury
From the New England Society for Vascular Surgery A 14-year experience with blunt thoracic aortic injury Jennifer Watson, MD, Jeffrey Slaiby, MD, Manuel Garcia Toca, MD, Edward J. Marcaccio Jr, MD, and
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
Endoanchor-assisted TEVAR
Endoanchor-assisted TEVAR May 29, 2015 NCVH2015 Grayson H. Wheatley III, MD Director of Aortic and Endovascular Surgery Associate Professor of Surgery Temple University School of Medicine Disclosures Consultant
Low profile TEVAR: is it an added value? Michel Bosiers, G. Torsello Münster
Low profile TEVAR: is it an added value? Michel Bosiers, G. Torsello Münster Disclosure Speaker name:...michel Bosiers... I have the following potential conflicts of interest to report: Consulting Employment
What Are the Current Guidelines for Treating Thoracic Aortic Disease?
What Are the Current Guidelines for Treating Thoracic Aortic Disease? Eric M. Isselbacher, M.D. Director, MGH Healthcare Transformation Lab Co-Director, MGH Thoracic Aortic Center Associate Professor of
Thoracic Endovascular Aortic Repair (TEVAR) Indications and Basic Procedure
Thoracic Endovascular Aortic Repair (TEVAR) Indications and Basic Procedure Tilo Kölbel, MD, PhD University Heart Center Hamburg University Hospital Eppendorf Disclosure Speaker name: Tilo Kölbel, MD I
Blunt traumatic aortic injury: Initial experience with endovascular repair
Blunt traumatic aortic injury: Initial experience with endovascular repair Ali Azizzadeh, MD, Kourosh Keyhani, DO, Charles C. Miller III, PhD, Sheila M. Coogan, MD, Hazim J. Safi, MD, and Anthony L. Estrera,
Aortic CT: Intramural Hematoma. Leslie E. Quint, M.D.
Aortic CT: Intramural Hematoma Leslie E. Quint, M.D. 43 M Mid back pain X several months What type of aortic disease? A. Aneurysm with intraluminal thrombus B. Chronic dissection with thrombosed false
From the Southern Association for Vascular Surgery
From the Southern Association for Vascular Surgery The advent of thoracic endovascular aortic repair is associated with broadened treatment eligibility and decreased overall mortality in traumatic thoracic
Remodeling of the Remnant Aorta after Acute Type A Aortic Dissection Surgery
Remodeling of the Remnant Aorta after Acute Type A Aortic Dissection Surgery Are Young Patients More Likely to Develop Adverse Aortic Remodeling of the Remnant Aorta Over Time? Suk Jung Choo¹, Jihoon Kim¹,
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
Effect of post-intubation hypotension on outcomes in major trauma patients
Effect of post-intubation hypotension on outcomes in major trauma patients Dr. Robert S. Green Professor, Emergency Medicine and Critical Care Dalhousie University Medical Director, Trauma Nova Scotia
Disclosures. Harborview Medical Center. Ruptured Aortic Aneurysms. April 6, Copyright UPM-Kymmene Group 1. Co-Founder: AORTICA Corporation
EVAR for Ruptured Abdominal Aortic Aneurysm How I Do It and What Are the Results? Disclosures Co-Founder: AORTICA Corporation Benjamin W. Starnes MD, FACS The Alexander Whitehill Clowes Endowed Chair of
OHSU. Blunt cerebrovascular injuries: anatomic and pathologic heterogeneity produce management uncertainties.
Kohler Pavilion With tram station Center for Health and Healing Top ten trauma papers published in the past year Presented at St Charles Medical Center, Bend, Oregon March 13, 2015 OHSU Richard J Mullins,
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
Redo treatment and open conversion after TEVAR
Redo treatment and open conversion after TEVAR Roberto Chiesa Vascular Surgery, Vita-Salute University Scientific Institute San Raffaele Milan, Italy Number of procedures Off-Label indications for TEVAR
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
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,
IMH/Penetrating Aortic Ulcers/ Saccular Aneurysms: How to manage and when to intervene
IMH/Penetrating Aortic Ulcers/ Saccular Aneurysms: How to manage and when to intervene UCSF Vascular Surgery Symposium 2018 Sukgu M Han, MD, MS Assistant Professor of Clinical Surgery Co-director, Comprehensive
Endo-Bentall: Fact or Fiction?
