Γιατί είναι σημαντικό για τον θεράποντα χειρουργό να γνωρίζει πως να μετρήσει ένα ανεύρυσμα και να επιλέξει το κατάλληλο μόσχευμα?
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1 Γιατί είναι σημαντικό για τον θεράποντα χειρουργό να γνωρίζει πως να μετρήσει ένα ανεύρυσμα και να επιλέξει το κατάλληλο μόσχευμα? Μ. Ματσάγκας MD, PhD, FEBVS Καθηγητής Αγγειοχειρουργικής Πανεπιστημίου Θεσσαλίας
2 Introduction Is it important for the treating physician to know how to measure an aneurysm?? It is essential!! Eligibility for ΤEVAR Complex endovascular operations Follow-up of the patient
3 Eligibility for TEVAR Proximal neck Diameter Length Angle Quality Aneurysm Shape Length Thrombus Access site Diameter Length Tortuosity, angle Quality
4 Eligibility for TEVAR Example 84 years old female patient Previous aortic surgery 5 years ago for ascending aorta aneurysm (7,9cm) AVR, CABG x 1, total ascending and arch replacement Hypertension Presenting with symptomatic TAA 8,4cm in diameter Eligible for TEVAR?
5 Eligibility for TEVAR Eligible for TEVAR?
6 Eligibility for TEVAR
7 Eligibility for TEVAR
8 Eligibility for TEVAR
9 Eligibility for TEVAR
10 Eligibility for TEVAR Decision Endovascular repair with coverage of the whole descending aorta length from the LSA to the celiac trunk
11 Eligibility for TEVAR Planning Thoracic stent-graft: Valiant Captivia (Medtronic) x 200 mm x x 150 mm x 1 - Access from Rt CFA - Percutaneous access from Lt CFA for angio
12 Operation Eligibility for TEVAR
13 Operation Eligibility for TEVAR
14 Operation Eligibility for TEVAR
15 Eligibility for TEVAR
16 Complex endovascular operations Decide if an endovascular approach can be accomplished and succeeded Aortic morphology Target vessels Access Measure, size and design Main graft TV stents
17 Complex endovascular operations Example 63 years old male patient Voice hoarseness from 7 months COPD hyperlipidemia ex-smoker
18 Complex endovascular operations Thoracic aortic aneurysm 6.6 cm Unfit for open repair Preference for endovascular repair Eligible for endo repair?
19 Complex endovascular operations
20 Complex endovascular operations SubCl
21 Complex endovascular operations
22 Complex endovascular operations InomA CarA SubCl
23 Complex endovascular operations
24 Decision Endovascular repair using a custom made thoracic endograft Lt carotid-subclavian by-pass Coverage of the Lt subclavian artery A wide scallop for the LCA to achieve an adequate sealing zone Vascular plug in the Lt SA Complex endovascular operations
25 Complex endovascular operations
26 Complex endovascular operations
27 Complex endovascular operations
28 Complex endovascular operations CAROTID- SUBCLAVIAN BYPASS
29 OCCLUDER Complex endovascular operations
30 Complex endovascular operations
31 Follow-up A good view of the treated aortic pathology Placement of the graft Kinking Measurement of aneurysm maximum diameter Measurement of graft diameters Capability to store the images!! Comparison in the future
32 Follow-up
33 Follow-up
34 Follow-up
35 Follow-up
36 So What do you need to measure and size a thoracic aortic aneurysm? CTA in digital format (DICOM files) Adequate software
37 Software Provided by CT scanner manufacturers Good capabilities Continuous development Available only in Picture Archiving and Communication System (PACS) stations in the hospital Sometimes restrictions in use for the vascular surgeon
38 Software Provided by graft manufacturers Support for the treating physicians Educational activities Sometimes online Help to plan and review your case with the dedicated company s representative, or even the company s team of specialists The involvement of a graft manufacturer in the planning procedure could produce bias in choosing the adequate graft
39 Software Stand alone software Commercially available Freeware Help to size and plan your case by yourself Be able to decide which graft fits most your patient, regardless of the industry proposals
40 3Mensio software Software Commercially available (expensive) Advanced, easy to use 2D and 3D visualization solution Runs on any modern Windows based computer with a 3D graphics card that meets the minimum requirements, eliminating the need for specialized hardware
41 Osirix software Freeware Software An image processing software dedicated to DICOM images produced by imaging equipment (CT, MRI, PET, etc.) Designed for navigation and visualization of multimodality and multidimensional images, offering all rendering modes Requires a Mac operating system (MAC OS-X) to function, meaning that it only works in a Mac computer (cost for hardware)
42 Software booklets
43 In conclusion Accurate preoperative assessment of the morphology of the aneurysm, the access vessels and the proximal and distal stent-graft landing zones, is critical for the early and late success of the procedure It can be stated that a significant part of the battle is won before getting into the OR by using data coming from adequate sizing and planning
44 In conclusion Spending time for sizing and planning before the operation Saves more time, radiation exposure and contrast media during the operation But most importantly, leads to better results!!
45
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