False Lumen Occlusion Techniques in CAD:

Similar documents
False Lumen Backflow In Chronic Aortic Dissections: What Is Its Role and How Can It Be Treated?

What is the best treatment for False Lumen growth after type B Dissection

Pioneering EVAR techniques in aortic dissection

The risk of air embolism in TEVAR and how to handle it!

Ascending and Arch Branch Endografts Incl. Carbondioxide Flushing To Prevent Air Embolism

Endovascular therapy for Ischemic versus Nonischemic complicated acute type B aortic dissection (catbad).

Endovascular Management of Thoracic Aortic Pathology Stéphan Haulon, J Sobocinski, B Maurel, T Martin-Gonzalez, R Spear, A Hertault, R Azzaoui

Ascending Aorta: Is The Endovascular Approach Realistic?

Residual Dissection and False Lumen Aneurysm After TEVAR

The Current Status Of Endovascular Repair Of Ascending Aorta And Aortic Arch

Are stent-grafts for acute type B dissection durable? Est-ce que les stents graft pour la dissection aigue de type B sont efficaces à moyen terme?

TEVAR for Chronic dissections: indications for TEVAR, long term results

Modified candy-plug technique for chronic type B aortic dissection with aneurysmal dilatation: a case report

Distal False Lumen Occlusion in Aortic Dissection With a Homemade Extra-Large Vascular Plug: The Candy-Plug Technique

Antegrade Thoracic Stent Grafting during Repair of Acute Debakey I Dissection: Promotes Distal Aortic Remodeling and Reduces Late Open Re-operation

Tips and Tricks to Deliver a Stengraft to the Ascending Aorta

The Petticoat Technique Managing Type B Dissection with both Early and Long Term Considerations

No Disclosure. Aortic Dissection in Japan. This. The Challenge of Acute and Chronic Type B Aortic Dissections with Endovascular Aortic Repair

UC SF. Disclosures. Thoracic Endovascular Aortic Repair 4/24/2009. Management of Acute Dissections: Is There Still a Role for Open Surgery?

I-Hui Wu, M.D. Ph.D. Clinical Assistant Professor Cardiovascular Surgical Department National Taiwan University Hospital

What is the benefit. of MEP s in BEVAR for TAAA. in preventing paraplegia?

Thoracic Endovascular Aortic Repair (TEVAR) Indications and Basic Procedure

Performance of the conformable GORE TAG device in Type B aortic dissection from the GORE GREAT real world registry

Total endovascular techniques utilization in aortic dissection radical treatment

Unravelling the Literature on. Aortic. Dissection. Tara M Mastracci, MD FRCS(C) FACS MSc (HRM) FRCS

Ascending Aorta: Is The Endovascular Approach Realistic?

Current State of Thoracic Branch Devices and Ongoing Clinical Trials

Hybrid Repair of a Complex Thoracoabdominal Aortic Aneurysm

Ascending Aorta: How I Do It.

Treatment of acute type B aortic dissection: Current status

Re-interventions after TEVAR:

Ascending Aorta: The Endovascular Approach

Experience of endovascular procedures on abdominal and thoracic aorta in CA region

Endovascular Treatment of the Aorta with Fenestrated and Branched Grafts

Clinical Trials of Acute and Chronic Dissections. Gregory Landry MD

Redo treatment and open conversion after TEVAR

Changing Spectrum of Re-Interventions following TEVAR. 31 st Annual Florida Vascular Society. PENN Surgery

Aortic Neck Issues Associated Clinical Sequelae/Implications for Graft Choice

Technique and Outcome of Laser Fenestration For Arch Vessels

UC SF An Algorithm to Choose Which Uncomplicated (Asymptomatic) Acute Type B Dissection Patients Should Undergo TEVAR. Disclosures.

