This document discusses abdominal aortic aneurysms (AAAs) and their endovascular repair (EVAR). It defines AAAs as a dilatation of the abdominal aorta over 3cm in diameter. EVAR involves inserting a folded graft through the femoral artery which expands to exclude the aneurysm sac from blood flow and pressure. The benefits of EVAR over open repair include lower peri-operative mortality and complications. Proper patient assessment including vascular anatomy and medical comorbidities is important for determining candidacy for EVAR. The procedure involves deploying graft components in the aorta and iliac arteries under imaging guidance. Post-operative surveillance with imaging is needed to monitor for complications like endoleaks.
This document discusses balloon-assisted coiling techniques for treating aneurysms. It notes that balloon-assisted coiling provides better immediate and follow-up occlusion rates compared to standalone coiling, though it may carry a higher risk of complications compared to standalone coiling. The document reviews the history and uses of balloon-assisted coiling, complications, techniques for different aneurysm situations, outcomes data on occlusion rates, and debates around its appropriate use compared to standalone coiling and stent-assisted coiling.
Stent design aspects and coronary artery disease were discussed. Coronary artery disease is a leading cause of death worldwide. Historical developments in treatments including balloon angioplasty, bare metal stents, and drug-eluting stents were covered. Mechanisms of in-stent restenosis and approaches to prevent it such as mechanical techniques, drug coatings, and biodegradable stents were described. Clinical measures for evaluating restenosis outcomes were defined.
1. Autogenous vein grafts have histological properties that make them less than ideal as vascular conduits compared to arteries, such as a lack of vasa vasorum and compliance mismatch.
2. Prosthetic grafts are more standardized but have higher risk of thrombosis and intimal hyperplasia. Various modifications aim to improve patency such as heparin bonding and venous adjuncts.
3. Surveillance of vascular grafts with duplex ultrasound is important to detect failing grafts which can be treated with thrombectomy or new bypass to preserve limb.
Annual Academic Conference
SLSVS 23
Joel Arudchelvam
MBBS, MD ( SUR ), MRCS (ENG), FCSSL
Consultant Vascular and Transplant Surgeon
Aortic aneurysms
Abnormal focal dilatation of a vessel of more than 50 % of its normal diameter
Abdominal aorta more than 3 cms (normal diameter - 2 cms)
Open AAA repair
Endo Vascular Aneurysm Repair (EVAR)
Arch de-branching
Sri Lankan Experience
15 Vascular and transplant units
Emergency AAA repair
Open TAA repair
Future directions
The document discusses endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms. It presents a case of a 62-year-old male undergoing EVAR for a 5.5cm AAA. EVAR involves deploying a graft via catheter to exclude the aneurysm from blood flow. Complications can include endoleaks, where blood leaks outside the graft but within the aneurysm sac. The main types of endoleaks are type I (inadequate seal at graft ends), type II (collaterals inside the sac), and type III (graft component disruption). EVAR has advantages over open repair like less invasiveness but risks like increased reintervention rates.
MT5007: The coronary stent revolution (A group project for the Management of ...Stefan
This project tracks the development of coronary artery disease interventions, ranging from early method of cardiac bypass to balloon angioplasty to the development of biomedical stents. Analyses of the competitive climate in the biomedical stents industry is discussed. New market and technology strategies are proposed for a regional MNC to leverage domestic industry infrastructure within emerging economies accompanied by a projected 30% growth in CAD due to increased consumption trends and lifestyle factors, e.g. smoking.
This document discusses different types of coronary stents. It describes how stents are metal mesh tubes that open blocked arteries. It then categorizes stents based on their material, design, and drug coatings. Some key types discussed are drug-eluting stents, which slowly release drugs to prevent reblockage, and biodegradable stents, which dissolve over time leaving no permanent implant. The document provides details on stent structure, composition, coatings, and examples like the Abbott Absorb stent, a bioresorbable vascular scaffold.
A stent is a small, expandable tube. During a procedure called angioplasty, the stent is inserted into a coronary artery and expanded using a small balloon. A stent is used to open a narrowed or clotted artery.
This presentation is all about patient prosthetic mismatch.what is PPM?.
Diameters of heart valve
Effective orifice area of different heart valves
How to avoid PPM
How to manage increased gradients across the heart valve
This document provides an overview of basic endovascular surgery techniques and interventions. It discusses the history and development of endovascular therapies from crude early techniques to modern devices. It describes common instruments used including needles, wires, catheters, sheaths, balloons, stents and stent grafts. It also summarizes access techniques, contrast agents, guidewire anatomy and construction, dilators, sheaths and catheters. The document discusses indications for endovascular interventions and various applications in treating conditions like abdominal aortic aneurysms, iliac, renal and carotid artery disease. It presents some future directions including gene identification and cell therapies.
