Abdominal Aortic Aneurysm Clinical Guideline

Size: px
Start display at page:

Download "Abdominal Aortic Aneurysm Clinical Guideline"

Transcription

1 Abdominal Aortic Aneurysm Clinical Guideline Definition: An abdominal aortic aneurysm (AAA) is an enlargement of the lower part of the aorta that extends through the abdominal area (at times, the upper portion of the aorta in the chest can be enlarged). The aorta is the main blood vessel that carries blood from the heart to the rest of the body. Like most arteries, the aorta is elastic, which allows it to be filled with blood under high pressure. An aneurysm develops when the wall of the artery becomes weakened and distended like a balloon. AAA suspected; are symptoms present? Based on history and physical Asymptomatic AAA Based on incidental imaging (spine MRI, US, CT, x-rays) Evaluate for key symptoms: back, flank, abdominal, leg, groin, scrotal pain signs of aortic fistula flank ecchymosis Evaluate for alternative symptoms: syncope, focal neurologic deficit (especially lower extremities), weakness, dizziness, GI bleed with anemia, anuria, or signs of limb ischemia Abdominal US imaging of choice Risk factor assessment (see Table One) Manage according to risk of rupture (see Table Three) imaging adequate at defining extent of aneurysm and maximum diameter including iliac arteries? Pre-notify vascular surgeon Order abdominal and pelvic CT angiogram Order abdominal and pelvic CT angiogram the patient hemodynamically unstable (SBP less than 100)? Manage according to risk of rupture (see Table Three) Physical exam suggests aneurysm and/or focused bedside ultrasound suggests aneurysm aneurysm known? AAA present? Prepare and transfer to endovascular suite Consider alternative diagnosis December 2015

2 Incidence, Mortality, and Risk Factors Abdominal aortic aneurysms (AAA) continue to be a significant medical and surgical problem with a high associated mortality rate. AAAs affect 4% to 9% of individuals over the age of 60, with a predilection for men between 65 and 79 years of age. The incidence of AAA is increasing as the population ages, with approximately 15,000 people dying from AAA each year in the United States (8,700 of these deaths occur from acute rupture). Abdominal aortic aneurysm is the tenth leading cause of death of older men in the United States and is responsible for 0.8% of all deaths. The mortality rate associated with elective operative repair is 2% to 6%, and there is a significant risk of major complications; higher complication rates are associated with emergent repair. The dreaded complication of an AAA is aortic rupture, which has a death rate of 80% for all patients reaching the hospital alive. The mortality rate is 50% for those patients able to undergo the emergent surgery necessary for vessel repair. An arterial aneurysm is defined as a permanent localized enlargement of an artery to more than 1.5 times its expected diameter. The normal abdominal aorta is 2 cm or less in diameter, and thus an abdominal aortic aneurysm is present once the aorta dilates to a diameter of 3 cm or more. Hypertension, diabetes, and hyperlipidemia contribute to atherosclerosis, which has traditionally been taught as the most significant risk factor for developing an AAA. Recent studies, however, have shown that genetics are more indicative of risk. Ruptured abdominal aortic aneurysms are a highly lethal vascular emergency. Mortality from an out-of-hospital rupture is over 60%, while patients who survive to hospital arrival have an operative mortality rate of approximately 41-50%. In contrast, patients undergoing elective repair have mortality rates of only 5-10% (see Table Two below). Current smokers are 7.6 times more likely to have an AAA than nonsmokers. The prevalence of AAAs among first-degree relatives of patients with an AAA is 15-29%, compared to 2% among relatives of controls. In general, the larger the aneurysm, the greater the risk of rupture. Additional risk factors for rupture include hypertension, underlying chronic obstructive pulmonary disease (COPD), a diameter exceeding 6 cm in men and 5 cm in women, local outpouchings, termed blebs or blisters of the aneurysm wall, eccentric or saccular aneurysms, rapid AAA expansion >1 cm per year, a familial history of AAAs in other first-degree relatives, and an increase in diameter over 5 mm in any 6-month period (regardless of initial or baseline size). Retroperitoneal AAA rupture is more likely to be seen in patients arriving at hospitals alive, while intraperitoneal rupture is usually rapidly fatal. A review of the patient s medical history for risk factors for AAA should include identification of those who have undergone previous surgical AAA grafting or endoluminal stent-graft repair. These patients are at particularly high risk for AAA rupture and face long-term complications, including graft infection, thrombosis, anastomotic aneurysm, dissection, and development of aortoenteric fistulas. Patients with a history of surgical or endovascular repair suffering complications will usually present in similar fashion with complaints of pain and fever. Table One: Risk Factors for AAA Risk Factors For Abdominal Aortic Aneurysm Hypertension Smoking Atherosclerotic disease Turner, Marfan, or Ehlers-Danlos Type IV Syndromes Familial connective tissue defects Male gender Age greater than 50 years Inflammatory or infectious aortitis Known aortic pathology or previous aortic surgery Table Two: Risk Factors for Aneurysm Rupture Hypertension Risk Factors for AAA Rupture Underlying chronic obstructive pulmonary disease (COPD) Diameter greater than 6 cm in men and greater than 5 cm in women Local outpouchings ( blebs or blisters ) of the aneurysm wall Eccentric or saccular aneurysms AAA expansion greater than 1 cm per year Familial history of AAAs in other first-degree relatives Increase in diameter of over 5 mm in any 6-month period Abdominal Aortic Aneurysm - 2

