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Published byRoy Gouldin
Modified about 1 year ago
Aortic dissection: current percutaneous options Advanced Angioplasty BSET Jan 2008
MY CONFLICTS OF INTEREST ARE Preceptor for complex endografts for Cook
Multidisciplinary ► Radiology ► Vascular Surgery ► Cardiology ► Anaesthesia ► Cardiothoracic surgery
Imaging ► Pre-operative CT and workstation review ► Intra-operative angiography ► TOE ► IVUS
Acute type B aortic dissection ► Endovascular intervention for: ► 1. Failure of medical therapy ► Malperfusion ► Rupture ► Rapid enlargement
Haemodynamics ► True lumen collapse ► Depends on ratio of inflow capacity to outflow capacity in true and false lumina ► Reduce FL inflow - ► Reduce FL inflow -endografts ► Increase FL outflow -fenestration
Primary treatment aim ► Cover the primary tear ► Stent grafts: ► PTFE, Dacron ► Nitinol, stainless steel ► Bare metal? ► Barbs proximally?
Length of stent graft?
Distal bare metal scaffolding ► PETTICOAT concept ► Provisional extension to induce complete attachment after stent graft placement in acute type B dissection C Nienaber JEVT 2006; 13:738-746
PETTICOAT ► 12 patients ► Primary tear covered ► Persistent distal true lumen collapse and perfused abdominal false lumen ► Adjunctive or staged ► Uncovered stents: Sinus, Fortress, Z-stents ► 120-230mm ► True lumen increase 4 – 21mm
Fenestration techniques ► Via natural fenestrations ► Punctured with guidewires, TIPS needles, re-entry devices ► Guided by angiography, snares, balloons, IVUS ► Enlarged by balloons, or guidewires - push cuts (scissor technique) or pulled
Percutaneous recanalisation devices
Courtesy of Roy Greenberg Percutaneous recanalisation devices
Other techniques: TIPS needle
Hartnell, Radiographics 2005
Conclusions ► Challenging and complex multidisciplinary area ► Evolving role and understanding of percutaneous options ► Stent grafts, visceral stents ► Fenestration ► Uncovered stents - scaffolding
Stent Assisted Balloon Induced Intimal Disruption and Relamination in Aortic Dissection Repair: The STABILISE Concept Sophie C. Hofferberth 1, Andrew E.
MANAGEMENT OF ACUTE TYPE B AORTIC DISSECTION นพ. อรรถภูมิ สู่ศุภอรรถ รพ. ราชวิถี
Evaluation of ReeKross balloon catheter in treating iliofemoral artery chronic total occlusions Xinwu Lu Vascular Center of Shanghai Jiaotong University.
New Techniques / Devices in Endovascular Treatment of Aortic Diseases Dr. Haji Zeinali Interventional Cardiologist Tehran Heart Center.
Aortic Symposium New York 2012 „Pseudoaneurysm After Endovascular Stent Graft Placement for Treatment of Type B Aortic Dissection“ R.A. Jánosi, M. Bettin,
Vascular Peter Lin, MD Southern Association for Vascular Surgery 2007 Postgraduate Course San Juan, Puerto Rico Penetrating Ulcer and Aortic Dissection.
Menaka Nadar, MD University of Virginia. CC: Acute onset abdominal pain HPI: 43 year old male with a history of Marfan’s syndrome presented to outside.
Thoracic Stent Graft Zenith ® TX1 Thoracic Stent Graft The Zenith ® TAA One Piece Endovascular Graft is a customized graft with the H&L-BOne-Shot™ Introducer.
Complication of needle aquired vascular access-when to call a vascular surgeon K.GUIROV MMA- Sofia.
Dr R H Stables Cardiothoracic Centre Liverpool, UK Thoracic Aortic Stent Grafting.
Interventional Treatment of obstructive aortoiliac disease Dr Afshin Ghofraniha Interventional Cardiologist.
Monzer Chehab, MD William Beaumont Hospital Royal Oak, Michigan.
Giampiero Esposito MD 2010-A-10-AATS Cardiovascular Surgery Unit CITTA’ DI LECCE HOSPITAL - ITALY GVM Hospitals of Care and Research Hybrid Approach to.
Number of Entry Tears Is Associated With Aortic Growth in Type B Dissections Ann Thorac Surg March 28, 2013 Thoracic Aortic Research Center, University.
Date of download: 6/2/2016 Copyright © The American College of Cardiology. All rights reserved. From: Retrograde Techniques and the Impact of Operator.
Double lumen remodeling balloon: New technique for treatment of MCA bifurcation aneurysm Kadziolka K, Leautaud A., Estrade L., W. Mustafa, Pierot L. CHU.
Imaging Experience of Type II Hybrid Aortic Arch Repair: Lessons learned from Zone 0 Debranching & Evolution to Zone 2 Arch Repair Vamshi Kotha, Eric J.
Hybrid Arch for Acute Type A Aortic Dissection Is the stent graft best served “Frozen” or “Warm” ? Jehangir J. Appoo Division of Cardiac Surgery Libin.