Endo-Bentall: Fact or Fiction? Eric E. Roselli, MD Chief, Adult Cardiac Surgery Surgical Director, Aorta Center Heart and Vascular Institute, Cleveland Clinic Disclosures Bolton Cook Cryolife Edwards Gore
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,
Management of Bleeding Pelvic Fractures
Management of Bleeding Pelvic Fractures Clay Cothren Burlew, MD FACS Professor of Surgery Program Director, SCC and TACS Fellowships Director, Surgical Intensive Care Unit Denver Health Medical Center/University
Delayed Splenic Rupture After Non-Operative Management of Blunt Splenic Injury A AAST Multi-Institutional Prospective Trial Data Collection Tool
Delayed Splenic Rupture After Non-Operative Management of Blunt Splenic Injury A AAST Multi-Institutional Prospective Trial Data Collection Tool Enrolling Center: Patient Number (sequential within center):
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
RESUSCITATION IN TRAUMA. Important things I have learnt
RESUSCITATION IN TRAUMA Important things I have learnt Trauma resuscitation through the decades What was hot and now is not 1970s 1980s 1990s 2000s Now 1977 Fluids Summary Dogs subjected to arterial hemorrhage
Emergency procedures on the descending thoracic aorta in the endovascular era
From the Southern Association for Vascular Surgery Emergency procedures on the descending thoracic aorta in the endovascular era Marc E. Mitchell, MD, Fred W. Rushton Jr, MD, A. Bradley Boland, MD, Taylor
Clinical management and treatment of thoracic aortic diseases. Evolution of IMH. Luigi Lovato
Clinical management and treatment of thoracic aortic diseases Evolution of IMH Luigi Lovato Cardio-Thoracic and Vascular Department Cardio-Thoracic Radiology-University Hospital S. Orsola-Malpighi Bologna-Italy
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
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
Case Presentation Conference Ravi Dhanisetty, M.D. Kings County Hospital Center
Case Presentation Morbidity and Mortality Conference Ravi Dhanisetty, M.D. Kings County Hospital Center 1 May 2009 Case Presentation 53 year old male bus driver had a syncopal episode and found down unresponsive.
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,
Diseases of the Aorta
Diseases of the Aorta ASE Review 2018 Susan E Wiegers, MD, FASE, FACC Professor of Medicine My great friend Dr. Roberto Lang Disclosure None related to this presentation 1 Objectives Aneurysm Dissection
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
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
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;
Asymptomatic Radiology / Clinical data Report / Cohort bias Referral bias. UCSF Vascular Symposium April 7-9, Acute Aortic Dissection
Aortic Dissection: Natural History What is the Natural History of Aortic Dissection? UCSF Vascular Symposium April 7-9, 2011 Asymptomatic Radiology / Clinical data Report / Cohort bias Referral bias Stephen
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
Recombinant Activated Factor VII: Useful. Department of Surgery Grand Rounds 11/8/10 David Mauchley MD
Recombinant Activated Factor VII: Useful Department of Surgery Grand Rounds 11/8/10 David Mauchley MD Hemostasis and Coagulation Traditional cascade model Two convergent pathways Series of proteolytic
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
The Current Status Of Endovascular Repair Of Ascending Aorta And Aortic Arch
The Current Status Of Endovascular Repair Of Ascending Aorta And Aortic Arch Tilo Kölbel German Aortic Center Dpt. of Vascular Medicine University Heart Center Hamburg Disclosures Research-grants, travelling,
Clinical Trials of Acute and Chronic Dissections. Gregory Landry MD
Clinical Trials of Acute and Chronic Dissections Gregory Landry MD No disclosures Acute vs chronic dissection: Definitions 1950s: Acute < 2 weeks, Chronic > 2 weeks 2013: European Interdisciplinary Consensus
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
TXA. Things Change. Tranexamic Acid TXA. Resuscitation 2017 TXA In The ED March 31, MAST Trousers. High Flow IV Fluids.
Resuscitation 2017 In The ED March 31, 2017 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN SECURE THE ABC S MAST
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
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;
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
Case Conference. Discussion. Indications of Trauma Blue. Trauma Protocol In SKH. Trauma Blue VS. Trauma Red. Supervisor:VS 楊毓錚 Presenter:R1 周光緯
Case Conference Supervisor:VS 楊毓錚 Presenter:R1 周光緯 Discussion 2010.7.14 2/81 Trauma Protocol In SKH Indications of Trauma Blue Trauma Blue VS. Trauma Red 3/81 Severe trauma mechanism : 1. Trauma to multiple
The Ventana Off-the-Shelf Graft for Pararenal AAA. Andrew Holden Associate Professor of Radiology Auckland Hospital
The Ventana Off-the-Shelf Graft for Pararenal AAA Andrew Holden Associate Professor of Radiology Auckland Hospital Disclosures Andrew Holden, MBChB, FRANZCR Investigator in Nellix and Ventana Trials Clinical
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
Perioperative mortality, paraplegia, stroke and long-term stent related complications after TEVAR for traumatic thoracic aortic lesions
Perioperative mortality, paraplegia, stroke and long-term stent related complications after TEVAR for traumatic thoracic aortic lesions Clark Zeebregts Professor of Vascular Surgery University Medical
2 nd AVRS 2016: Nimesh D. Desai, M.D., Ph.D. Co Director, Aortic and Vascular Center for Excellence University of Pennsylvania
2 nd AVRS 2016: Nimesh D. Desai, M.D., Ph.D. Co Director, Aortic and Vascular Center for Excellence University of Pennsylvania Knowing what to Do Know what NOT to Do The Exquisite art of Timing. or is
Just like Adults? Evaluating the Impact of Fluid Resuscitation in Pediatric Trauma
Just like Adults? Evaluating the Impact of Fluid Resuscitation in Pediatric Trauma Abbas PI 1,2, Carpenter K 2, Sheikh F 1,2, Peterson ML 1,2, Kljajic M 1, Naik-Mathuria B 1,2 1 Texas Children s Hospital
An outcome analysis of endovascular versus open repair of blunt traumatic aortic injuries
From the Southern Association for Vascular Surgery An outcome analysis of endovascular versus open repair of blunt traumatic aortic injuries Ali Azizzadeh, MD, a Kristofer M. Charlton-Ouw, MD, a Zhongxue