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1. VNVDA-Fen and Br.pdf
- 1. Fenestrated and Branched Endografts Of the Thoracoabdominal Aorta: Current Status Stephen W.K. Cheng VNVDA 4 June 2023 DEPARTMENT OF SURGERY THE UNIVERSITY OF HONG KONG
- 3. Access from below Contralateral large sheath Exact positioning Clutter Less space Cannulation issues Covered stents Fenestrated Graft Arm access / arch anatomy No need No need Less clutter Space required Cannulation easier Longer stents Branched Graft
- 4. • Alternatives Chimneys / Endoanchors Branches • Choices Custom In situ / PMEGs • Branch stability Bridging stents • Techniques Advanced Imaging Endovascular Tools
- 9. 2015 More complex design – Increase reinterventions Less complex design – Increase type I endoleak Trend to increase no. of fenestrations Cleveland Clinic n=610
- 10. 2015 N=969, Type Ia: 2.8% (Poor choice of LZ) Aorta-related mortality
- 12. Visceral Fenestrated / Branched EVAR: QMH
- 20. Oderich, J Vasc Surg In press
- 21. JVS Oct 2018 14% in 1 year
- 24. IIIb
- 26. IIIc
- 28. IIIc
- 29. Intraop renal loss 10 (8%) N=71 (128 RA) Upward renals Aortic angle >46% Branches Early renal loss 4 (3%) Type D renals Branches
- 30. 2017
- 31. • re-circulation zones were generally smaller when the renal stent faced downwards
- 33. Flow Rate/Shear Stress and Renal Angle Flow rate and shear stress were generally higher when renal stent faced caudally, and constantly better in custom-made models. 2017
- 35. Branches: Higher Target Vessel Loss (9% vs 2%)
- 36. Branches: Inferior Patency at 3 years (98 vs 92%) Branches: 3.5x Higher Reintervention
- 37. Ic
- 38. 2016 N=449 20 month reintervention Renal occlusion 2 year freedom renal occlusion BEVAR 4.7% 9.6% 90.4% FEVAR 5.2% 2.3% 97.1% (235) (214)
- 39. Renal Occlusion
- 40. 2013 2018
- 42. V12/icast Less flexible VBX Fatigue resistence, tracks better Begraft Lower profile, newer, iCover New, lower profile Fluency Prone to kinking, relining Viabahn Control difficult Covera Angle problems
- 47. • Always land in parallel aorta • CMD / fenestrations • Secondary interventions • Better tools • Surveillance F/BEVAR in 2023
- 48. Antalya 30 Nov – 3 Dec