Total endovascular repair for thoraco abdominal aortic aneurysms
-
Upload
uvcd -
Category
Presentations & Public Speaking
-
view
166 -
download
2
Transcript of Total endovascular repair for thoraco abdominal aortic aneurysms
Total endovascular repair for thoraco Total endovascular repair for thoraco abdominal aortic aneurysmsabdominal aortic aneurysms
Michael Jacobs, Geert Willem Schurink
TAAA Surgery: always some problem …
Is TEVAR already applicable for TAAA ?
Limited experience, mainly in high surgical risk patients
Complex technology, very expensive
Questionable longevity of material (interconnections)
Serious complications
Unclear indications
But, ……it will eventually dictate the future
Furthermore,….endosurgery of TAAA is more than introducing a device
Judging CT-MRA images
Performing adequate measurements
Designing an endovascular/hybrid plan
Execute the plan
Understanding and treating complications
Part of a multidisciplinary team
Distance Reference LineDistance Reference Line
LOWER COELIAC 00
MID SMAMID SMA
LOWER SMALOWER SMA
MID RIGHT RENALMID RIGHT RENAL
MID LEFT RENALMID LEFT RENAL
13131818
28283434
Man (1940) Man (1940) TAAA IV (TAAA IV (Ø 70 mm) after aortic arch and Ø 70 mm) after aortic arch and
descending thoracic repairdescending thoracic repair
TAAA repairTAAA repair
� Mortality (30day) 13% 15% 5,4%
� Paraplegia 4,5% 8,4% 2,7%
� MI 3,6% ? 5,4%
� Dialysis 1,8% 4% 1,4%
1) Maastricht Open Experience. Jacobs et al. JVS 2006
2) St Mary’s/Heidelberg/Munich. Drinkwater et al. EJVES 2009
3) Cleveland Clinic, presented at AATS, 2006
Open repair(n=112)
Hybrid repair(n=107)
Endo repair(n=73)
It needs to be ...It needs to be ...
FasterIn situ fenestration??
BetterMore flexible
Low(er) profile endoprostheses