Hostile Neck During EVAR, The Role Of Endoanchores
|
|
- Morris Berry
- 5 years ago
- Views:
Transcription
1 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 Hospital & Research Center Riyadh, KSA
2
3
4 Straight Tapered R. tapered Angulated <30 Bulge Short Source: Ionel Droc, Dieter Raithel and Blanca Calinescu (2012). Abdominal Aortic Aneurysms - Actual Therapeutic Strategies, Aneurysm, Dr. Yasuo Murai (Ed.), ISBN: , InTech, DOI: /48596
5 DREAM EVAR-1 ACE De Bruin et al. NEJM 2010 Greenhalgh et al. NEJM 2010 Becquemin et al. JVS 2011 Late ruptures in EVAR, none in open surgery Unlike open repair, endoleaks and migration are major complications of EVAR Open surgery remains a more durable option
6 Meta-Analysis of 7 major studies in EVAR by Antoniou et al 1 compared outcomes in hostile vs. friendly neck anatomies (total patients N = 1559) Study Sample Size Endografts Torsello et al, Endurant Type AbuRahma I endoleaks et al, 4.5x 2010 more likely 238 at 1-year AneuRx, after endograft Excluder, implantation Zenith, in hostile proximal aortic neck anatomy (P = Talent.010) Hoshina et al, Excluder, Zenith Aneurysm-related mortality risk 9x greater in hostile neck anatomy (P=.013) Abbruzzese et al, 565 AneuRx, Excluder, Zenith 2008 Choke et al, Talent, Zenith, Excluder, AneuRx Fulton et al, AneuRx Fairman et al, Talent 1 Antoniou GA et al. JVS. 2013;57(2):
7 Another similar meta-analysis by Stather et al. of 16 major studies confirms higher risks in hostile necks Total sample size: N=11,959 patients EVAR still faces significant challenges in hostile proximal neck anatomy Stather et al. JEVT. 2013;20:
8 Influence of multiple hostile neck parameters Speziale et al. shows greater proximal seal complication risks as the number of hostile neck parameters increases Neck hostility Intra-op adjunctive procedure s Intra-op endoleaks All cause mortality >2 PARAMETERS RISK On label 9.9% 0.5% 1.1% 2 hostile neck parameters 26.7% 6.7% 13.3% >2 hostile neck parameters 50% 16.7% 16.7% Greater than 1 hostile neck parameter substantially increases mortality, major adverse events, intra-op endoleaks and adjunctive procedures Speziale et al, Annals VS. 2014
9 Type I Endoleak? What have been our options Image courtesy of National Institute of Health TAA Classification Ascending Aortic Arch Possible Type I EL TX Options Open surgical conversion TEVAR Revision*, hybrid What do we do when: Image courtesy of National Institute of Health Descending AAA Classification Juxta-renal Supra-renal TEVAR Revision* Possible Type I EL TX Options Standard revision techniques cannot be used or don t seal the Infra-renal endoleak? Patients are unfit for FEVAR or open surgical conversion? EVAR Revision*, open surgical conversion, FEVAR conversion Open surgical conversion, FEVAR conversion, parallel grafts Open surgical conversion, FEVAR conversion, parallel grafts *Ballooning, cuffs, Palmaz, coils, Onyx and/or CHIMPs may be considered in EVAR/TEVAR revision
10 3 mm Cross Bar 1.0 mm 3.5 mm
11 Displacement force in Newtons IT Create the stability of a surgical anastomosis in EVAR and TEVAR Surgical Anastomosis EndoAnchoring Endoanchores bring the stability of the surgical anastomosis to EVAR and TEVAR Talent Endurant Excluder Zenith Mean Hand No EndoAnchors With EndoAnchors Sewn Case images from John Aruny MD, Bart Edward Muhs, MD, PhD. Melas et al. JVS 2012;55(6):
12 Aptus Heli-FX Thoracic EndoAnchor System 18Fr OD, 90cm working length Aptus Heli-FX EndoAnchor System 16Fr OD, 62cm working length
13 5/26/
14 How to Manage EVAR with EndoAnchors? Select Subset of Endovascular Patients Existing Seal Complications Highly Challenging Anatomies A B C Mitigating Risk Factors Acute & late type I endoleaks 2 Type I endoleaks in urgent or ruptured EVAR Augmenting stability in migrated grafts 1 Secondary Irregularly shaped necks (short, wide, highly angulated, conical) 1 Difficult landing zones 2 Primary Severe comorbidities Patients potentially lost during F/U 3 Long remaining life expectancy 3 Primary 1 Jordan et al. J Vasc Surg. 2015:61(6): de Vries. JEVT. 2013;20(4): Schanzer et al. Circulation 2011;123:
15 To Lock Graft to the Aorta, EndoAnchors Must Penetrate Aortic Tissue Areas to avoid: Mural thrombus >2mm thick and 180º of circumference Porcelain aorta (severe circumferential calcification) Loss of graft apposition with resulting gap Nellx EVAS System 5/26/2018 1
16
17 17
18
19
20
21 ANCHOR Registry Primary Arm Revision Arm Prophylactic Use Intraprocedural Type Ia Endoleaks
22 ANCHOR Registry Enrollment Status (Aug 10, 2015) ANCHOR Registry 593 Subjects (74.9% US/25.1% OUS) Primary Arm 439 Subjects Revision Arm 154 Subjects Stent Grafts - Primary Arm Medtronic Endurant Gore Excluder Cook Zenith Stent Grafts - Revision Arm Metronic Endurant Medtronic Talent Medtronic AneuRx Gore Excluder Cook Zenith Jotec
23 ANCHOR Registry Prophylactic Use Data Highlights Prophylactic Use 269 patients Clinical follow-up: 21.3 months CT follow-up: 8.2 months Sites Excludes revisions or treatment of Type Ia endoleaks at Index 11.2% urgent cases (rupture or symptomatic) Subjects U.S., 72.5% E.U., 27.5% U.S., 84.4% E.U., 15.6%
24 Baseline Characteristics Male (n/n, %) 77.7% (209/269) Age 74.4 Aneurysm Measurements (Core Lab) Number with Baseline CT Scans 205 Aneurysm Diameter 55.5 mm Proximal Neck Length 16.6 mm Infrarenal Diameter 25.7 mm Suprarenal Angulation 15 Infrarenal Angulation 35 Average Neck Calcium Thickness 1.1 mm Conical Neck (>10%/10mm) 41.0% Hostile Necks 77.6% Definitions for HOSTILE NECK Criteria Threshold Aortic Diameter at Renals 28 Proximal Neck Length 10 Infrarenal Angulation to Bifurcation 60 Neck Thrombus Avg Thickness 2 Neck Thrombus Circum >1mm 180 Neck Calcium Avg Thickness 2 Neck Calcium >1mm 180
25 ANCHOR Registry Prophylactic Subjects PROXIMAL ENDOLEAKS AND MIGRATION MEAN FOLLOW-UP 8.2 MONTHS All Primary Cases Type Ia Endoleaks 1a ELs CTs % % Endograft Migration (>10mm) All Primary Cases Migration CTs % % Migration was assessed in comparison to the 1-month CT scan
26 ANCHOR Registry Prophylactic Subjects Sac Diameter Changes All Prophylactic Patients Mean 8 months Prophylactic Patients with 1-Year CTs 9-12 month window SAC DIAMETER CHANGES Patients >5mm Regression % >5mm Enlargement 1 0.6% Patients N=154 >5mm Regression % >5mm Enlargement 0 0.0% Patients N=39 Sac regression/enlargement was assessed in comparison to the 1-month CT scan. Analysis includes only those patients with a 1-month CT and at least one more CT obtained after 1 month.
27 ANCHOR Registry Prophylactic Subjects WHEN TO USE ENDOANCHORS? TO PREVENT /MITIGATE RISK FOR TYPE 1A ENDOLEAKS To improve durability of EVAR for hostile necks Calcium, thrombus, angulated, conical, short Current ANCHOR registry analysis demonstrates no migration and <2% Type 1a EL in Primary Prophylactic cases (8.2 month mean f/u)
28 ANCHOR Registry Therapeutic Use ANCHOR Registry Primary Arm Revision Arm Prophylactic Use Type Ia Endoleaks Intraprocedural Type Ia Endoleaks Re-intervention
29 Adjunctive Devices Primary (N=141) Revision (N=122) All (N=263) Aortic Extender Cuff 25 (17.7%) 62 (50.8%) 87 (33.1%) Giant bare stent (e.g. Palmaz) 2 (1.4%) 4 (3.3%) 6 (2.3%) Cuff + Palmaz 0 (0%) 2 (0.8%) 2 (0.8%) Chimney 0 (0%) 2 (0.8%) 2 (0.8%) Fenestrated 0 (0%) 1 (0.4%) 1 (0.4%) Debranching 0 (0%) 1 (0.4%) 1 (0.4%) EndoAnchors alone 114 (80.9%) 50 (41.0%) 164 (62.4%)
30 CORE LAB MEAN CT FOLLOW-UP 10.4 MONTHS Cohort All Cases 1a ELs CTs % All % Primary % Revision %
31 Regression >5mm Enlargement >5mm Regressed % Enlarged % All 27/ % 10/ % Primary 21/ % 4/84 4.8% Revision 6/ % 6/ % Core Lab Analysis Diameter change between 1-month (0-60d) and 1-year (9-12m) CTs
32 Reinterventions* Number (%) Successful** Open surgical conversion 2/24 (8%) 2/2 Fenestrated graft 2/24 (8%) 0/2 Additional EndoAnchors 1/24 (4%) 0/1 Aortic extension cuff 1/24 (4%) No Imaging No additional procedures reported 18/24 (75%) N/A *Data from 24 patients with persistent Type Ia endoleaks reported by the Core Laboratory. **Successful is defined by no type Ia endoleak on imaging studies after the reintervention.
