Thoraco-Abdominal Aneurysms Endovascular Approach
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Thoraco-Abdominal Aneurysms Endovascular Approach Chirurgie Vasculaire - Hôpital Cardiologique CHRU de Lille - France
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Thoraco-Abdominal Aneurysms Endovascular Approach. Chirurgie Vasculaire - Hôpital Cardiologique CHRU de Lille - France. HYBRID PROCEDURES. CONCEPT. Endovascular repair of complex aortic aneurysms involving : Visceral vessels (juxtarenal, pararenal, TAAA) Both common iliac arteries. CONCEPT. - PowerPoint PPT Presentation
Transcript of Thoraco-Abdominal Aneurysms Endovascular Approach
Thoraco-Abdominal AneurysmsEndovascular Approach
Chirurgie Vasculaire - Hôpital CardiologiqueCHRU de Lille - France
HYBRID PROCEDURES
CONCEPT
• Endovascular repair of complex aortic aneurysms involving :
– Visceral vessels (juxtarenal, pararenal, TAAA)
– Both common iliac arteries
CONCEPT
• Sealing zones determined on pre operative CT = length of aorta to be covered
• Endograft designed with fenestrations and / or branches to perfuse vessels covered by fabric
Endovascular Options to Perfuse Target Vessels
– REINFORCED FENESTRATIONS
BRANCHES
PRELOADED CATHETER
Bridging Stentgraft
SIZING: 3D-Volume Rendering
Bone Removal
CPR
LEFT RENAL
at 2.45
Short neck AAA,Juxta and Pararenal Aneurysms
PROCEDURE
POST-OPERATIVE CT
Type IV TAAA
ANGULATION OF AORTIC BRANCHES
Contemporary Retrospective Comparative Analysis
• Consecutive elective TAAA repair over 5 years
• Retrospective review
• All films pre and post procedure evaluated– All patients classified using identical criteria
• Outcomes evaluated– 30 day mortality
– 12 month survival
– Paraplegia
• Timing
• SeverityGreenberg R, Lu Q, et al, Circ In Press 2008
Comparison of Patients (N=734)
Age (mean ±SD) 62.7±13 71.3±12 P<0.001Smoking (%) 54 62 P=0.03Diabetes (%) 5 11 P=0.003Cardiac History of CAD (%) 33 50 P<0.001 EF<30 (%)* 3 6 P=0.03Pulmonary FEV1* 2.2±0.8 1.7±0.8 P<0.001 <1 liter (%)* 3 20 P<0.001 FEF 25-75%* 1.7±0.9 0.9±0.7 P<0.001
History of cancer (%)9 13 P=0.09
Renal <40 (%) 9 17 P=0.001 <60 (%) 28 40 P=0.001
Aortic diameter (cm, mean ±SD) 6.2±1.3 6.3±1.3 P=0.9
SR (n=372) ER (n=352)
Repair n
Mortality at 30 days
Mortality at 1 year SCI
n %* Rate** n %* Rate** n %
0 ERSR
163136
88
54
0.620.73
2015
1211
0.140.13
11
11
I ERSR
8251
61
72
0.940.24
15 2
19¶
40.250.04
87
1014
II ERSR
1659
110
617
0.802.36
513
3622
0.450.30
313
1922
III ERSR
2262
28
912
1.161.68
713
3421
0.520.27
16
510
IV ERSR
6964
34
46
0.550.80
816
1222
0.180.30
21
32
All ERSR
352372
2031
67
0.721.07
5559
1615
0.210.19
1528
48
Paraplegia
ORN=372
ERN=352
n % n %
Immediate SCI 8 29 2 13
Delayed SCI 20 71 13 87
Total 28 15
Greenberg R, Lu Q, et al, Circ In Press 2008
LIMITS
• PRICE
• EMERGENCIES
• TRAINING
CONCLUSIONS
• Endoprothèses multibranches = alternative à la chirurgie conventionnelle
• LIMITES– Patients à haut risque chirurgical– Résultats à moyen et long terme ?