La fibrilación auricular es una arritmia cardíaca que causa latidos irregulares y rápidos. Puede aumentar el riesgo de accidente cerebrovascular e insuficiencia cardíaca. Existen varios tipos dependiendo de la duración y frecuencia de los episodios. Las causas más comunes son enfermedades cardíacas como hipertensión o valvulopatías. Los tratamientos incluyen medicamentos, ablación por catéter, y en casos graves la cirugía MAZE que realiza incisiones en las aurículas para restaurar un rit
Treatment of thoracoabdominal aortic aneurysms. surgery alone or hybriduvcd
This document summarizes treatment approaches for thoracoabdominal aortic aneurysms including open surgical repair and hybrid repair techniques. It presents data on outcomes from open surgical repair at Lenox Hill Hospital including mortality rates of 6%, paraplegia rates of 2%, and risk factors for mortality such as need for hemodialysis or ventilation over 48 hours. It also compares outcomes from open repair to endovascular and hybrid techniques reported in other studies. Both open and hybrid repair are described as extremely complex operations, with open repair remaining the standard approach for appropriately selected patients.
This document discusses abdominal aortic aneurysms (AAAs) and their endovascular repair (EVAR). It defines AAAs as a dilatation of the abdominal aorta over 3cm in diameter. EVAR involves inserting a folded graft through the femoral artery which expands to exclude the aneurysm sac from blood flow and pressure. The benefits of EVAR over open repair include lower peri-operative mortality and complications. Proper patient assessment including vascular anatomy and medical comorbidities is important for determining candidacy for EVAR. The procedure involves deploying graft components in the aorta and iliac arteries under imaging guidance. Post-operative surveillance with imaging is needed to monitor for complications like endoleaks.
This document discusses balloon-assisted coiling techniques for treating aneurysms. It notes that balloon-assisted coiling provides better immediate and follow-up occlusion rates compared to standalone coiling, though it may carry a higher risk of complications compared to standalone coiling. The document reviews the history and uses of balloon-assisted coiling, complications, techniques for different aneurysm situations, outcomes data on occlusion rates, and debates around its appropriate use compared to standalone coiling and stent-assisted coiling.
Stent design aspects and coronary artery disease were discussed. Coronary artery disease is a leading cause of death worldwide. Historical developments in treatments including balloon angioplasty, bare metal stents, and drug-eluting stents were covered. Mechanisms of in-stent restenosis and approaches to prevent it such as mechanical techniques, drug coatings, and biodegradable stents were described. Clinical measures for evaluating restenosis outcomes were defined.
1. Autogenous vein grafts have histological properties that make them less than ideal as vascular conduits compared to arteries, such as a lack of vasa vasorum and compliance mismatch.
2. Prosthetic grafts are more standardized but have higher risk of thrombosis and intimal hyperplasia. Various modifications aim to improve patency such as heparin bonding and venous adjuncts.
3. Surveillance of vascular grafts with duplex ultrasound is important to detect failing grafts which can be treated with thrombectomy or new bypass to preserve limb.
Annual Academic Conference
SLSVS 23
Joel Arudchelvam
MBBS, MD ( SUR ), MRCS (ENG), FCSSL
Consultant Vascular and Transplant Surgeon
Aortic aneurysms
Abnormal focal dilatation of a vessel of more than 50 % of its normal diameter
Abdominal aorta more than 3 cms (normal diameter - 2 cms)
Open AAA repair
Endo Vascular Aneurysm Repair (EVAR)
Arch de-branching
Sri Lankan Experience
15 Vascular and transplant units
Emergency AAA repair
Open TAA repair
Future directions
The document discusses endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms. It presents a case of a 62-year-old male undergoing EVAR for a 5.5cm AAA. EVAR involves deploying a graft via catheter to exclude the aneurysm from blood flow. Complications can include endoleaks, where blood leaks outside the graft but within the aneurysm sac. The main types of endoleaks are type I (inadequate seal at graft ends), type II (collaterals inside the sac), and type III (graft component disruption). EVAR has advantages over open repair like less invasiveness but risks like increased reintervention rates.
MT5007: The coronary stent revolution (A group project for the Management of ...Stefan
This project tracks the development of coronary artery disease interventions, ranging from early method of cardiac bypass to balloon angioplasty to the development of biomedical stents. Analyses of the competitive climate in the biomedical stents industry is discussed. New market and technology strategies are proposed for a regional MNC to leverage domestic industry infrastructure within emerging economies accompanied by a projected 30% growth in CAD due to increased consumption trends and lifestyle factors, e.g. smoking.