Kopp R, Puippe G, Rancic Z, Hofmann M, Pecoraro F, Pfammatter T, Lachat M.. University Hospital Zurich, Switzerland

Considerations for a Durable Repair

for Thoracoabdominal Aneurysms

Abdominal and thoracic aneurysm repair

Development of Stent Graft. Kato et al. Development of an expandable intra-aortic prothesis for experimental aortic dissection.

Associate Professor Walter W. Buckley Endowed Chair in Research Cleveland Clinic Lerner College of Medicine-CWRU. Houston Aortic Symposium 2017

Contemporary Management of Acute Type B Aortic Dissection

Aortic Center of Excellence at Sentara

TEVAR. (Thoracic Endovascular Aortic Repair) for Aneurysm and Dissection. Bruce Tjaden MD Vascular Surgery Fellow

Toward Total Endovascular Therapy of the Aorta. Adam W. Beck, MD. Associate Professor of Surgery Division of Vascular Surgery and Endovascular Therapy

SANWICH TECHNIQUE TO REDUCE COMPLICATIONS WHEN TREATING BILATERAL INTERNAL ILIAC ARTERY

Challenges. 1. Sizing. 2. Proximal landing zone 3. Distal landing zone 4. Access vessels 5. Spinal cord ischemia 6. Endoleak

Optimal repair of acute aortic dissection

Three year experience with multilayer stent in the treatment of thoracoabdominal aneurysms no evidence for aneurysm stabilization

ChEVAR Vs. fevar for juxtarenal Aneurysm. E.Ducasse MD PhD FEVBS Unit of vascular surgery CHU bordeaux

EVAR and TEVAR: Extending Their Use for Rupture and Traumatic Injury. Conflict of Interest. Hypotensive shock 5/5/2014. none

Is a Paradigm Shift towards Early Endovascular Treatment of Type B Dissection justified?

Therapeutic Pathway In Acute Aortic Dissection. Speaker: Cesare Quarto Consultant Cardiac Surgeon Royal Brompton Hospital, London UK

EndoVascular Aneurysm Sealing (EVAS) with Nellix

Disclosures. EVAR follow-up: actual recommendation. EVAR follow-up: critical issues

UC SF Early Intervention in Type B Dissection: Results From the INSTEAD XL Trial. Acute Type B Dissection. Outline. Disclosures.

FEVAR FIFTEEN YEARS OF EFFICIENCY E.DUCASSE MD PHD FEBVS CHU DE BORDEAUX

The conundrum about complicated and uncomplicated type B dissection New concepts?

Aggressive Resection/Reconstruction of the Aortic Arch in Type A Dissection

Endovascular Treatment of Malperfusion Syndrome

Conflicts of Interest. Endovascular Repair of Thoracoabdominal Aneurysm. Overview PLANNING ANATOMIC CONSIDERATIONS FOR COMPLEX AORTIC REPAIR

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

Introducing the GORE TAG Conformable Thoracic Stent Graft with ACTIVE CONTROL System

Is there a way to predict the risk in uncomplicated Type B aortic dissections? FRANS MOLL University Medical Centre Utrecht - Netherlands

Do the Data Support Endovascular Therapy for Descending Thoracic AD? Woong Chol Kang, M.D.

Treatment options of late failures of EVAS. Michel Reijnen Rijnstate Arnhem The Netherlands

THORACOABDOMINAL AORTIC ANEURYSMS HYBRID REPAIR

Type B Dissection Sub-Categories

Presente e futuro negli aneurismi dell arco aortico

Global Evidence for the Treatment of Type B Aortic Dissection

Type 1a Endoleak in hostile neck anatomies: Endoanchor can fix it! D. Böckler University Hospital Heidelberg, Germany

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

WHICH PLACE FOR EMERGENT INTERVENTION IN COMPLICATED ACUTE TYPE B DISSECTION (ctbaod)

RETROGRADE BRANCH. Gustavo S. Oderich MD Professor of Surgery Director of Endovascular Therapy Division of Vascular and Endovascular Surgery