3 Diagnostic Imaging Patients with suspected AAA generally require immediate imaging. CT scanning without contrast, recommended by some as the first diagnostic test in the evaluation of a potentially ruptured AAA, may be used as a confirmatory test after ultrasound (US) has been performed, either in the ED or by radiology when the patient is stable. In unstable patients, focused ED bedside US permits continued resuscitative efforts, without the need to transport patients out of the ED. Ultrasound findings consistent with an AAA include an enlarged abdominal aorta greater than 3 cm (i.e., a 50% increase in its normal diameter) or focal dilatation of the aorta. When there are no contraindications, contrast-enhanced CT scanning is useful in identifying the entire aorta, the retroperitoneum, and the branch and end arteries, which allows for surgical planning. US is insensitive for retroperitoneal bleeding from rupture, and its sensitivity in detecting extraluminal blood flow is as low as 4% in some studies. AAAs typically rupture into the retroperitoneum and are best diagnosed with a CT scan. MRI has high accuracy and provides excellent anatomical detail, but MRI availability and the stability of patients often preclude its use. Vascular Surgery Considerations For intact AAAs, aneurysms greater than 5.5 cm in diameter warrant surgery. Those less than 4 cm are followed with regular imaging. The AAAs that are between 4 cm and 5.5 cm in diameter are in an ambiguous zone for surgical intervention and thus need urgent evaluation by a vascular surgeon. Many institutions use a cut-off of 5 cm for vascular surgery evaluation. Elective surgery is recommended due to the risk of rupture if the AAA is greater than cm in men or greater than 5.0 cm in women, or if diameters between 4.5 and 5.9 cm increase greater than 1 cm/year, or for any increase in diameter over 5 mm in any 6-month period (regardless of initial or baseline size). A recommendation for early elective repair may also be made in patients with a familial history of AAA, local outpouchings of the aneurysm, or eccentric or saccular aneurysms. Abdominal Aortic Aneurysm Management Symptomatic AAA Management: The most critical management step is notifying the surgical and anesthesia team, especially if the patient is hemodynamically unstable. Large bore IV access (x2) should be established and blood sent for cross match. Attempts to resuscitate a hypotensive patient with fully normalized vital signs in the ED should be avoided and patient should be taken to the operating room or endovascular suite immediately if leaking or ruptured aneurysm is suspected with minimal diagnostic testing. Preoperative hypotension is a strong predictor of mortality in patients with a ruptured AAA; correction of hypotension before the aorta is clamped may not improve mortality and may even be harmful. Hypotension may slow the bleeding in patients with AAA and allow local clot formation and tamponade of the rupture site. Raising intravascular volume and blood pressure before occluding the aorta may dislodge clots and cause further bleeding. Large volumes of crystalloid solution may contribute to further bleeding by causing a delusional coagulopathy. Blood pressure should be raised with crystalloid or blood products to a level that maintains adequate cerebral and myocardial perfusion with a reasonable target of a systolic blood pressure of 90 to 100 mmhg. Patients with a leaking or ruptured AAA rarely present with hypertension induced by pain or associated with chronic hypertension; no evidence exists that lowering the blood pressure is beneficial; lowering the blood pressure puts the patient at risk for developing precipitous hypotension. Asymptomatic AAA Management: In asymptomatic patients, the surgical risk of complications from endovascular or open AAA repair is greater than the risk of rupture until the aneurysmal diameter exceeds 5.5 cm. Aneurysms of 5.5 cm or greater are associated with a high risk of rupture and therefore surgical intervention is generally recommended. The 2009 guidelines from the Society for Vascular Surgery recommend observation for asymptomatic AAA less than 5.5 cm in diameter. Other factors may influence the timing of AAA repair which includes coexistent peripheral artery disease, advanced age, ongoing smoking, rapid aneurysm expansion rate, or additional peripheral artery aneurysms such as iliac or femoral aneurysms. A small (<4.0 cm) or medium (4 to 5.5 cm) AAA that expands 0.5 cm over six months at follow-up is considered to be at high risk for rupture. A small to medium-sized AAA (less than 5.5 cm) expands at an average rate of 2-3 mm/year, while larger aneurysms expand at approximately 3-4 mm per year. Aneurysm expansion tends to be more rapid for smokers and it has been estimated that smoking increases the aneurysm expansion rate percent per year. Comparatively, expansion occurs less rapidly in patients with diabetes mellitus or peripheral artery disease. (continues next page) Abdominal Aortic Aneurysm - 3