This document discusses different types of coronary stents. It describes how stents are metal mesh tubes that open blocked arteries. It then categorizes stents based on their material, design, and drug coatings. Some key types discussed are drug-eluting stents, which slowly release drugs to prevent reblockage, and biodegradable stents, which dissolve over time leaving no permanent implant. The document provides details on stent structure, composition, coatings, and examples like the Abbott Absorb stent, a bioresorbable vascular scaffold.
A stent is a small, expandable tube. During a procedure called angioplasty, the stent is inserted into a coronary artery and expanded using a small balloon. A stent is used to open a narrowed or clotted artery.
This presentation is all about patient prosthetic mismatch.what is PPM?.
Diameters of heart valve
Effective orifice area of different heart valves
How to avoid PPM
How to manage increased gradients across the heart valve
This document provides an overview of basic endovascular surgery techniques and interventions. It discusses the history and development of endovascular therapies from crude early techniques to modern devices. It describes common instruments used including needles, wires, catheters, sheaths, balloons, stents and stent grafts. It also summarizes access techniques, contrast agents, guidewire anatomy and construction, dilators, sheaths and catheters. The document discusses indications for endovascular interventions and various applications in treating conditions like abdominal aortic aneurysms, iliac, renal and carotid artery disease. It presents some future directions including gene identification and cell therapies.
La fibrilación auricular es una arritmia cardíaca que causa latidos irregulares y rápidos. Puede aumentar el riesgo de accidente cerebrovascular e insuficiencia cardíaca. Existen varios tipos dependiendo de la duración y frecuencia de los episodios. Las causas más comunes son enfermedades cardíacas como hipertensión o valvulopatías. Los tratamientos incluyen medicamentos, ablación por catéter, y en casos graves la cirugía MAZE que realiza incisiones en las aurículas para restaurar un rit
Treatment of thoracoabdominal aortic aneurysms. surgery alone or hybriduvcd
This document summarizes treatment approaches for thoracoabdominal aortic aneurysms including open surgical repair and hybrid repair techniques. It presents data on outcomes from open surgical repair at Lenox Hill Hospital including mortality rates of 6%, paraplegia rates of 2%, and risk factors for mortality such as need for hemodialysis or ventilation over 48 hours. It also compares outcomes from open repair to endovascular and hybrid techniques reported in other studies. Both open and hybrid repair are described as extremely complex operations, with open repair remaining the standard approach for appropriately selected patients.
This document summarizes research on chronic cerebrospinal venous insufficiency (CCSVI) and its proposed link to multiple sclerosis (MS). Several studies found no association between CCSVI and MS, including a large blinded case-control study. The validity of ultrasound criteria for CCSVI was also challenged. While initial studies reported benefits from angioplasty to treat CCSVI, later work revealed major flaws and no evidence was found to support CCSVI playing a causal role in MS or to justify further research on the proposed "liberation treatment."
Current role of tever in acute and chronic dissection results in chinauvcd
Current Role of TEVER in Acute and Chronic Dissection: Results in China discusses the increasing rates of acute and chronic type B aortic dissection in China, with over 15,000 new cases annually. While there are no standardized treatment guidelines in China, TEVAR is commonly used to treat over 70% of cases, especially those with complications. The use of TEVAR has grown significantly in China since the first case in 1999, with over 12,000 cases treated in 2012. The summary discusses developments in TEVAR techniques and management strategies used in China for various aortic dissection cases and complications.
How can we reduce the mortality of ruptured aaauvcd
This document discusses ways to reduce mortality from ruptured abdominal aortic aneurysms (AAA). It recommends protocolizing patient care from initial contact through discharge and concentrating ruptured AAA cases at high-volume hospitals with experienced teams. Endovascular repair (EVAR) is preferable to open surgery when possible due to its less invasive nature. Key pitfalls to avoid include using CT angiography over ultrasound for imaging, ensuring the EVAR team and procedure remains consistent, and monitoring post-operatively for abdominal compartment syndrome and intestinal injury.
Hybrid tevar for the treatment of aortic dissectionuvcd
- Hybrid TEVAR involves using open surgery and endovascular stent grafting to treat aortic dissection.
- It can be used for acute type A dissection to allow total arch repair followed by TEVAR for the descending thoracic aorta. It is also indicated for chronic type B dissection when there is no suitable proximal landing zone by creating one through open surgery.
- The author presents results from their hospital demonstrating the safety and effectiveness of hybrid TEVAR for both acute type A and chronic type B dissection, with favorable outcomes including high rates of false lumen thrombosis and regression.
