case report : large thoracoabdominal aneurysm with narrow ... · 2 sessions to reduce paraplegia...
TRANSCRIPT
2018
Case Report : Large thoracoabdominal
aneurysm with narrow access vessels
MichelBosiers,MD
DepartmentofVascularSurgery,Münster
2018
Pa<ent details
• 80y,female
• Arterialhypertension
• coronaryheartdisease,previousCABG
• COPDGoldIII
• Thoracoabdominalaneurysm67mm
• Externaliliac:6-7mmdiameter
2018
Planning
2018
What would be your treatment strategy?
• Openrepair• ConservaLvetreatment• Chimney/SandwichEVAR• Off-the-shelfbranchedendograQ• Custom-made-branchedendograQ• Custom-made-fenestratedendograQ• OtheropLon...
2018
Our concept
2sessionstoreduceparaplegiarisk
• 1.TEVARstarLngattheleveloftheleQsubclavianarterytoapproximately2cmproximaloftheceliactrunc
• 2.custommadebranchedendograQ,low-profiledevice(18F)dueto
narrowiliacs
2018
Planning
SMA
Celiactruncstenosed
LRA
RRA
2018
• Stagedprocedureinordertoreduceparaplegiarisk:
1.Session:TEVAR(Zenithalpha,Cook)
ZTA-PT-36-32-209
2.Session:custommadelowprofile(18F)device(Cook)4branches
andbifurcatedendograQ;8weekslater
Treatment
2018
Treatment
FirstSession:TEVAR
2018
Treatment
Step1:deployingCMDbranchedendograQ(Cook)Step2:distalcompleLonwithbifurcatedendograQStep3:groinclosure(ProStarXLAbboa)Step4:12Fflexorsheath(Cook)fromtransaxillaryapproachFollowedby8Fsheath(Cook)
2018
Treatment: aAaching SMA
8x59mmAdvanta(Maquet)+10x50mmViabahn(Gore)
2018
Treatment: aAaching right renal artery
6x38mmAdvanta(Maquet)+6x50mmViabahn(Gore)
UpwardfacingRRA
2018
Treatment: aAaching leE renal artery
6x38mmAdvanta(Maquet)+6x100mmViabahn(Gore)
2018
Subtotalstenosed+excellentcollateralisationviaSMA
Treatment: aAaching celiac trunc
• 8x38mmAdvanta
(Maquet)
• 10mmAmplatzerPlug
(St.JudeMedical)
forbranchocclusion
2018
Result
2018
• 2daysatIntensivecareunit(standardatourinsLtuLon)
• Noparaplegia/paraparesis
• Dischargepostopday7
• CT-Scanpostop+followup(12months):
Noendoleak;Patentbranches
Results
2018
Ques<ons to Vascupedians
• WhatisyourpreferredbridgingstentgraQinupwardfacingrenal
arteries?
• DoyougenerallytreatoctogenarianswithTAAA?
• Whatisyourtreatmentstrategytoreduceparaplegiarisk
• ShouldbranchedendograQsonlybeperformedinspecialized
centers?