4 Approaches to Limit Aortic Expansion Smoking cessation is the most important modifiable risk factor in patients with AAA. Moderate physical activity such as running, biking, swimming, hiking, or golfing do not precipitate AAA rupture. Heavy lifting and weight lifting associated with breath-holding or other strenuous activities leading to Valsalva transiently induce significant increases in blood pressure and should be avoided. Beta blockers have NOT been clearly shown to reduce aneurysmal expansion rates. ARBs and ACE inhibitors have NOT clearly demonstrated decreased aneurysm rates. Diuretics and calcium channel blockers have NO impact on expansion rates. Patients with AAA are considered to have a coronary equivalent and should be treated with statins and aspirin daily. Follow-up and surveillance: A statement from the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery estimated the annual rupture risk according to AAA diameter as follows: Zero for AAA <4.0 cm in diameter 0.5 to 5 percent for AAA 4.0 to 4.9 cm in diameter 3 to 15 percent for AAA 5.0 to 5.9 cm in diameter 10 to 20 percent for AAA 6.0 to 6.9 cm in diameter 20 to 40 percent for AAA 7.0 to 7.9 cm in diameter 30 to 50 percent for AAA 8.0 cm in diameter If aneurysm surveillance interval is extended beyond a year, there is potential for patients to be "lost to follow-up." Such gaps in surveillance are associated with AAA rupture; a reminder system should be in place. Patient anxiety associated with a diagnosis of AAA will be reduced with regular surveillance and proper education (see Table Three below). Table Three: Screening Recommendations for Asymptomatic AAA Diameter (cm) Screening Frequency (months) Abdominal Aortic Aneurysm - 4

5 Table Four: ICD-10 - Abdominal Aortic Aneurysm (AAA) ICD 10 I71.00* Description Dissection of aorta, unspecified site I71.01 Dissection of aorta, thoracic I71.02 Dissection of aorta, abdominal I71.03 Dissection of aorta, thoracoabdominal I71.1 Thoracic aneurysm, ruptured I71.2 Thoracic aneurysm without mention of rupture I71.3 Abdominal aneurysm, ruptured I71.4 Abdominal aneurysm without mention of rupture I71.8 Aortic aneurysm of unspecified site, ruptured I71.5 Thoracoabdominal aneurysm, ruptured I71.6 Thoracoabdominal aneurysm, without mention of rupture I71.9 Aortic aneurysm of unspecified site without mention of rupture *Codes with greater degree of specificity should be considered first. References 1. Brewster DC, Cronenwett JL, Hallett JW Jr, et al. Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery. J Vasc Surg 2003; 37: Chaikof EL, Brewster DC, Dalman RL, et al. The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. J Vasc Surg 2009; 50:S2. 3. Chaikof EL, Brewster DC, Dalman RL, et al. SVS practice guidelines for the care of patients with an abdominal aortic aneurysm: executive summary. J Vasc Surg 2009; 50: Cosford PA, Leng GC. Screening for abdominal aortic aneurysm. Cochrane Database Syst Rev. 2007;(2):CD Cosford PA, Leng GC. Screening for abdominal aortic aneurysm. Cochrane Database Syst Rev. 2007;(2):CD Fillinger MF, Raghavan ML, Marra SP, et al. In vivo analysis of mechanical wall stress and abdominal aortic aneurysm rupture risk. J Vasc Surg. 2002;36(3): Malkawi AH, Hinchliffe RJ, Xu Y, et al. Patientspecific biomechanical profiling in abdominal aortic aneurysm development and rupture. J Vasc Surg. 2010;52(2): Santilli SM, Littooy FN, Cambria RA, et al. Expansion rates and outcomes for the 3.0-cm to the 3.9-cm infrarenal abdominal aortic aneurysm. J Vasc Surg 2002; 35: Stanley, J. Open surgical treatment of pararenal abdominal aortic aneurysms. In: Aortic Aneurysms, Contemporary Cardiology, Upchurch, G, Criado, E. (Eds), Humana Press, p Truijers M, Pol JA, Schultzekool LJ, et al. Wall stress analysis in small asymptomatic, symptomatic, and ruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2007;33(4): Tsai TT, Nienaber CA, Eagle KA: Acute Aortic Syndromes. Circulation 112: 3802, Wittels K. Aortic emergencies. Emerg Med Clin rth Am. 2011;29(4): , vii This clinical guideline outlines the recommendations of Mount Carmel Health Partners for this medical condition and is based upon the referenced best practices. It is not intended to serve as a substitute for professional medical judgment in the diagnosis and treatment of a particular patient. Decisions regarding care are subject to individual consideration and should be made by the patient and treating physician in concert. Original sue Date: December 2015 Abdominal Aortic Aneurysm - 5 Revision Dates:

Abdominal Aortic Aneurysm - Part 1. Learning Objectives. Disclosure. University of Toronto Division of Vascular Surgery

Abdominal Aortic Aneurysm - Part 1. Learning Objectives. Disclosure. University of Toronto Division of Vascular Surgery University of Toronto Division of Vascular Surgery Abdominal Aortic Aneurysm - Part 1 Dr Mark Wheatcroft & Dr Elisa Greco Vascular Surgeon, St Michael s Hospital, Toronto & University of Toronto Disclosure

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

Medical management of abdominal aortic aneurysms

Medical management of abdominal aortic aneurysms Medical management of abdominal aortic aneurysms Definition of AAA - Generally a 50% increase in native vessel diameter - Diameter 3 cm - Relative measures compared with nondiseased aortic segments less

More information

THORACIC AORTIC DISSECTION

THORACIC AORTIC DISSECTION The Essence of Aortic Dissection THORACIC AORTIC DISSECTION Aortic dissection can be classified as acute if it s onset has been less than 14 days or chronic if its onset has been more than 14 days. Mortality

