martin malina director - mac conference 2017past.mac-conference.com/xconfig/upload/files/$07-fr_m....
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Martin MalinaDirector EVAR
Is EVAR Appropriate???
How?
EVAR
Seoul***:
41 %***Sang Dong Kim et al, 2012
Copenhagen*:
35 %
*Shahidi S et al, 2009
57 % (≥75 yrs)
Mortality of OR in rAAA
Medicare**:
38 % - 56 % (depending on hospital volume)
**Egorova N et al, 2009
rAAA
100 %
50 %
1990 2000 2010
35%
Year
>90%
eEVARMortality *
*Holst J et al, 2006
rAAA
1990 2000 2010
35%
Year
eEVARMortality
>90%
rAAA Survivors
(n)
More rAAA´s Offered Tx!
Pts ”Unsuitable for EVAR” Benefit the Most!
Tips for Juxtarenal rAAA
Type of SG
Standard SG?!
eEVAR Outcome in No Neck
Type of SG
Standard Fenestrated Branched Chimneys
Not available for sale.
Off-the Shelf
P-Branch
Top Cap
Top Cap
Top Cap
eEVAR in Juxtarenal rAAA Conclusion
Outcome Is Worse
All rAAA Can Be Treated with eEVAR
(Obviously!)
More Pts Get Treated
Overall Improved rAAA Survival
Probably Better than OR
eEVAR in Juxtarenal rAAA Conclusion
Consider a Standard SG!
The Worst Candidates Benefit Most!
ChEVAR +/- Occlusion Balloon for
the Truly Unstable Pts
Fenestrated and Branched Off-the-Shelf
The ShardLondon
Turning TorsoMalmö