Endovascular repair for type b aortic dissection with visceruvcd
This document discusses endovascular repair for type B aortic dissection and reports the following key findings:
1. 926 cases of aortic dissection were treated with endovascular repair, with some experiencing ischemia of visceral arteries like the celiac, SMA, and renal arteries.
2. Emergency TEVAR was performed in 74 cases to treat visceral artery ischemia, while 5 others received conservative treatment first before undergoing TEVAR.
3. All cases of visceral artery ischemia were successfully treated with endovascular repair. Follow-up ranged from 7 to 122 months, and mid-term results were successful and durable.
This document discusses the treatment of incompetent perforator veins. It recommends treating them to improve clinical outcomes for medial, recurrent, and large ulcers. The best method is SEPS (subfascial endoscopic perforator surgery), but new minimally invasive techniques need further evaluation in trials. Quality control of the SEPS procedure is important to maximize effectiveness.
Repositioning the future of evar real life experience with the gore excluder ...uvcd
Repositioning the future of evar real life experience with the gore excluder featuring c3 delivery system and one year results of the european registry
Endo vascular treatment of infected aa as is surgıcal draınage and debrıdemen...uvcd
1) Endovascular treatment of infected abdominal aortic aneurysms (AAAs) is an alternative to open surgery that provides less invasive and rapid aneurysm exclusion with prompt bleeding control.
2) Successful endovascular repair requires broad-spectrum antibiotics, adjunct procedures like surgical debridement for eliminating infection sources, and prolonged antibiotic therapy.
3) Endovascular repair alone may be sufficient for well-controlled infections, while unstable patients may require additional drainage; long-term antibiotic therapy is always needed.
Combined carotid and coronary disease the strategy should beuvcd
1. Combined carotid and coronary artery disease presents challenges in determining the optimal treatment strategy. Performing carotid endarterectomy and coronary artery bypass grafting simultaneously or in stages both carry risks.
2. Factors such as the severity of stenosis in the carotid and coronary arteries, and a patient's surgical risk profile must be considered. High grade stenosis in both territories typically warrants staged procedures to avoid complications.
3. Preventing embolic sources, maintaining adequate cerebral perfusion and temperature, and using monitoring techniques can help reduce risks of central nervous system injuries during combined or staged carotid and cardiac surgeries. Close evaluation of individual patient characteristics is important for surgical planning.
1.Uludağ Nöroşirürji Kış Sempozyumu'nda Subaraknoid kanama ve kanamış anevrizmaların tedavisi hakkında sunum dosyası.
http://www.nihategemen.com/norosirurji/norosirurji-kis-sempozyumu
Kardiyopulmoner bypass ve miyokardiyal koruma dr. bilgin emrecan
Yeni jenerasyon endovaskuler stent greftler evar endikasyonunu genisletti mi
1. Dr Özalp KARABAY
DEÜTF Kalp Damar Cerrahi AD-İzmir
Yeni Jenerasyon Endovasküler Stent-Greftler
EVAR Endikasyonunu Genişletti mi?
Dr Özalp KARABAY
DEÜTF Kalp Damar Cerrahi AD-İzmir
2. • Aortik anevrizmaların tedavisinde, endovasküler
yöntemler son iki dekatta popüler bir tedavi
yöntemi haline gelmiştir.
• Endovasküler anevrizma tamirinde önemli
noktalardan biri, kullanılan cihazlardaki teknolojik
ve teknik gelişmelerdir.
3. • Volodos ve ark.1991 yılında aort rekonstrüksiyonu için
kendiliğinden fikse olan sentetik endoprotezlerin kullanımı
ile ilgili deneyimlerini yayınlamışlardır.
• Aynı yıl içerisinde Parodi ve ark.endovasküler yolla tedavi
uyguladıkları beş anevrizma olgusunu yayınlamışlardır.
4. EVAR
Başarılı girişim
Sınırlamalar
ve
Sorunlar
• Kısa boyun % 54
• Ulaşım arterlerinde darlık % 47
• Geniş anevrizma boynu % 40
• Yüksek dereceli boyun açılanması % 14
• Bilateral iliac anevrizma % 21
• Mural trombus % 10
• Aksesuar renal arter % 6
5. - Endovasküler işleminuygulanabilirliğini artıran ve başarı
oranlarını belirleyen birçok önemli faktör vardır.
- Bunların arasında, hastanın vasküler anatomisi,
anevrizma boynunun uzunluk ve açılanması, iliyak
arterlerin kıvrımlı olması ve visseral arterlerin
anevrizmadan orijin alması başta gelen faktörlerdir.