More information

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

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

More information

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

TAVR : Caring for your patients before and after TAVR

TAVR : Caring for your patients before and after TAVR TAVR : Caring for your patients before and after TAVR Zubair Ahmed MD FSCAI Interventional Cardiologist Washington Regional Medical Center / Walker Heart Institute What is Aortic Valve Stenosis? AVA ~4

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

Asymptomatic Radiology / Clinical data Report / Cohort bias Referral bias. UCSF Vascular Symposium April 7-9, Acute Aortic Dissection

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

More information

AORTIC ANEURYSM. howmed.net

AORTIC ANEURYSM. howmed.net AORTIC ANEURYSM howmed.net ANATOMY It is important to understand the anatomy of the aorta Need to know the extent of the aneurysm Need to know the vessels involved This helps with Medical or Surgical management

More information

Case Presentation Conference Ravi Dhanisetty, M.D. Kings County Hospital Center

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.

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

Diseases of the aorta

Diseases of the aorta Diseases of the aorta Aneurysm, dissection and aortitis are the main pathologies (Fig. 18.79 ). data:text/html;charset=utf-8,%3ch2%20id%3d%22cc5a0836d6aa490ca26dd7c15632b559%22%20style%3d%22margin%3a%201.3em%200px%200.5em%3b%20padding%3a%200px%3b%20border%3a%200px%3b%20font-fa

More information

Abdominal Aortic Aneurysm

Abdominal Aortic Aneurysm Abdominal Aortic Aneurysm David N. Duddleston, MD VP and Medical Director Southern Farm Bureau Life Jackson, Mississippi A Case Ms. Ima Bolgin,, age 54, $1.2 million, sent to you for review. Smoker, ½

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

AORTIC DISSECTION. DISSECTING ANEURYSMS OF THE AORTA or CLASSIFICATION

AORTIC DISSECTION. DISSECTING ANEURYSMS OF THE AORTA or CLASSIFICATION DISSECTING ANEURYSMS OF THE AORTA or AORTIC DISSECTION CLASSIFICATION DeBakey classified aortic dissections into types I, II, and III :- Type I dissection the tear site originates in the ascending aorta,

More information

2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Outcome

2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Outcome Quality ID #259: Rate of Endovascular Aneurysm Repair (EVAR) of Small or Moderate Non-Ruptured Infrarenal Abdominal Aortic Aneurysms (AAA) without Major Complications (Discharged to Home by Post Operative

More information

Current treatment of Aortic Aneurysms and Dissections. Adam Keefer, MD, FACS Sean Hislop, MD, FACS

Current treatment of Aortic Aneurysms and Dissections. Adam Keefer, MD, FACS Sean Hislop, MD, FACS Current treatment of Aortic Aneurysms and Dissections Adam Keefer, MD, FACS Sean Hislop, MD, FACS Patient 1 69 year old well-educated man with reoccurring pain in his upper abdomen and a pulsatile mass.

More information

Aneurysms & a Brief Discussion on Embolism

Aneurysms & a Brief Discussion on Embolism Aneurysms & a Brief Discussion on Embolism Aneurysms, overview = congenital or acquired dilations of blood vessels or the heart True aneurysms -involve all three layers of the artery (intima, media, and

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

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

2017 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Outcome

2017 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Outcome Measure #347 (NQF 1534): Rate of Endovascular Aneurysm Repair (EVAR) of Small or Moderate Non- Ruptured Infrarenal Abdominal Aortic Aneurysms (AAA) Who Die While in Hospital National Quality Strategy Domain:

More information

WHI Form Report of Cardiovascular Outcome Ver (For items 1-11, each question specifies mark one or mark all that apply.

WHI Form Report of Cardiovascular Outcome Ver (For items 1-11, each question specifies mark one or mark all that apply. WHI Form - Report of Cardiovascular Outcome Ver. 6. COMMENTS To be completed by Physician Adjudicator Date Completed: - - (M/D/Y) Adjudicator Code: OMB# 095-044 Exp: 4/06 -Affix label here- Clinical Center/ID:

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

Disclosures: Acute Aortic Syndrome. A. Michael Borkon, M.D. Director of CV Surgery Mid America Heart Institute Saint Luke s Hospital Kansas City, MO

Disclosures: Acute Aortic Syndrome. A. Michael Borkon, M.D. Director of CV Surgery Mid America Heart Institute Saint Luke s Hospital Kansas City, MO Acute Aortic Syndrome Disclosures: A. Michael Borkon, M.D. Director of CV Surgery Mid America Heart Institute Saint Luke s Hospital Kansas City, MO No financial relationships to disclose 1 Acute Aortic

More information

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 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

More information

AAA Management: A Review of Current Therapy, Techniques, Outcomes and Best Practices

AAA Management: A Review of Current Therapy, Techniques, Outcomes and Best Practices Sanger Heart & Vascular Institute Symposium 2015 Cardiovascular Update For Primary Care Physicians Frank R. Arko, III, MD Professor, Cardiovascular Surgery Co Director, Aortic Institute Director, Endovascular