Hybrid Arch for Acute Type A Aortic Dissection Is the stent graft best served “frozen” or “warm” ? Jehangir J. Appoo Division of Cardiac Surgery Libin.
Achieving Acute Success and Durable Results with Complete Total Occlusion? Christopher J. Kwolek, MD FACS Harvard Medical School Division of Vascular and.
Viabahn Covered Stents for Cephalic Arch Stenosis Can Improve Patency and Longevity of Upper Arm AV Fistulas Toufic Safa, MD, FACS Vascular & Endovascular.
Percutaneous Transluminal Angioplasty for Axillary Artery Dissection After Open Reduction of Shoulder Fracture- Dislocation by Hiroshi Yamazaki, Yusuke.
SIR-RFS AngioClub Ethan M. Dobrow, PGY-4 Maine Medical Center, Portland, Maine (The Freeman Hospital, Newcastle-Upon-Tyne, UK)
Osaka University Department of Cardiovascular Surgery Osaka University Department of Cardiovascular Surgery The efficacy of debranching TEVAR for arch.
Tomov, E. MD Department of Vascular Surgery, Tokuda Hospital Sofia.
KIAN OLSEN, COOKMEDICAL. The Beginning 50 Years ago- First PTA January 16 th 1964 Charles Dotter.
Intervention of Aortic Coarctation: from Angioplasty to Stent Gejun Zhang, Zhongying Xu, Shiliang Jiang Cardiovascular Institute & Fuwai Hospital CAMS.
ONE STAGE REPAIR IN COMPLEX AORTIC DISEASE : SURGERY COMBINED WITH OPEN DISTAL STENT GRAFTING REQUIRES A NEW STENT GRAFT DESIGN U. Herold, M. Kamler, I.
Angioplasty Coding ASDIN Coding University 1 Angioplasty Coding Angioplasty may be venous or arterial; these have different codes and special rules that.
Treatment of Hand Ischemia Dialysis Associated Steal Syndrome (DASS) ASDIN Coding University 1.
Coronary Stent Megan French. What is a Stent A small, mesh-like device made of metal Acts as a support or scaffold, in keeping the vessel open Stent helps.
TOTAL AORTIC ARCH REPLACEMENT WITH THORAFLEX HYBRID FROZEN ELEPHANT TRUNK PROSTHESIS: RESULTS OF FIRST 100 PATIENTS Malakh Shrestha, Heike Krueger, Tim.
What Is Being Done Where Endovascular Treatment of Infrarenal Abdominal Aortic Aneurysm with Short and Angulated Neck in High-Risk Patient -Greece- E.
Osaka University Graduate School of Medicine Division of Cardiovascular Surgery Strategy of TEVAR for acute aortic dissection Osaka University Graduate.
Angioclub Case Series: Aortic Pathology Candace L. White MA, MD Mount Sinai Medical Center of Florida.
TOKUDA HOSPITAL SOFIA VASCULAR SURGERY AND ANGIOLOGY DEPARTMENT DR. A. DASKALOV, ASSOC. PROFF. V. CHERVENKOV.
Call for CASES Leszek D. Stachaczyk, MD Pawel Buszman, MD, FESC, FSCAI American Heart of Poland, Ustroñ, Poland & CCU, Upper-Silesian Center of Cardiology,
Aortic Pathology Angioclub Case Alex Copelan M.D. William Beaumont Hospital October 24, 2013.
Transradial Type I Endoleak Ethylene Vinyl Alcohol Copolymer (Onyx) Embolization Zachary L. Bercu, MD Department of Interventional Radiology, Icahn School.
Chimney technique for aortic arch dissection: middle-term result 烟囱技术治疗主动脉夹层的中期结果 Dept. of Vascular Surgery, the 2nd Xian-Ya Hospital, CSU. ChangShu 中南大学湘雅二医院血管外科.
Should We Be Doing This? Sealing Dissections: Thoracic Stenting Dr Peter Wilde – Consultant Cardiac Radiologist Dr K Balachandran – Cardiology SpR Mr A.
(1) Arch Debranching vs. Elephant Trunk for Hybrid Repair of the Proximal Thoracic Aorta Arch Debranching versus Elephant Trunk Procedures for Hybrid Repair.
Angiography and Interventional Radiography Chapter 17.
Results of “Type II” Hybrid Arch Repair with Zone 0 Stent Graft Deployment Jehangir Appoo, William Kent, Eric Herget, Jason Wong, Alberto Pochettino and.
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Cardiac Case 9/15/07. Coarctation of the Aorta Congenital narrowing of the thoracic aorta; typically distal to the left subclavian artery. M:F – 2:1.
M. P. Cherian, P. Mehta T. Kalyanpur, S. S. Hedgire, K. S. Narsinghpura, V. Kasi, R. R, K. Muthukrishnan, V. K,; Kovai Medical Center & Hospital, Coimbatore.
Date of download: 6/22/2016 Copyright © The American College of Cardiology. All rights reserved. From: A Novel Modification of the Retrograde Approach.
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