33 The use of EndoAnchors for treatment of proximal (Type Ia) endoleaks at the time of initial endovascular aneurysm repair ( Primaries ) is associated with excellent results, at least through 1-year follow-up. 96% of patients remain free of recurrent proximal endoleaks through 1-year CT imaging follow-up. The use of EndoAnchors for Type Ia endoleak remote from an EVAR procedure ( Revisions ) is successful in the majority of cases, but persistent endoleaks remain in 32% of such patients. Of note, 75% of these patients with persistent endoleaks did not undergo further reinterventions despite the leak.
34 Endoanchoes provide additional endovascular option for prevention or treatment of stentgraft nonalignment, migration or type I endoleak. Other therapeutic options have to be considered. No EndoAnchor application in patients anatomically unsuitable (very short or no neck). Long term data are required.
35 THANK YOU FOR YOUR ATTENTION Academia
Improving Endograft Durability with EndoAnchors
Improving Endograft Durability with EndoAnchors William D. Jordan, Jr., M.D. John E. Skandalakis Chair in Surgery Professor and Chief Division of Vascular Surgery and Endovascular Therapy Emory University
More informationEVAR Revision Setting - How can Heli-FX EndoAnchors improve the outcomes?
D. Böckler Department of Vascular and Endovascular Surgery University Hospital Heidelberg EVAR Revision Setting - How can Heli-FX EndoAnchors improve the outcomes? Disclosures Speaker name: Dittmar Böckler
More informationTechnique and Tips for Complicated AAA Cases with Stent Graft
Technique and Tips for Complicated AAA Cases with Stent Graft Seung-Woon Rha, MD, PhD FACC, FAHA, FESC, FSCAI, FAPSIC Cardiovascular Center, Korea University Guro Hospital Mar 15, 2018 LINC AP 2018 Endoleak;
More informationUse of Aptus Heli-FX EndoAnchor implants with standard endografts to strengthen seal in hostile anatomies:
Use of Aptus Heli-FX EndoAnchor implants with standard endografts to strengthen seal in hostile anatomies: technical tips, case experience and clinical results CACVS Medtronic Symposium Paris, France January
More informationRalf R. Kolvenbach. Verbund Katholischer Kliniken Gefäßzentrum Augusta Krankenhaus Düsseldorf
Ralf R. Kolvenbach Verbund Katholischer Kliniken Gefäßzentrum Augusta Krankenhaus Düsseldorf Endograft migration Stent no longer above renal artery 15 mm migration 6 Mos Do we really need any adjuncts
More informationPatient selection in Hostile Necks and how. to prevent endoleaks a word of caution
Patient selection in Hostile Necks and how to prevent endoleaks a word of caution P M Kasprzak, K. Pfister Department of Vascular Surgery Endovascular Surgery University Hospital Regensburg, Germany Conflict
More informationType 1a Endoleak in hostile neck anatomies: Endoanchor can fix it! D. Böckler University Hospital Heidelberg, Germany
Type 1a Endoleak in hostile neck anatomies: Endoanchor can fix it! D. Böckler University Hospital Heidelberg, Germany Disclosures Speaker name: Dittmar Böckler I have the following potential conflicts
More informationMid-term results from ANCHOR: How does this data influence the treatment algorithm for hostile EVAR anatomies
Mid-term results from ANCHOR: How does this data influence the treatment algorithm for hostile EVAR anatomies Jean-Paul P.M. de Vries Head Department of Surgery, University Medical Centre Groningen The
More informationWhen to use standard EVAR with EndoAnchors or CHEVAR in short-neck AAAs LINC ASIA 18
When to use standard EVAR with EndoAnchors or CHEVAR in short-neck AAAs JEAN-PAUL P.M. DE VRIES, DIRECTOR OF VASCULAR SURGERY ST.ANTONIUS HOSPITAL NIEUWEGEIN, THE NETHERLANDS. LINC ASIA-PACIFIC HongKong,
More informationTreating very short necks ( 4mm <10mm) using the Endurant stent graft + EndoAnchors: 1-year results and current insights
Treating very short necks ( 4mm
More informationAnatomical challenges in EVAR
Anatomical challenges in EVAR M.H. EL DESSOKI, MD,FRCS PROFESSOR OF VASCULAR SURGERY CAIRO UNIVERSITY Disclosure Speaker name:... I have the following potential conflicts of interest to report: Consulting
More informationHow to select FEVAR versus EVAR + endoanchors in short-necked AAAs
How to select FEVAR versus EVAR + endoanchors in short-necked AAAs Jean-Paul P.M. de Vries, Richte C.L. Schuurmann St. Antonius Hospital Nieuwegein, The Netherlands 21st Critical Issues Congress Nuernberg,
More informationEndoanchor-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
More informationAnatomy-Driven Endograft Selection for Abdominal Aortic Aneurysm Repair S. Jay Mathews, MD, MS, FACC
Anatomy-Driven Endograft Selection for Abdominal Aortic Aneurysm Repair S. Jay Mathews, MD, MS, FACC Interventional Cardiologist/Endovascular Specialist Bradenton Cardiology Center Bradenton, FL, USA Disclosures
More informationHow to Categorize the Infrarenal Neck Properly? I Van Herzeele Dept. Thoracic and Vascular Surgery, Ghent University, Belgium
How to Categorize the Infrarenal Neck Properly? I Van Herzeele Dept. Thoracic and Vascular Surgery, Ghent University, Belgium Disclosure Speaker name: Isabelle Van Herzeele I have the following potential
More informationConsiderations for a Durable Repair
Considerations for a Durable Repair Eric Verhoeven, MD, PhD, A. Katsargyris, MD Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany Disclosures William Cook
More informationStandardization of the CHEVAR procedure: How a standard approach has improved outcomes. Prof Peter Holt St George s, London
Standardization of the CHEVAR procedure: How a standard approach has improved outcomes Prof Peter Holt St George s, London Disclosure Speaker name: Prof Peter Holt I have the following potential conflicts
More informationNow that Endoanchors are Approved (and paid for) We have a Durable Solution to Short Necks That s so Easy!