More information

CT angiography in type I acute aortic dissection complicated with malperfusion - a visual review of obstruciton patterns

CT angiography in type I acute aortic dissection complicated with malperfusion - a visual review of obstruciton patterns CT angiography in type I acute aortic dissection complicated with malperfusion - a visual review of obstruciton patterns Eneva M. St. Ekaterna University Hospital Report objectives 1. Review malperfusion

More information

Surveillance of Abdominal Aortic Aneurysms (AAA)

Surveillance of Abdominal Aortic Aneurysms (AAA) Surveillance of Abdominal Aortic Aneurysms (AAA) Exceptional healthcare, personally delivered This leaflet tells you about small abdominal aortic aneurysms. What is the aorta? The aorta is the largest

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

National Vascular Registry

National Vascular Registry National Vascular Registry AAA Repair Patient Details Patient Consent* 0 No 1 Yes 2 Not Required If patient not consented: Date consent recorded / / (DD/MM/YYYY) Do not record NHS number, NHS number* name(s)

More information

Detailed Order Request Checklists for Cardiology

Detailed Order Request Checklists for Cardiology Next Generation Solutions Detailed Order Request Checklists for Cardiology 8600 West Bryn Mawr Avenue South Tower Suite 800 Chicago, IL 60631 www.aimspecialtyhealth.com Appropriate.Safe.Affordable 2018

More information

Abdominal Aortic Aneurysm 가천대길병원 이상준

Abdominal Aortic Aneurysm 가천대길병원 이상준 Abdominal Aortic Aneurysm 가천대길병원 이상준 1 Definition Diameter of the aorta 1.5 times greater than normal. Most are infrarenal, and a significant number extend down into one or both iliac arteries Abdominal

More information

Aortic Aneurysms: What s s New?

Aortic Aneurysms: What s s New? 25th Annual Advances in Heart Disease 12 December 2008 Aortic Aneurysms: What s s New? Melvin D. Cheitlin, M.D., MACC Emeritus Professor of Medicine UCSF 1 AAA in the U.S. 13th cause of death -16,000 deaths/yr

More information

2017 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Outcome

2017 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Outcome Measure #258: Rate of Open Repair of Small or Moderate Non-Ruptured Infrarenal Abdominal Aortic Aneurysms (AAA) without Major Complications (Discharged to Home by Post-Operative Day #7) National Quality

More information

Abdominal Aortic Aneurysms (AAA) and Surveillance

Abdominal Aortic Aneurysms (AAA) and Surveillance Abdominal Aortic Aneurysms (AAA) and Surveillance Exceptional healthcare, personally delivered Ask 3 Questions Preparation for your Appointments We want you to be active in your healthcare. By telling

More information

A FAMILY HISTORY OF ABDOMINAL AORTIC ANEURYSM (AAA) DISEASE

A FAMILY HISTORY OF ABDOMINAL AORTIC ANEURYSM (AAA) DISEASE Important Information for You and Your Family A FAMILY HISTORY OF ABDOMINAL AORTIC ANEURYSM (AAA) DISEASE Have you been diagnosed with AAA disease? There is a 15% chance that one of your family members

More information

Endovascular Repair o Abdominal. Aortic Aneurysms. Cesar E. Mendoza, M.D. Jackson Memorial Hospital Miami, Florida

Endovascular Repair o Abdominal. Aortic Aneurysms. Cesar E. Mendoza, M.D. Jackson Memorial Hospital Miami, Florida Endovascular Repair o Abdominal Aortic Aneurysms Cesar E. Mendoza, M.D. Jackson Memorial Hospital Miami, Florida Disclosure Nothing to disclose. 2 Mr. X AAA Mr. X. Is a 70 year old male who presented to

More information

Management of Endoleaks

Management of Endoleaks Management of Endoleaks Sarah Ikponmwosa, MD Brooklyn VA 6/20/08 Questions Advantages of endovascular repair Definition of an endoleak Types of endoleaks Management of type lll endoleak Diagnosis of type

More information

Small Abdominal Aortic Aneurysms AAA Information for Patients and Carers

Small Abdominal Aortic Aneurysms AAA Information for Patients and Carers What causes an AAA? Small Abdominal Aortic Aneurysms AAA Information for Patients and Carers This leaflet tells you about small abdominal aortic aneurysms. What is the aorta? The exact reason why an aneurysm

More information

INCREASING RADIOLOGY VALUE IN PATIENT CARE: STANDARDIZED EVIDENCE-BASED SURVEILLANCE RECOMMENDATIONS FOR ABDOMINAL AORTIC ANEURYSMS

INCREASING RADIOLOGY VALUE IN PATIENT CARE: STANDARDIZED EVIDENCE-BASED SURVEILLANCE RECOMMENDATIONS FOR ABDOMINAL AORTIC ANEURYSMS INCREASING RADIOLOGY VALUE IN PATIENT CARE: STANDARDIZED EVIDENCE-BASED SURVEILLANCE RECOMMENDATIONS FOR ABDOMINAL AORTIC ANEURYSMS AUTHORS Sameer Ahmed 1, Jason Mitsky 2, Upma Rawal 2, Pamela Johnson

More information

Deb Coghlan AMS (Vascular and General ) Brisbane, Australia

Deb Coghlan AMS (Vascular and General ) Brisbane, Australia Deb Coghlan AMS (Vascular and General ) Brisbane, Australia ANEURYSMAL DIISEASE The infrarenal aorta enlarges with age, and is the commonest site for arterial aneurysms. An aneurysm is a permanent focal

More information

Aortic CT: Intramural Hematoma. Leslie E. Quint, M.D.

