IS STENTING TO MAINTAIN VASCULAR PATENCY GOING TO BE THE FUTURE
Kamentsidis Dimitrios MD, FETCS Cardiac Surgeon St. Luke’s ... · The coronarography confirmed...
Transcript of Kamentsidis Dimitrios MD, FETCS Cardiac Surgeon St. Luke’s ... · The coronarography confirmed...
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Kamentsidis Dimitrios MD, FETCS Cardiac Surgeon, St. Luke’s Hospital
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Patient
Male 67 years old
HBP
Diabetes NID
Smoker (stopped 7 years ago)
CABG ( LIMA, RIMA), 7 years ago
Abdominal Aorta Aneurysm, 7 years ago
(Endovascular repair)
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Asymptomatic
Incidental discovery
Aortic Arch Aneurysm 6,7 cm
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Conventional Surgery , Extra-corporal Circulation ,
Hypothermia
(Euroscore II 21,9%)
Branched stent-graft
(No, because of the age and the rapid evolution of the
illness)
Hybrid Treatment
(Supraortic Debranching + Endoprothesis)
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Because of the proximity of the aneurysm to the Left Subclavian Artery and in order to achieve landing zone over 2 cm it was decided a Total SupraaorticDebranching
The coronarography confirmed patency of the LIMA RIMA grafts( in order to avoid myocardial ischemia we should maintain constant flow to the LSA and RSA)
It was decided an one-stage procedure of two steps off-pump Total Supraaortic Debranching + right trans-femoral stent graft
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Avoid the use of Extra-corporal Circulation
Avoid Hypothermia
Minimizing the danger of Neurological damage
BUT
Very demanding procedure because of the previous CABG and the presence of patent LIMA RIMA
Danger of Myocardial Ischemia
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General anesthesia/ Left and Right Radial arterial lines
Midline Sternotomy
Symphisiolisis - exposure Ascending Aorta
exposure Supraaortic Vessels at their origin
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Proper positioning of the stent graft
Patent Supraaortic Grafts
Patent LIMA, RIMA
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Uneventful
Two days in the ICU
Four days to the ward
Discharged 6th PO day
Three months follow-up
Clinically well
CT-scan
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Exclusion of the aneurysm
Patent debranching Grafts (Supraaortic)
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Total exclusion of the aneurysm
Thrombosis of the aneurysmal sac (No Endoleaks)
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MERCI BEAUCOUP !!!