Now that Endoanchors are Approved (and paid for) We have a Durable Solution to Short Necks That s so Easy! David H. Deaton, MD Vascular Surgery / University of South Carolina / Palmetto Health Chief Medical
More informationAortic 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,
More informationConflicts of Interest. When and Why Complex EVAR in Tx of juxta/suprarenal AAA? Summary. Infrarenal EVAR for short necks 2y postop
When and Why Complex EVAR in Tx of juxta/suprarenal AAA? Tim Resch MD Vascular Center Skane University Hospital Conflicts of Interest COOK Medical - Consulting, Speakers Bureau, IP, Research support Medtronic
More informationJean M. Panneton, MD, FRCSC, FACS. Professor of Surgery, Chief & Program Director Division of Vascular Surgery. Norfolk, VA
Jean M. Panneton, MD, FRCSC, FACS Professor of Surgery, Chief & Program Director Division of Vascular Surgery Eastern Virginia Medical School Norfolk, VA The Houston Aortic Symposium Houston TX, February
More informationAbdominal 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 informationEndoAnchors: Endovascular Stitching During EVAR and TEVAR
EndoAnchors: Endovascular Stitching During EVAR and TEVAR BY JEAN-PAUL P. M. de VRIES, MD, PhD THE EVOLUTION OF ENDOVAS- CULAR REPAIR IS CHARACTER- IZED BY INNOVATION Endovascular aneurysm repair (EVAR)
More informationOptimizing Accuracy of Aortic Stent Grafts in Short Necks
Optimizing Accuracy of Aortic Stent Grafts in Short Necks Venkatesh Ramaiah, MD, FACS Medical Director Arizona Heart Hospital Director Peripheral Vascular and Endovascular Research Arizona Heart Institute
More informationCASE BOOK: ENDOANCHOR TM FIXATION UC EN
CASE BOOK: ENDOANCHOR TM FIXATION UC201700368 EN PURPOSE OF THIS MATERIAL The Aptus TM Heli-FX TM EndoAnchor TM systems have been used in over 5,000 patients worldwide, with over 30,000 EndoAnchor implants
More informationAAA: DEBATE THERE ARE NO LIMITS USING EVAR FOR AAA. 2 nd -3 rd June 2016.