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

More information

Abdominal Aortic Aneurysms (AAA): Management in 2012

Abdominal Aortic Aneurysms (AAA): Management in 2012 Abdominal Aortic Aneurysms (AAA): Management in 2012 Matthew S. Edwards, MD, MS, FACS Associate Professor of Surgery and Public Health Sciences Department of Vascular and Endovascular Surgery General Considerations

More information

Animesh Rathore, MD 4/21/17. Penetrating atherosclerotic ulcers of aorta

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

More information

An aneurysm is a localized abnormal dilation of a blood vessel or the heart Types: 1-"true" aneurysm it involves all three layers of the arterial

An aneurysm is a localized abnormal dilation of a blood vessel or the heart Types: 1-true aneurysm it involves all three layers of the arterial An aneurysm is a localized abnormal dilation of a blood vessel or the heart Types: 1-"true" aneurysm it involves all three layers of the arterial wall (intima, media, and adventitia) or the attenuated

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

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 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

More information

CT of Acute Thoracic Aortic Syndromes Stuart S. Sagel, M.D.

CT of Acute Thoracic Aortic Syndromes Stuart S. Sagel, M.D. CT of Acute Thoracic Aortic Syndromes Stuart S. Sagel, M.D. Thoracic Aortic Aneurysms Atherosclerotic Dissection Penetrating ulcer Mycotic Inflammatory (vasculitis) Traumatic Aortic Imaging Options Catheter

More information

VASCULAR SURGERY, PART I VOLUME

VASCULAR SURGERY, PART I VOLUME CME Pretest VASCULAR SURGERY, PART I VOLUME 42 7 2016 To earn CME credit, completing the pretest is a mandatory requirement. The pretest should be completed BEFORE reading the overview and taking the posttest.

More information

OHTAC Recommendation

OHTAC Recommendation OHTAC Recommendation of Abdominal Aortic Aneurysms for Low Surgical Risk Patients Presented to the Ontario Health Technology Advisory Committee in October, 2009 January 2010 Background In 2005, the Ontario

More information

Abdominal Aortic Aneurysm (AAA)

Abdominal Aortic Aneurysm (AAA) Abdominal Aortic Aneurysm (AAA) Vascular Workshop: Objectives Anatomy Keith VanHaltren Indications Technique Cases Abdominal Aorta: Normal Size Abdominal aortic aneurysm: Definition Normal diameter of

More information

Screening for abdominal aortic aneurysm reduces overall mortality in men. A meta-analysis of the

Screening for abdominal aortic aneurysm reduces overall mortality in men. A meta-analysis of the Title page Manuscript type: Meta-analysis. Title: Screening for abdominal aortic aneurysm reduces overall mortality in men. A meta-analysis of the mid- and long- term effects of screening for abdominal

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

Visceral aneurysm. Diagnosis and Interventions M.NEDEVSKA

Visceral aneurysm. Diagnosis and Interventions M.NEDEVSKA Visceral aneurysm Diagnosis and Interventions M.NEDEVSKA History 1953 De Bakeyand Cooley Visceral aneurysm VAAs rare, reported incidence of 0.01 to 0.2% on routine autopsies. Clinically important Potentially

More information

National Vascular Registry

National Vascular Registry National Vascular Registry AAA Repair Patient Details Patient Consent* 0 No 2 Not Required If patient not consented: Date consent recorded / / (DD/MM/YYYY) Do not record NHS number, NHS number* name(s)

More information

Carotid Stenosis (carotid artery disease)

Carotid Stenosis (carotid artery disease) 1 Carotid Stenosis (carotid artery disease) Overview Carotid stenosis is a narrowing of the carotid arteries, the two major arteries that carry oxygenrich blood from the heart to the brain. Also called

More information

Abdominal Aortic Aneurysm (AAA) General Information. Patient information Leaflet

Abdominal Aortic Aneurysm (AAA) General Information. Patient information Leaflet Abdominal Aortic Aneurysm (AAA) General Information Patient information Leaflet 18 th April 2017 WHAT IS THE AORTA? The aorta is the largest artery (blood vessel) in the body. It carries blood from the

More information

Management of the persistent sciatic artery with coexistent aortoiliac aneurysms; endovascular and open techniques.