- Günümüzde bu faktörlerden en azından bazılarına
çözüm olabilecek teknolojik gelişmeler sağlanmış ve yeni
jenerasyon greftler kullanıma girmiştir.
29. • Chimney greft teknikleri; visseral ve supraaortik dallara
uygulanarak standart stent-greftler ile yeterli fiksasyon bölgesi
olmayan anevrizmaların tedavisine imkan sağlamaktadır.
• Chimney greft t ekniği ayrıca vasküler kıvrım nedeniyle fenestre
stent-greftlerin kullanılamadığı seçilmiş olgularda tedaviyi
mümkün kılmaktadır.
32. - Kaplı olmayan multilayer stentlerin temel özelliği, stent örgüsünün birkaç katlı olması ve stent
üzerindeki porların çok küçük (0.1 mm) olmasıdır.
- Multilayer stentlerin kullanılması, anevrizmatik lümen içerisindeki akımın laminar hale gelmesini
sağlayarak duvar basıncı, akım kayma gerilimi ve türbülan akım gibi anevrizmanın büyümesinde
etkili olduğu düşünülen faktörlerin etkilerini azaltır ve anevrizma kesesi içerisinde tromboz
oluşumunu kolaylaştırır.
-Kaplı stentlerden farklı olarak, multilayer stentlerin önemli bir özelliği ise anevrizma kesesi
içerisinden orijin alan visseral arterlere akıma izin vermesidir.
33. Nellix Endovasküler Sistem
- Nellix stentgreft; anevrizma kesesini biyolojik olarak uyumlu polimer
içyastıklarla doldurarak kaçak oranını ve migrasyonu azaltmaktadır.
34.
35. •Robot-yardımlı antegrad in-situ fenestre stent-greftleme yöntemi,
yönlendirilebilir bir kateter kullanılarak, kateter ucunun hedeflenen noktaya
doğru pozisyonlamasına ve hekimin X-ışını kaynağından korunmasınada
olanak sağlamktadır.
36. Yeni jenerasyon stent-greftler;
Endovasküler tedavi komplikasyonlarını azaltırken,
stent-greftlerin kullanım alanını ve dayanıklılığını artırarak
aort anevrizmalarının % 90’nı tedavi etmemize merkezlerin
deneyim artışı ile birlikte olanak sağlayacaktır.
Sonuç
39. Sonuç
- On yıl önce arkus ve jukstarenal anevrizmalar endovasküler yöntemle
tedavi edilememekte iken, teknolojik gelişmelerin komplikasyon ve
kontrendikasyonlara getirdiği çözümlerle birlikte, günümüzde
tüm dünyada çok sayıda merkezde rutin olarak
uygulanabilir hale gelmiştir.
- Visseral arterlerin anatomik varyasyonları, tedaviyi uygulayan hekime
zorluk oluşturabilmekte ancak endovasküler tedavi açısından kesin
kontrendikasyon oluşturan durumlar oldukça nadir
olarak ortaya çıkmaktadır.
Editor's Notes
Figure 2. An angiographic image during implantation of a fenestrated endograft is depicted. The left renal fenestration (yellow oval) is aligned, and a mating uncovered stent has been placed. A sheath had been placed into the right renal fenestration (green oval). Note the longitudinal appearance of the left renal fenestration markers in contrast to the splayed appearance of the equivalent 4 markers around the right renal area. This implies that the C-arm is perpendicular to the left renal orientation, whereas the right renal orientation is actually more anterior. A scallop was created for the inferior aspect of the superior mesenteric artery origin (red oval), and the black arrows illustrate the markers that assist with rotational alignment and longitudinal positioning.
Figure 1. A, Aortic-based extra-anatomic bypass procedure performed via a left retroperitoneal approach. An infrarenal aneurysm was repaired with a tube graft, and retrograde bypasses were attached to the aortic graft. The 2 green arrows denote the bypasses to the celiac and superior mesenteric arteries, the blue arrow depicts the right renal bypass, and the left renal artery (purple arrow) was transected and sewn end-to-side to the celiac graft. B, Reconstruction from a follow-up computed tomographic scan of a patient with an iliac-based mesenteric bypass with a single kidney (right). The aorta has been relined with 3 thoracic components followed by a bifurcated distal component to secure distal seal and fixation within the iliac arteries, above the origin of the extra-anatomic bypass. C and D, Aorta of a patient with type IV Ehlers-Danlos syndrome and an extensive aneurysm. The proximal aorta was replaced, and an elephant trunk graft was created in addition to a visceral bypass that originated from the left common iliac artery. Thoracic endografts were then used to reline the aorta, attaching proximally into the elephant trunk graft and distally immediately above the native renal ostia.