AAA: DEBATE THERE ARE NO LIMITS USING EVAR FOR AAA JORGE FERNÁNDEZ NOYA ANGIOLOGY AND VASCULAR SURGERY DEPARTMENT UNIVERSITARY CLINICAL HOSPITAL SANTIAGO DE COMPOSTELA 2 nd -3 rd June 2016. 1888 ENDOANEURYSMORRHAPHY
More informationNo Neck Is Needed! Treat the Aneurysm Instead! Andrew Holden, MD Associate Professor of Radiology Auckland City Hospital
No Neck Is Needed! Treat the Aneurysm Instead! Andrew Holden, MD Associate Professor of Radiology Auckland City Hospital Disclosures Andrew Holden, MBChB, FRANZCR No financial investment to disclose Investigator
More informationNellix 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 informationNEW INNOVATIONS IN ENDOLEAK MANAGEMENT
DISCLOSURES NEW INNOVATIONS IN ENDOLEAK MANAGEMENT Kelley HodgkissHarlow, MD, RPVI, FACS Vascular and Endovascular Surgery Kaiser Permanente, San Diego Nothing to disclose GOALS BACKGROUND Background Surveillance
More informationYoung-Guk Ko, M.D. Severance Cardiovascular Hospital, Yonsei University Health System,
Young-Guk Ko, M.D., Dangas G, J Am Coll Cardiol Intv 2012;5:1071 All-cause Mortality Dangas Severance G, J Am Coll Cardiovascular Cardiol Intv Hospital, 2012;5:1071 Yonsei University Health System Aneurysm-related
More informationDurability of The Endurant Stent-Graft through 5 Years
Durability of The Endurant Stent-Graft through 5 Years Michel S. Makaroun MD Co-Director, UPMC Heart and Vascular Institute Professor and Chair, Division of Vascular Surgery University of Pittsburgh School
More informationManagement of Endoleaks
Management of Endoleaks Murray Shames, MD Professor and Chief, Director Tampa General Hospital Aortic Program Vice Chair of Research, Dept. of Surgery Conflict of Interests: Speaker: Gore, Medtronic, Cook
More informationEndoAnchors Advance Treatment of Aortic Aneurysms: Experience in a Community Hospital
EndoAnchors Advance Treatment of Aortic Aneurysms: Experience in a Community Hospital BY MAZIN FOTEH, MD CONFRONTING THE COMPLEX ANATOMY OF AAAs AND THE LIMITATIONS OF EVAR Even though endovascular aortic
More informationCurrent Status of EVAR for Infrarenal AAA. 31 st Annual Florida Vascular Society. PENN Surgery
Current Status of EVAR for Infrarenal AAA 31 st Annual Florida Vascular Society PENN Surgery No Disclosures Stent Grafts Design Related Differences What really matters? Modular Unibody Supported Unsupported
More informationRedo 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
More informationChallenges with Complex Anatomies Advancing Care in Endovascular Aortic Treatment
Challenges with Complex Anatomies Advancing Care in Endovascular Aortic Treatment Robert Y. Rhee, MD Chief, Vascular and Endovascular Surgery Director, Aortic Center Maimonides Medical Center Brooklyn,
More informationENCORE, 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 informationTaming The Aorta. David Minion, MD Program Director, Vascular Surgery University of Kentucky Medical Center Lexington, Kentucky, USA
Taming The Aorta David Minion, MD Program Director, Vascular Surgery University of Kentucky Medical Center Lexington, Kentucky, USA Faculty Disclosure Consulting: Endologix, Cook 1 Objectives Review the
More informationTriVascular Ovation Prime Abdominal Stent Graft System
TriVascular Ovation Prime Abdominal Stent Graft System Science of the Seal O-Ring Sealing Technology O-Ring Sealing in Proven Engineering Solutions O-rings are designed to seal by blocking the flow of
More informationHostile Proximal Neck: A New Conformable EVAR Device
Hostile Proximal Neck: A New Conformable EVAR Device Young-Guk Ko, M.D., Seoul, Korea Currently Available Devices for EVAR in Korea, 2018 Zenith Flex, Cook Endurant IIs, Medtronic INCRAFT, Cordis AFX2,
More informationEXPERIENCE AFTER 500 ENDOLUMINAL STENT GRAFTS. DEVICES SPECIFIC OUTCOME AND LESSONS LEARNED.
EXPERIENCE AFTER 500 ENDOLUMINAL STENT GRAFTS. DEVICES SPECIFIC OUTCOME AND LESSONS LEARNED. A/Prof. B. Patrice Mwipatayi MD, MMed (Surg), MClinEd (Melb), FCS, FRACS Department of Vascular Surgery, Royal
More information14F OD Ovation Abdominal Stent Graft System
14F OD Ovation Abdominal Stent Graft System 2 Year Results from the European Study Dierk Scheinert, MD Center for Vascular Medicine Angiology and Vascular Surgery Park Hospital Leipzig, Germany Disclosure
More informationDegeneration of the Neck Post Implementation - a New Era of AAA Stent
Degeneration of the Neck Post Implementation - a New Era of AAA Stent New Mexico Heart Institute Albuquerque, New Mexico USA - Gore Current FDA-Approved EVAR Devices Sealing Mechanism Endologix Lombard
More informationThe 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
More informationGORE EXCLUDER AAA Endoprosthesis demonstrates long-term durability. Michel Reijnen Rijnstate Hospital Arnhem, The Netherlands
GORE EXCLUDER AAA Endoprosthesis demonstrates long-term durability Michel Reijnen Rijnstate Hospital Arnhem, The Netherlands Disclosure Speaker name: Michel Reijnen I have the following potential conflicts
More informationEndovascular Treatment of the Aorta with Fenestrated and Branched Grafts
Endovascular Treatment of the Aorta with Fenestrated and Branched Grafts Eric LG Verhoeven,MD, PhD, A. Katsargyris, MD Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany
More informationEndovascular 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 informationEndoVascular Aneurysm Sealing (EVAS) with Nellix
1 2 EndoVascular Aneurysm Sealing (EVAS) with Nellix Designed to seal entire aneurysm with contained biostable polymer Non-modular design with complete fixation Expands endovascular patient eligibility
More informationNASDAQ: ELGX December Innovation that Empowers
NASDAQ: ELGX www.endologix.com December 2014 Innovation that Empowers Safe Harbor This presentation contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act
More informationEVAS using Nellix in my practice Where are we today?