Management of the persistent sciatic artery with coexistent aortoiliac aneurysms; endovascular and open techniques. ISPUB.COM The Internet Journal of Thoracic and Cardiovascular Surgery Volume 14 Number 2 Management of the persistent sciatic artery with coexistent aortoiliac aneurysms; endovascular and open A Rodriguez-Rivera,

More information

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

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

More information

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

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

More information

Objectives. Abdominal Aortic Aneuryms 11/16/2017. The Vascular Patient: Diagnosis and Conservative Treatment

Objectives. Abdominal Aortic Aneuryms 11/16/2017. The Vascular Patient: Diagnosis and Conservative Treatment The Vascular Patient: Diagnosis and Conservative Treatment Ferrell-Duncan Clinic Zachary C. Schmittling, M.D., F.A.C.S. Vascular and General Surgery Ferrell-Duncan Clinic Cox Health Systems Objectives

More information

Cardiovascular Disorders Lecture 3 Coronar Artery Diseases

Cardiovascular Disorders Lecture 3 Coronar Artery Diseases Cardiovascular Disorders Lecture 3 Coronar Artery Diseases By Prof. El Sayed Abdel Fattah Eid Lecturer of Internal Medicine Delta University Coronary Heart Diseases It is the leading cause of death in

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

Peripheral Arterial Disease (PAD): Presentation, Diagnosis, and Treatment

Peripheral Arterial Disease (PAD): Presentation, Diagnosis, and Treatment Peripheral Arterial Disease (PAD): Presentation, Diagnosis, and Treatment Prepared and Presented by Jon Manocchio, Pharm D Blanchard Valley Hospital October 2011 Introduction PAD is a condition that is

More information

Endovascular treatment of acquired arteriovenous fistula with severe hemodynamic effects: a case report

Endovascular treatment of acquired arteriovenous fistula with severe hemodynamic effects: a case report Endovascular treatment of acquired arteriovenous fistula with severe hemodynamic effects: a case report The Leipzig Interventional Course, January 24 27, 2017 El Samman K., Šedivý P., Šnajdrová A., Přindišová

More information

SCREENING AND MANAGEMENT

SCREENING AND MANAGEMENT SCREENING AND MANAGEMENT OF ABDOMINAL AORTIC ANEURYSM (AAA) IN HIGH RISK POPULATIONS Brindy Chris Paet, BSN RN. Augustina Manuzak, MD, MPH, PhD CONTENTS Introduction Natural History of the Disease Disease

More information

Epidemiology of Aortic Aneurysm Repair in the United States from 1993 to 2003

Epidemiology of Aortic Aneurysm Repair in the United States from 1993 to 2003 Epidemiology of Aortic Aneurysm Repair in the United States from 1993 to 2003 JOHN A. COWAN, JR., JUSTIN B. DIMICK, PETER K. HENKE, JOHN RECTENWALD, JAMES C. STANLEY, AND GILBERT R. UPCHURCH, Jr. University

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

6. Endovascular aneurysm repair

6. Endovascular aneurysm repair Introduction The standard treatment for aortic aneurysm, open repair, involves a large abdominal incision and cross-clamping of the aorta. In recent years, a minimally invasive technique, endovascular

More information

Aortic arch pathology. Cerebral ischemia following carotid artery stenosis.

Aortic arch pathology. Cerebral ischemia following carotid artery stenosis. Important: -Subclavian Steal Syndrome -Cerebral ischemia Aortic arch pathology. Cerebral ischemia following carotid artery stenosis. Mina Aubeed & Alba Hernández Pinilla Aortic arch pathology Common arch

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

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

DENOMINATOR: Patients aged 18 and older with infrarenal non-ruptured endovascular AAA repairs

DENOMINATOR: Patients aged 18 and older with infrarenal non-ruptured endovascular AAA repairs Measure #347 (NQF 1534): Rate of Endovascular Aneurysm Repair (EVAR) of Small or Moderate Non-Ruptured Abdominal Aortic Aneurysms (AAA) Who Die While in Hospital National Quality Strategy Domain: Patient

More information

From Valve to Arch: How s Your Aorta? March 7, 2011

From Valve to Arch: How s Your Aorta? March 7, 2011 From Valve to Arch: How s Your Aorta? March 7, 2011 Susan Housholder-Hughes, RN, MSN, ANP-BC, FAHA, AACC Nurse Practitioner, Multidisciplinary Aortic Program Cardiovascular Center Adjunct Clinical Instructor,

More information

Echocardiographic Evaluation of the Aorta

Echocardiographic Evaluation of the Aorta Echocardiographic Evaluation of the Aorta William F. Armstrong M.D. Director Echocardiography Laboratory Professor of Medicine University of Michigan The Aorta: What to Evaluate Dimensions / shape Atherosclerotic

More information

Vascular surgery in Victorian public hospitals Report to the public

Vascular surgery in Victorian public hospitals Report to the public Vascular surgery in Victorian public hospitals 2003 Report to the public Vascular surgery in Victorian public hospitals 2003 Report to the Public Published by the Quality and Safety Branch, Victorian Government

More information

2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY

2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY Measure #258: Rate of Open Repair of Small or Moderate Non-Ruptured Abdominal Aortic Aneurysms (AAA) without Major Complications (Discharged to Home by Post-Operative Day #7) National Quality Strategy

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

Approaches to type II Endoleaks: Transcaval, transarterial, translumbar. Saher Sabri,MD University of Virginia

Approaches to type II Endoleaks: Transcaval, transarterial, translumbar. Saher Sabri,MD University of Virginia Approaches to type II Endoleaks: Transcaval, transarterial, translumbar Saher Sabri,MD University of Virginia Saher Sabri, M.D. Speakers Bureau: W.L.Gore & Associates, Abbott Type 2 Endoleaks after EVAR