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

Current strategies to prevent spinal cord ischemia in TAAA repair

Jean M Panneton, MD Professor of Surgery Program Director Vascular Surgery Chief EVMS. Arch Pathology: The Endovascular Era is here

Title. Different arch branched devices are available, is morphology the. main criteria of choice? Ciro Ferrer, MD

Paraplegia in endovascular repair of TAA and in TEVAR: Incidence, prevention and therapy. Johannes Lammer Medical University Vienna, Austria

The Auckland Experience with the Nellix EVAS System. Andrew Holden, MBChB, FRANZCR

DIFFICULT ACCESS REMAINS A CONTRAINDICATION FOR EVAR APOSTOLOS K. TASSIOPOULOS, MD, FACS PROFESSOR AND CHIEF DIVISION OF VASCULAR SURGERY

Optimised management of type A aortic dissection with visceral malperfusion concept to reconsider

Development of a Branched LSA Endograft & Ascending Aorta Endograft

The Ventana Off-the-Shelf Graft for Pararenal AAA. Andrew Holden Associate Professor of Radiology Auckland Hospital

Why Nellix? Treating Concomitant Common Iliac Aneurysms

Animesh Rathore, MD 4/22/17. The Great Debate 45yo Man With Uncomplicated Acute TBAD: The Case For Medical Management

Management of the hypogastric artery during EVAR. Francesco Torella Liverpool Vascular & Endovascular Service

The role of false lumen intervention to promote remodelling via induced thrombosis the FLIRT concept

Daniela Branzan MD, Department of Vascular Surgery and Department of Interventional Angiology University Hospital Leipzig

Insights from the PROTAGORAS/PERICLES Registries: impact on ChEVAR results

ENCORE, a Study to Investigate the Durability of Polymer EVAR with Ovation A Contemporary Review of 1296 Patients

Accepted Manuscript. Is A More Extensive Operation Justified for Acute Type A Dissection Repair? Dr. Leonard N. Girardi

Hostile Neck During EVAR, The Role Of Endoanchores

Chungbuk Regional Cardiovascular Center, Division of Cardiology, Departments of Internal Medicine, Chungbuk National University Hospital Sangmin Kim

Teresa Martín González, MD; Blandine Maurel, MD, PhD; Adrien Hertault, MD; Jonathan Sobocinski, MD, PhD; Rafaëlle Spear, MD, PhD; Richard Azzaoui,

Transcription:

University Heart Center Hamburg GERMAN AORTIC CENTER False Lumen Occlusion Techniques in CAD: What is ist role? How is it done? Tilo Kölbel Fiona Rohlffs, Nikos Tsilimparis, Sebastian Debus German Aortic Center University Heart Center Hamburg

Disclosures! Research-grants, travelling, proctoring speaking-fees, IP with Cook.! Discussion of investigational devices, which are not FDA-aprooved.

Open Surgery for CTBAD 19 studies, n=970, 58y mean age! 30d mortality: 11%! Stroke: 6%, SCI: 5%, CNI: 8%! 3/10y survival: 74/50%! Conclusion: poorer compared to TEVAR Tian et al. 2014; Ann Cardiothorac Surg 3:340-50

TEVAR in Chronic Type B False Lumen Perfusion No Aortic Remodelling Death Mani et al. 2012; Eur J Vasc Endovasc Surg 43: 386-91

Failure to Remodel in Chronic Dissection! Perfusion and pressure unchanged in false lumen! Presence of Intercostals originating from false lumen! False lumen back flow to Intercostals! FL-TAA in 1/3 of TEVAR-patients!

