endovascular repair for type b aortic dissection with viscer
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Endovascular Repair for Type B Aortic Dissection is successful and Durable
Chang Shu
The Second Xiangya Hospital, Central-South University, China
Email: [email protected]
Visceral artery ischemia
From July,2002—Feb,2013: 926 AD cases:
Distal port of aorta ischemia: folding of the aorta: 1
Ischemia of the vertebral artery: 6
Celiac ischemia: 21
SMA ischemia: 19
Renal ischemia: 17
Spinal cord ischemia: 5
Lower limbs ischemia: 10
Clinical Material
Emergency TEVAR: 74
Conservative treatment for 3-14 days, then TEVAR: 5
Follow up: 7months---122 months
Result
All ischemia of the visceral arteries were revised;
Two cases exist disfunctions because of the spinal cord ischemia
One patient need another stent deploy inside the renal artery
Folding of The aorta:
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Emergency TEVAR is very important!
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Spinal malformation combined with aortic dissection: ischemia of the spinal cord
VİDEO
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VİDEO
10
AD related Visceral Arteries: ischemia of the celiac artery
Can we cover the celiac A?
AD related Celiac Artery
AD related celiac Artery
AD related Visceral Arteries
AD related Visceral Arteries
AD related Visceral Arteries
AD related Visceral Arteries
AD related Visceral Arteries
AD related Visceral Arteries
AD related Visceral Arteries
Ischemia of the Vertebral Artery: Retrograde Type A AD
Retrolgrade dissection but the entry is in decending aorta
TEVAR for retrograde type A AD
TEVAR for retrograde type A AD
TEVAR for retrograde type A AD
on set 2 weeks later
TEVAR for retrograde type A AD
TEVAR for retrograde type A AD
TEVAR for retrograde type A AD
TEVAR for retrograde type A AD
Emergency TEVAR is a must or not?
TEVAR for retrograde type A AD
TEVAR for retrograde type A AD
TEVAR for retrograde type A AD
TEVAR for retrograde type A AD
TEVAR for retrograde type A AD
Special TBAD : the distal partial is totally compressed
Emergency TEVAR is the only method
Special TBAD
Special TBAD
The true lumen is completely compressed by the false lumen.
Special TBAD
Special TBAD
Special TBAD
True lumen in abdomian aorta is compressed
Special TBAD
Post-TEVAR, the patient recovered well.
Special TBAD
Post-TEVAR, the patient recovered well.
New tear cause the ischemia of the distal aorta
A new entry tear at the distal side of the stent-graft formed after TEVAR
Special TBAD
another stent graft was overlapped with the previous one, and covered the new entry tear. Then the true lumen is open.
Special TBAD
another stent graft was overlapped with the previous one, and covered the new entry tear.
Special TBAD : dissection combined with lower extremity ischemia
The right side iliac artery is compressed totally
Special TBAD
The right common iliac artery is completely compressed by the false lumen.
Special TBAD
The right common iliac artery is completely compressed by the false lumen.
Special TBAD
Special TBAD ： emergency repair is the best method to save the
patient’s life
Special TBAD
Special TBAD
The right common iliac artery is preserved after TEVAR.
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Big false aneurysmCombined withdissection
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Muti-entries ofThe aorta, and the dissectionIs like a big Stomach, cause The distal side True lumen of the aorta compressed
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The first entry is just near the left Subclavian A, andThe left carotid AIs also very near the subclavian AThe left side vertebralA ischemia
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A right carotid to Left carotid and Subclabin A bypassIs performed first
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The traditional Way to treat the Dissection whichAortic arch isinvolved
A longStent-graft is used To cover the first Entry, and the left Carotid and subclavinA were also covered
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Only Sub or both Sub & carotid
Aortic dissection combined with ischemia of the renal: kidney failure
17 aortic dissection combined with kidney failure
12 patients had been given hemodialysis before being treated by stent-graft (3days-2 weeks)
5 patient suffered from kidney failure for 2 days,
17 case were treated via stent-graft
After deployed the stent-graft, the kidney function were recover back well among 1-14 days(14 cases).
3 cases were add another bear stent inside the renal A after 2, 4, 6 weeks, and the kidney function recover back.
Discussion
Emergency TEVAR is very important to the ischemia of the visceral arteries;
Some AD with visceral artery ischemial patients will be accept TEVAR a few days later because of the bad conditions or complications
Middle-term result of TEVAR for these patients is successful and durable
