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Visceral debranching for the treatment of taaa
1. Prof Dr Hakan Posacıoğlu
Ege Üniversitesi Kalp ve Damar Cerrahisi
Prof Dr Hakan Posacıoğlu
Ege Üniversitesi Kalp ve Damar Cerrahisi
VISCERAL DEBRANCHING FOR THE TREATMENT OF TAAAVISCERAL DEBRANCHING FOR THE TREATMENT OF TAAA
2. MANAGEMENT OF THE TAAAMANAGEMENT OF THE TAAA
- OPEN SURGERY- OPEN SURGERY
Mortality rates 2-20%(rates are
higher for type II)
Complications of repair include
-renal failure (2-12%)
-cardiopulmonary (4-33%)
-neurologic deficit (1-15%)
20-30% patients being discharged
to another instution rather than
home
Mortality rates 2-20%(rates are
higher for type II)
Complications of repair include
-renal failure (2-12%)
-cardiopulmonary (4-33%)
-neurologic deficit (1-15%)
20-30% patients being discharged
to another instution rather than
home
3. -ENDOVASCULAR-ENDOVASCULAR
-FENESTRATED OR BRANCHED STENT GRAFTS
-CHIMNEY OR SNORKEL TECHNIQES COMBINED WITH STENT GRAFT
-FENESTRATED OR BRANCHED STENT GRAFTS
-CHIMNEY OR SNORKEL TECHNIQES COMBINED WITH STENT GRAFT
5. DEFINITION OF VISCERAL DEBRANCHINGDEFINITION OF VISCERAL DEBRANCHING
EXTRA-ANATOMIC REVASCULARIZATION
OF 1- CELIAC
2- SMA
3- RENAL ARTERIES
EXTRA-ANATOMIC REVASCULARIZATION
OF 1- CELIAC
2- SMA
3- RENAL ARTERIES
THE KEY PRINCIPLES OF THIS
HYBRID TAAA REPAIR
THE KEY PRINCIPLES OF THIS
HYBRID TAAA REPAIR
-RETROGRADE FASHION REVASCULARIZATION
-COMPLETE EXCLUSION OF TAAA WITH STANDARD
ENDOVASCULAR STENT GRAFTS
-RETROGRADE FASHION REVASCULARIZATION
-COMPLETE EXCLUSION OF TAAA WITH STANDARD
ENDOVASCULAR STENT GRAFTS
6. VISCERAL HYBRID TAAA REPAIRVISCERAL HYBRID TAAA REPAIR
ADVANTAGES;
-REDUCED VISCERAL ISCHEMIC TIME AND SPINAL CORD ISCHEMIA
-NO AORTIC CROSS CLAMP
-AVOIDANCE OF THORACOTOMY, LESS PULMONARY COMPLICATIONS
-LESS HEMODYNAMIC INSTABILITY
-REDUCED HOSPITAL STAY
-LESS BLOOD LOSS/REDUCED TRANSFUSION REQUIREMENT
ADVANTAGES;
-REDUCED VISCERAL ISCHEMIC TIME AND SPINAL CORD ISCHEMIA
-NO AORTIC CROSS CLAMP
-AVOIDANCE OF THORACOTOMY, LESS PULMONARY COMPLICATIONS
-LESS HEMODYNAMIC INSTABILITY
-REDUCED HOSPITAL STAY
-LESS BLOOD LOSS/REDUCED TRANSFUSION REQUIREMENT
IN EMERGENCY CASES, THESE STENT GRAFTS ARE READILY AVAILABLE,
UNLIKE FENESTRATED OR BRANCHED STENT-GRAFTS
IN EMERGENCY CASES, THESE STENT GRAFTS ARE READILY AVAILABLE,
UNLIKE FENESTRATED OR BRANCHED STENT-GRAFTS
7. DETERMINATION OF INFLOW SITEDETERMINATION OF INFLOW SITE
1-EXTEND OF ANEURYSMAL DISEASE
(IF RENAL ARTERIES ARE NOT INVOLVED ABDOMINAL AORTA
CAN BE USED)
1-EXTEND OF ANEURYSMAL DISEASE
(IF RENAL ARTERIES ARE NOT INVOLVED ABDOMINAL AORTA
CAN BE USED)
2-PREVIOUS EVAR OR INFRA RENAL SURGERY
FOR AAA REPAIR( affect the determination
of inflowsite)
2-PREVIOUS EVAR OR INFRA RENAL SURGERY
FOR AAA REPAIR( affect the determination
of inflowsite)
3-COMMON AND EXTERNAL ILIAC ARTERY DIAMETER,PRE- EXISTENCE OF
STENOSIS,TORTUOSITY AND KINKING ARE ALSO IMPORTANT FACTORS IN
CHOOSING INFLOW SITE
3-COMMON AND EXTERNAL ILIAC ARTERY DIAMETER,PRE- EXISTENCE OF
STENOSIS,TORTUOSITY AND KINKING ARE ALSO IMPORTANT FACTORS IN
CHOOSING INFLOW SITE
**WE NEVER USE INFLOW ILIAC ARTERY AS A SITE FOR STENT GRAFT
INSERTION
**WE NEVER USE INFLOW ILIAC ARTERY AS A SITE FOR STENT GRAFT
INSERTION
8. GRAFT CHOICEGRAFT CHOICE
- HEPARIN BOUNDED PTFE GRAFT
- SMA OR CELIAC GRAFTS CONSTITUTE MAIN TRUNK
THE OTHERS WERE ANASTOMOSED TO MAIN TRUNK
END TO SIDE FASHION
- HEPARIN BOUNDED PTFE GRAFT
- SMA OR CELIAC GRAFTS CONSTITUTE MAIN TRUNK
THE OTHERS WERE ANASTOMOSED TO MAIN TRUNK
END TO SIDE FASHION
IF DOPPLER SIGNALS ARE SATISFACTORY
IN THE BYPASS GRAFTS, NATIVE ARTERIES ARE LIGATED
TO PREVENT TYPE II ENDOLEAK .