EVAS using Nellix in my practice Where are we today? Prof. dr. Michel MPJ Reijnen Department of Vascular Surgery, Rijnstate Hospital Arnhem Faculty of Science and Technology, University of Twente The Netherlands
More informationHistory of the Powerlink System Design and Clinical Results. Edward B. Diethrich Arizona Heart Hospital Phoenix, AZ
History of the Powerlink System Design and Clinical Results Edward B. Diethrich Arizona Heart Hospital Phoenix, AZ Powerlink System: Unibody-Bifurcated Design Long Main Body Low-Porosity Proprietary eptfe
More informationInsights from the PROTAGORAS/PERICLES Registries: impact on ChEVAR results
Insights from the PROTAGORAS/PERICLES Registries: impact on ChEVAR results Konstantinos P. Donas, Giovanni Torsello Department of Vascular Surgery St. Franziskus Hospital Münster, Germany Disclosure Speaker
More informationSanti Trimarchi, MD, PhD Vascular Surgeon Thoracic Aortic Research Center, Director IRCCS Policlinico San Donato University of Milan
The Gore GREAT Registry: Update about a real life data collection Santi Trimarchi, MD, PhD Vascular Surgeon Thoracic Aortic Research Center, Director IRCCS Policlinico San Donato University of Milan Disclosures
More informationTreatment options of late failures of EVAS. Michel Reijnen Rijnstate Arnhem The Netherlands
Treatment options of late failures of EVAS Michel Reijnen Rijnstate Arnhem The Netherlands Disclosure Speaker name: Michel Reijnen I have the following potential conflicts of interest to report: Consulting
More informationLOWERING THE PROFILE RAISING THE BAR
LOWERING THE PROFILE RAISING THE BAR INNOVATIVE LOW PROFILE. ADVANCED CLINICAL PERFORMANCE. The AFX TM Endovascular AAA System integrates anatomical fixation with an advanced delivery system and graft
More informationAnalysis of Type IIIb Endoleaks Encountered with Endologix Endografts
Analysis of Type IIIb Endoleaks Encountered with Endologix Endografts Alan R. Wladis, MD, FACS, David Varnagy, MD, FACS, Manuel R. Perez-Izquierdo, MD, Mark Ranson, MD FACS, Delos Clift, MD FACS, Rebecca
More informationDisclosures. EVAR follow-up: actual recommendation. EVAR follow-up: critical issues
Disclosures is it time to discuss individualized follow-up schemes based on preoperative anatomy and high quality completion angiography? Consultant / Speaker / Proctor Cook Cordis Medtronic Invatec W.L.
More informationLessons learned from Ch-EVAR for the treatment of. Miltos Matsagkas MD, PhD, FEBVS Professor of Vascular Surgery University of Thessaly
Lessons learned from Ch-EVAR for the treatment of pararenal AAAs Miltos Matsagkas MD, PhD, FEBVS Professor of Vascular Surgery University of Thessaly Ch-EVAR Ch-EVAR = Chimney-EVAR Placement of single
More informationCase Report A Case of Successful Coil Embolization for a Late-Onset Type Ia Endoleak after Endovascular Aneurysm Repair with the Chimney Technique
Case Reports in Vascular Medicine Volume 2016, Article ID 5307416, 4 pages http://dx.doi.org/10.1155/2016/5307416 Case Report A Case of Successful Coil Embolization for a Late-Onset Type Ia Endoleak after
More informationSince Parodi and his colleagues introduced the
Managing Difficult Aortic Necks A perspective from a Chinese vascular program. By Xiao Tang, MD; Weiguo Fu, MD; and Yuqi Wang, MD Since Parodi and his colleagues introduced the important concept of endovascular
More informationPercutaneous 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 informationInfluence of patient selection and IFU compliance on outcomes following EVAS
Influence of patient selection and IFU compliance on outcomes following EVAS LUNCH SYMPOSIUM LINC 2017 Jan MM Heyligers, MD, PhD, FEBVS Consultant Vascular Surgeon Elisabeth TweeSteden Hospital Tilburg,
More informationOvation. Sean Lyden, MD Department Chair, Vascular Surgery Cleveland Clinic
Ovation Sean Lyden, MD Department Chair, Vascular Surgery Cleveland Clinic Disclosure Statement of Financial Interest Within the past 12 months, I or my spouse/partner have had a financial interest/arrangement
More informationChallenges. 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 informationWhat does the data tell us about outcomes of EVAR in challenging anatomy?