FL-Aneurysm in Chronic AD 70%! N=100: 51 post TAAD; 49 TBAD! FU: 53±26 months: FL-Aneurysm! Aortic arch 3%! Upper desc. aorta 14%! Mid desc. aorta 8%! Lower desc. aorta 4%! Abdominal aorta 3% Song et al. 2007; JACC 50:799-804

Direct False Lumen Occlusion

Direct False Lumen Occlusion! TEVAR-extension to CA! Embolisation or Knickerbocker! Seperates aortic FL-compartments!! Does not restrict further distal techniques like fenestrated EVAR Bulkhead

When/Why Are They Needed?! Open surgery in CTBAD reserved to good risk patients.! TEVAR in CTBAD fails in 1/3 of patients.! False lumen occlusion needed if proximal thoracic aorta expands or diameter requires immediate occlusion.

Filters, Balloons, Thrombin! 2 Cases 1. FL-TAA-occlusion with:! 2 Greenfield filters! 6 detachable balloons! 5ml thrombin 2. FL-TAA-occlusion with:! 24mm Talent occluder Loubert et al. 2003; J Endovasc Ther 10: 244-8

Coils, Plugs, Glue Preop. CT Intervention Postop. CT

Iliac Occluder Idrees et al. 2014; J Vasc Surg 60:1507-13

Candy-Plug 50mm 22mm Amplatzer plug II 22mm ZIP iliac-occluder Kölbel et al. 2013; J Endovasc Ther 20: 484-9

Candy-Plug Kölbel et al. 2013; J Endovasc Ther 20: 484-9

Kölbel et al. 2014; J Endovasc Ther 21: 117-22 Knickerbocker-Technique

Kölbel et al. 2014; J Endovasc Ther 21: 117-22 Knickerbocker-Technique

Kölbel et al. 2014; J Endovasc Ther 21: 117-22 Knickerbocker-Technique

Kölbel et al. 2014; J Endovasc Ther 21: 117-22 Knickerbocker-Technique

What Are The Complications?! Risk for spinal cord ischemia:! Observation! SF-drainage! BP-control! 1 anecdotal case in ruptured CTBAD and surgeon-modified candyplug Knickerbocker:! Risk for FL-rupture:! 1case: salvaged by additional coil and glue embolisation.

What Is The World Experience? Recently collected data, all Cook-Medical CMDs! Knickerbocker:! German Aortic Center Hamburg, Germany! Fabio Verzini, University of Perugia, Italy! Andrew Holden, Auckland City Hospital, New Zealand! Carla van Rijswijk, Leiden UMC, Netherlands! Anders Wanhainen, Uppsala UniversityHospital, Sweden! Candyplug:! German Aortic Center Hamburg, Germany! Matt Thompson, St. Georges Hospital London, Great Britain! Joachim Florek, Helios-Klinikum Freital, Germany! Hence Verhagen, Erasmus UMC Rotterdam, Netherlands

Candy-Plug! N=18! Technical success 18/18! No rupture! No SCI! No mortality! 3 reinterventions for continous perfusion! Secondary FLthrombosis all patients

FL-Aneurysm in Chronic AD! N=100: 51 post TAAD; 49 TBAD 20%! FU: 53±26 months: FL-Aneurysm! Aortic arch 3%! Upper desc. aorta 14%! Mid desc. aorta 8%! Lower desc. aorta 4%! Abdominal aorta 3% Song et al. 2007; JACC 50:799-804

fevar in Chronic Type B Courtesy of Stephan Haulon, Lille

fevar in Chronic Type A/B! 2010-2014! N=31, 17 months FU! 6 Type II EL; 6 type 1b EL! 30d-mortality: 9.6%! Technical success: 93.5%! FL-thrombosis: 88% Oikonomou et al. 2014; J Vasc Endovasc Surg 48: 641-8

Conclusion! Tubular stent-graft sufficient in majority cases of TBAD.! False lumen backflow limiting treatment success in chronic TBAD.! Techniques for false-lumen embolisation:! Plugs, coils, glue! Candy-plug! Knickerbocker-technique! World experience promising, but future role to be defined.

2024 © healthdocbox.com Privacy Policy | Terms of Service | Feedback