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

BC Vascular Day. Contents. November 3, Abdominal Aortic Aneurysm 2 3. Peripheral Arterial Disease 4 6. Deep Venous Thrombosis 7 8

BC Vascular Day. Contents. November 3, Abdominal Aortic Aneurysm 2 3. Peripheral Arterial Disease 4 6. Deep Venous Thrombosis 7 8 BC Vascular Day Contents Abdominal Aortic Aneurysm 2 3 November 3, 2018 Peripheral Arterial Disease 4 6 Deep Venous Thrombosis 7 8 Abdominal Aortic Aneurysm Conservative Management Risk factor modification

More information

INL No. A0075 Project Medtronic Patient Information Leaflet Description 16 page booklet

INL No. A0075 Project Medtronic Patient Information Leaflet Description 16 page booklet INL No. A0075 Project Medtronic Patient Information Leaflet Description 16 page booklet www.inl-agency.com PATIENT INFORMATION BOOKLET Endovascular stent grafts: A treatment for Abdominal Aortic Aneurysms

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

Infected Lower Extremity Aneurysms C. Stefan Kénel-Pierre, MD

Infected Lower Extremity Aneurysms C. Stefan Kénel-Pierre, MD Infected Lower Extremity Aneurysms C. Stefan Kénel-Pierre, MD University Hospital of Brooklyn Department of Surgery History 52F c PMHx of HTN, asthma p/w fever, malaise s/p one week of ABx for presumed

More information

HEART AND SOUL STUDY OUTCOME EVENT - MORBIDITY REVIEW FORM

HEART AND SOUL STUDY OUTCOME EVENT - MORBIDITY REVIEW FORM REVIEW DATE REVIEWER'S ID HEART AND SOUL STUDY OUTCOME EVENT - MORBIDITY REVIEW FORM : DISCHARGE DATE: RECORDS FROM: Hospitalization ER Please check all that may apply: Myocardial Infarction Pages 2, 3,

More information

Overview of Subclavian & Innominate Artery Interventions

Overview of Subclavian & Innominate Artery Interventions TCT 2016 Washington, DC, USA Tuesday November 1st, 2016 Peripheral vascular interventions Overview of Subclavian & Innominate Artery Interventions Dr Jacques Busquet Vascular & Endovascular Surgery Paris,

More information

Shonak Patel MD Vascular Specialists of Central Florida Assistant Professor at UCF

Shonak Patel MD Vascular Specialists of Central Florida Assistant Professor at UCF Shonak Patel MD Vascular Specialists of Central Florida Assistant Professor at UCF Evaluating Aortic Disease Consider the process degenerative Atherosclerosis, dissection, connective tissue disease Treatment

More information

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

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

More information

9/21/15. Joshua Pruitt, MD, FAAEM Medical Director, LifeGuard Air Ambulance Iowa PA Society Fall CME Conference September 29, 2015

9/21/15. Joshua Pruitt, MD, FAAEM Medical Director, LifeGuard Air Ambulance Iowa PA Society Fall CME Conference September 29, 2015 Unless they prove otherwise. ~Every ED attending ever Joshua Pruitt, MD, FAAEM Medical Director, LifeGuard Air Ambulance Iowa PA Society Fall CME Conference September 29, 2015 AAA with rupture Mesenteric

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

Nellix Endovascular System: Clinical Outcomes and Device Overview

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

More information

Endovascular Repair or Surveillance of Patients with Small AAA

Endovascular Repair or Surveillance of Patients with Small AAA Eur J Vasc Endovasc Surg 29, 496 503 (2005) doi:10.1016/j.ejvs.2005.03.003, available online at http://www.sciencedirect.com on Endovascular Repair or Surveillance of Patients with Small AAA C.K. Zarins,

More information

Subclavian artery Stenting

Subclavian artery Stenting Subclavian artery Stenting Etiology Atherosclerosis Takayasu s arteritis Fibromuscular dysplasia Giant Cell Arteritis Radiation-induced Vascular Injury Thoracic Outlet Syndrome Neurofibromatosis Incidence

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

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

Endovascular Treatment of Malperfusion Syndrome

Endovascular Treatment of Malperfusion Syndrome Endovascular Treatment of Malperfusion Syndrome in Type B Aortic Dissection Department of Cardiology, Pusan National luniveristy i Hospital, Han Cheol Lee Endovascular Treatment Indication of Type B Aortic

More information

Imaging in the Evaluation of Coronary Artery Disease and Abdominal Aortic Aneurysm

Imaging in the Evaluation of Coronary Artery Disease and Abdominal Aortic Aneurysm Imaging in the Evaluation of Coronary Artery Disease and Abdominal Aortic Aneurysm Mark J. Sands, MD Vice Chairman, Imaging Institute Clinical Operations and Quality Objectives Review of available radiologic

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

Preoperative Cardiac Risk Assessment: Approach & Guidelines

Preoperative Cardiac Risk Assessment: Approach & Guidelines Preoperative Cardiac Risk Assessment: Approach & Guidelines By, Liam Morris, MD., FACC (02/03/18) CPG : Clinical Practice Guidelines GDMT : Guidelines Directed Medical Therapy GWC : Guideline Writing Committee

More information