What does the data tell us about outcomes of EVAR in challenging anatomy? UCSF Vascular Surgery Symposium 2018 Sukgu M Han, MD, MS Assistant Professor of Clinical Surgery Co-director, Comprehensive Aortic
More informationA New EVAR Device for Infrarenal AAAs
A New EVAR Device for Infrarenal AAAs Peter Nelson, MD, MS Assistant Professor of Surgery MM0203 Rev. 01 Current U.S. EVAR Devices Anatomical Fixation Proximal Fixation Powerlink - Endologix Excluder WL
More informationThe Auckland Experience with the Nellix EVAS System. Andrew Holden, MBChB, FRANZCR
The Auckland Experience with the Nellix EVAS System Andrew Holden, MBChB, FRANZCR Disclosure Speaker name: Associate Professor Andrew Holden I have the following potential conflicts of interest to report:
More informationLow 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
More informationEndovascular Aneurysm Sealing System for Treating Abdominal Aortic Aneurysms: Early Outcomes from a Single Center
Endovascular Aneurysm Sealing System for Treating Abdominal Aortic Aneurysms: Early Outcomes from a Single Center Thiti Chanmayka MD*, Anucha Ahooja MD**, Chalach Mitprachapranee MD*, Chawalit Wongbhuddha
More informationCase Report Early and Late Endograft Limb Proximal Migration with Resulting Type 1b Endoleak following an EVAR for Ruptured AAA
Hindawi Case Reports in Vascular Medicine Volume 2017, Article ID 4931282, 5 pages https://doi.org/10.1155/2017/4931282 Case Report Early and Late Endograft Limb Proximal Migration with Resulting Type
More informationJean M Panneton, MD Professor of Surgery Program Director Vascular Surgery Chief EVMS. Arch Pathology: The Endovascular Era is here
Jean M Panneton, MD Professor of Surgery Program Director Vascular Surgery Chief EVMS Arch Pathology: The Endovascular Era is here Disclosures Consultant: Cook Medical, Bolton Medical, Medtronic Inc, Volcano,
More informationCHALLENGING EVAR S: LONG TERM OPTIMIZATION WITH ONYX RALF R. KOLVENBACH
CHALLENGING EVAR S: LONG TERM OPTIMIZATION WITH ONYX RALF R. KOLVENBACH DISCLOSURE No Disclosures THE ROLE OF LIQUID EMBOLIZATION Type I Endoleaks Type II Endoleaks Gutters ONYX Onyx is a liquid embolic
More informationMy personal experience with INCRAFT in standard and challenging cases
My personal experience with INCRAFT in standard and challenging cases G Pratesi, MD Vascular Surgery University of Rome Tor Vergata giovanni.pratesi@uniroma2.it Disclosure Speaker name: Giovanni Pratesi,
More informationHow to achieve a successful proximal sealing in TEVAR? Pr L Canaud
How to achieve a successful proximal sealing in TEVAR? Pr L Canaud CHU de Montpellier France Disclosure I have the following potential conflicts of interest to report: Consulting: Medtronic. Proximal neck
More informationPredictors of abdominal aortic aneurysm sac enlargement after EVAR Longterm results from the ENGAGE Registry
Predictors of abdominal aortic aneurysm sac enlargement after EVAR Longterm results from the ENGAGE Registry D. Böckler Department of Vascular and Endovascular Surgery University Hospital Heidelberg Disclosure
More informationNATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE GUIDANCE EXECUTIVE (GE)
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE GUIDANCE EXECUTIVE (GE) Review of TA167; Endovascular stent-grafts for abdominal aortic aneurysms Final recommendation post consultation The guidance should
More informationEndoleaks after F-BEVAR How to Assess & Treat? Gustavo S. Oderich, MD Mayo Clinic Rochester, MN
Endoleaks after F-BEVAR How to Assess & Treat? Gustavo S. Oderich, MD Mayo Clinic Rochester, MN FACULTY DISCLOSURE Gustavo S. Oderich MD Consulting, DSMB, CEC* Cook Medical Inc., WL Gore, Lombardi Honoraria
More informationChallenges in the treatment of infrarenal aneurysm & considerations for a durable repair
Challenges in the treatment of infrarenal aneurysm & considerations for a durable repair Nilo J Mosquera, MD. Head of Department Angiology and Vascular Surgery. CHUO Hospital. Ourense. Spain Disclosure
More informationFrom 1996 to 1999, a total of 1,193 patients with
THE ANEURX CLINICAL TRIAL AT 8 YEARS Lessons learned following the US AneuRx clinical trial from 1996 to 2004. BY CHRISTOPHER K. ZARINS, MD From 1996 to 1999, a total of 1,193 patients with infrarenal
More informationAccess More Patients. Customize Each Seal.
