Aortic Triumph or Tragedy. Sean Lyden, MD Cleveland Clinic Cleveland, Ohio
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1 Aortic Triumph or Tragedy Sean Lyden, MD Cleveland Clinic Cleveland, Ohio
2 Disclosures Consultant: Phillips, Endologix, Shockwave, Abbott, BSC, Medtronic, PQ Bypass VIVA Physicians 501c3 Board Member Stock Ownership: None Research Trials: Bolton, Gore, Medtronic, Endologix, Surmodics, Boston Scientific, NIH
3 71 yo man 10.2 cm TAAA 3 cm growth over 1 year History Type B AD Open thoracic fenestration w Juxtarenal ABI FEVAR w chimney and periscopes
4 Medical History HTN Mild CAD EF 56% Atrial fibrillation Childs A Cirrhosis Hepatocellular Carcinoma Anaphylaxis to IV Contrast
5 Surgical History 7/01 Open repair of Type B AD 30 mm Dacron Graft in chest Visceral aorta left intact fenestrated 24 x 12 to infrarenal segment with reimplant accessory left renal 7/12 FEVAR chimney & periscopes 6.1 cm AAA
6 Surgical History 9/12 SMA stent graft migration 10/12 Hepatic to SMA bypass, ligation SMA 2/13 Amplatzer Plug to limb to SMA
7 36 x 16 x 145 mm Endurant Stent Graft 16 x 28 x 82 mm Limb Extension 28 x 28 x 82 mm Limb Extension 32 x 32 x 100 Valiant Stent Graft 16 x 16 x 124 mm Contralateral Limb 9 x 38 icast Chimney to Celiac Amplatzer Plugs Dislodged 8 x 59 icast to SMA 6 x 59 icast Periscope to Right Renal 7 x 59 icast Chimney to Left Renal
8
9 Type 2 Endoleak Intercostal
10 Type 3 Endoleak From Junction of Contralateral Limb And Chimney Grafts Amplatzer Plug
11 Dislodged SMA Stent graft with amplatzer plug Retrograde flow from origin of SMA
12
13 Chimney to Left Renal Artery Right Renal Artery Periscope Type 1 B Distal Endoleak
14 36 x 16 x 145 mm Endurant Stent Graft 16 x 28 x 82 mm Limb Extension 28 x 28 x 82 mm Limb Extension 32 x 32 x 100 Valiant Stent Graft 16 x 16 x 124 mm Contralateral Limb 9 x 38 icast Chimney to Celiac Amplatzer Plugs Dislodged 8 x 59 icast to SMA 6 x 59 icast Periscope to Right Renal 7 x 59 icast Chimney to Left Renal
15 What Now?
16 Celiac Access Relign SMA and Celiac Large Endoleak Viabahn in SMA
17 Relign R Renal Periscope Periscope to Right Renal Artery Type 1 B Endoleak Chimney To Left Renal Excluder Stent Graft Distal Extension
18 CTAG Extension
19 Extension R Renal Periscope Post Stenting
20 Post Operative Testing Post Operative CTA Compression of proximal SMA Stent Graft. Compression of Left Renal Stent Graft Type 2 lumbar endoleak Duplex Slow flow in SMA Stent Graft. Stenotic Left Renal Artery Chimney Lumbar endoleak.
21
22 Compressed Left Renal Artery Chimney Stent Graft Endoleak Compressed SMA Chimney Stent Graft
23 Restented Viscerals and Left Renal Periscope and Translumbar Glue embolization Duplex no Leak
24 Follow Up Imaging at Two Months Dislodged SMA Stent graft with Amplatzer Plug Left Renal Artery Chimney Proximal SMA Stent Graft Patent SMA Chimney N- Butyl Cyanoacrylate
25 Follow Up December 2014 MRI? Leak
26 Follow Up May 2015 Duplex no leak MRI? Leak cant identify source CT non contrast? 2mm larger Now What? May 2016 No leak stable AAA diameter Lost to follow up
27 October 2018 Stable Visceral Aorta
28 October 2018 Growth of Thoracic Aorta
29 Lessons Failed chimneys are not better salvaged by more chimneys Custom fenestrated devices are superior Maybe I should have removed it all to begin with I will be back again
30 November 3-7, 2019 at Wynn Las Vegas, Nevada, USA Attend the conference live from your computer!
31 Aortic Triumph or Tragedy Sean Lyden, MD Cleveland Clinic Cleveland, Ohio
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