Access More. Customize Each Seal. The Least Invasive Path Towards Proven Patency ULTRA LOW PROFILE TO EASE ADVANCEMENT The flexible, ultra-low 12F ID Ovation ix delivery system enables you to navigate
More informationEVAR 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 informationManagement 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 informationPerformance of the conformable GORE TAG device in Type B aortic dissection from the GORE GREAT real world registry
University of Milan Thoracic Aortic Research Center Performance of the conformable GORE TAG device in Type B aortic dissection from the GORE GREAT real world registry Santi Trimarchi, MD, PhD Associate
More informationToward Total Endovascular Therapy of the Aorta. Adam W. Beck, MD. Associate Professor of Surgery Division of Vascular Surgery and Endovascular Therapy
Toward Total Endovascular Therapy of the Aorta Adam W. Beck, MD Associate Professor of Surgery Division of Vascular Surgery and Endovascular Therapy University of Alabama at Birmingham Disclosures Grant
More informationEvolution of gender-related differences in outcome of EVAR
Evolution of gender-related differences in outcome of EVAR Erik Debing Department of Vascular Surgery University Hospital Brussels Disclosure Speaker name: ERIK DEBING... I have the following potential
More informationChungbuk 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 informationThe Short Proximal AAA Neck
The Short Proximal AAA Neck A comparison of EVAR outcomes among groups of patients with different proximal neck lengths. BY ALEXANDRA A. MACLEAN, MD, AND BARRY T. KATZEN, MD, FOR THE BCVI ENDOVASCULAR
More informationAortic Arch pathology options: Open,Hybrid, fenestration, Chimney or branched stent-graft?
Aortic Arch pathology options: Open,Hybrid, fenestration, Chimney or branched stent-graft? Chang Shu, M.D., Ph.D Vascular Surgery Center National Center for Cardiovascular Diseases. Fuwai Hospital, CAMS
More informationTrattamento Endovascolare degli Aneurismi dell Aorta Addominale con Colletto Prossimale Ostile:
Trattamento Endovascolare degli Aneurismi dell Aorta Addominale con Colletto Prossimale Ostile: Risultati Precoci e a Medio Termine in Esperienza Monocentrica A.Lauricella - R.Silingardi Chirurgia Vascolare,
More informationTitle. Different arch branched devices are available, is morphology the. main criteria of choice? Ciro Ferrer, MD
Different arch branched devices are available, is morphology the Title main criteria of choice? Ciro Ferrer, MD Vascular Surgery Unit Sapienza University of Rome Disclosure Speaker name: Ciro Ferrer Proctoring/speaking
More informationEight Year Experience with Type I Endoleaks at a Tertiary Care Center
Eight Year Experience with Type I Endoleaks at a Tertiary Care Center Adam Tanious MD, Megan Carroll MD, Mathew Wooster MD, Andrew Jung BA, Marcello Giarelli MSN, Martin Back MD, Bruce Zwiebel MD, Peter
More informationOvercoming Challenging Aortic Anatomy: from Hostile Necks to Tortuous Iliac arteries
Overcoming Challenging Aortic Anatomy: from Hostile Necks to Tortuous Iliac arteries Robert Fisher Royal Liverpool University Hospital, UK Liverpool Vascular and Endovascular Service Introduction Late
More informationBilateral use of the Gore IBE device for bilateral CIA aneurysms and a first interim analysis of the prospective Iceberg registry
Bilateral use of the Gore IBE device for bilateral CIA aneurysms and a first interim analysis of the prospective Iceberg registry Michel MPJ Reijnen, MD, PhD Department of Vascular Surgery, Rijnstate Hospital
More informationSide effects of TEVAR and EVAR on the heart: Myth or reality?
Side effects of TEVAR and EVAR on the heart: Myth or reality? Christos D. Liapis, MD, FACS, FRCS, FEBVS Professor (Em) of Vascular Surgery National & Kapodistrian University of Athens Director Vascular
More informationMODERN 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 informationCombined 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 informationExperience 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 informationCUSTOM-MADE SCALLOPED THORACIC ENDOGRAFTS IN DIFFERENT HOSTILE AORTIC ANATOMIES
CUSTOM-MADE SCALLOPED THORACIC ENDOGRAFTS IN DIFFERENT HOSTILE AORTIC ANATOMIES A SERIES OF THREE CASE REPORTS Joel Sousa Department of Department of Angiology and Vascular Surgery Hospital S. João, Porto,
More informationAortic stents, types, selection, tricks in deployment.
Aortic stents, types, selection, tricks in deployment. Hamdy Soliman.M.D,FSCAI Consultant of Cardiology&Head of Endovascular Unit National Heart Institute Endovascular Treatment of Thoracic Aortic Aneurysms
More informationCOMBINED TECHNIQUE CHIMNEY + FENESTRATED ENDOGRAFT FOR COMPLEX ANEURYSMS ERIC DUCASSE - MD PHD FEVBS CHU BORDEAUX
COMBINED TECHNIQUE CHIMNEY + FENESTRATED ENDOGRAFT FOR COMPLEX ANEURYSMS ERIC DUCASSE - MD PHD FEVBS CHU BORDEAUX DISCLOSURE SPEAKER NAME: PR. E. DUCASSE I HAVE THE FOLLOWING POTENTIAL CONFLICTS OF INTEREST
More information