IF DOPPLER SIGNALS ARE SATISFACTORY
IN THE BYPASS GRAFTS, NATIVE ARTERIES ARE LIGATED
TO PREVENT TYPE II ENDOLEAK .
**THERE IS ONE EXCEPTION (CELIAC TRUNK). VERY DENSE VENOUS
COLLATERALS AND LYMPHATICS MAKE THE DISSECTION AND LIGATION
VERY DIFFICULT.
CT LEFT UNLIGATED AND CLOSED WITH COILS OR VASCULAR PLUG 2-4
WEEKS AFTER OP.
**THERE IS ONE EXCEPTION (CELIAC TRUNK). VERY DENSE VENOUS
COLLATERALS AND LYMPHATICS MAKE THE DISSECTION AND LIGATION
VERY DIFFICULT.
CT LEFT UNLIGATED AND CLOSED WITH COILS OR VASCULAR PLUG 2-4
WEEKS AFTER OP.
Coils and glue
HYBRID REPAIR OF
TYPE II TAAA
HYBRID REPAIR OF
TYPE II TAAA
9. OPERATIVE TECHNIQUEOPERATIVE TECHNIQUE
MIDLINE LAPAROTOMYMIDLINE LAPAROTOMY
1- CELIAC TRUNK EXPOSURE1- CELIAC TRUNK EXPOSURE
COMMON HEPATIC ARTERY(OUT
FLOW FOR CELIAC
REVASCULARIZATION)
COMMON HEPATIC ARTERY(OUT
FLOW FOR CELIAC
REVASCULARIZATION)
GASTRODUODENAL ARTERYGASTRODUODENAL ARTERY
WE PERFORM OUTFLOW ANASTOMOSIS FIRSTWE PERFORM OUTFLOW ANASTOMOSIS FIRST
ACCESS IS OBTAINED IN THE LESSER SAC, LEFT LOBE OF THE LIVER
SLIGHTLY RETRACTED TO THE RIGHT, STOMACH AND PANCREAS HELD
CAUDALLY
ACCESS IS OBTAINED IN THE LESSER SAC, LEFT LOBE OF THE LIVER
SLIGHTLY RETRACTED TO THE RIGHT, STOMACH AND PANCREAS HELD
CAUDALLY
10. PTFE GRAFT (USUALLY 6 MM) ANASTOMOSED COMMON HEPATIC ARTERY.PTFE GRAFT (USUALLY 6 MM) ANASTOMOSED COMMON HEPATIC ARTERY.
THE GRAFT IS TUNNELLED BETWEEN THE PANCREAS AND STOMACH
TO THE RETROPERITONEUM
THE GRAFT IS TUNNELLED BETWEEN THE PANCREAS AND STOMACH
TO THE RETROPERITONEUM
PANCREASPANCREAS
STOMACHSTOMACH
COMMON HEPATIC
ARTERY
COMMON HEPATIC
ARTERY
11. 2- SMA EXPOSURE2- SMA EXPOSURE
IT STARTS LIKE STANDARD INFRENAL ABDOMINAL
AORTIC EXPOSURE
IT STARTS LIKE STANDARD INFRENAL ABDOMINAL
AORTIC EXPOSURE
DUODENUM AND TREIZ LIGAMENT MOBILIZED.
SMA TRUNK CAN BE FOUND 1 OR 1.5 CM ABOVE THE RENAL ARTERY ORIFICES
DUODENUM AND TREIZ LIGAMENT MOBILIZED.
SMA TRUNK CAN BE FOUND 1 OR 1.5 CM ABOVE THE RENAL ARTERY ORIFICES
8MM PTFE GRAFT IS ANASTOMOSED TO SMA END TO SIDE FASHION8MM PTFE GRAFT IS ANASTOMOSED TO SMA END TO SIDE FASHION
SMASMA
“LAZY C” GRAFT“LAZY C” GRAFT
COMMON
HEPATIC
GRAFT
COMMON
HEPATIC
GRAFT
12. 3-LEFT AND RIGHT RENAL ARTERY EXPOSURE3-LEFT AND RIGHT RENAL ARTERY EXPOSURE
DURING LRA EXPOSURE ; WE PERFORM ANTERIOR APPROACH
SIMILAR TO THAT USED FOR CONVENTIONAL AAA REPAIR. LEFT RENAL VEIN
FREED AND SOME BRANCHES LIGATURED.
DURING LRA EXPOSURE ; WE PERFORM ANTERIOR APPROACH
SIMILAR TO THAT USED FOR CONVENTIONAL AAA REPAIR. LEFT RENAL VEIN
FREED AND SOME BRANCHES LIGATURED.
RIGHT RENAL EXPOSURE; IT REQUIRES LIMITED TAKE DOWN OF
THE HEPATIC FLEXURE OF THE COLON .
RIGHT RENAL EXPOSURE; IT REQUIRES LIMITED TAKE DOWN OF
THE HEPATIC FLEXURE OF THE COLON .
MOST DIFFICULT EXPOSURE AND ANASTOMOSIS IS THE
RIGHT RENAL ARTERY;
1- EXTENSIVE DISSECTION
2-VERY DISTAL ANASTOMOSIS DUE TO VCI (4-5 MM RENAL ARTERY)
3-TUNNELING OF THE GRAFT TO THE INFLOW SITE IS DIFFICULT
4-SURGEON SOULD BE AWARE OF EARLY BRANCHING OR MULTIPLE RENAL
ARTERIES
MOST DIFFICULT EXPOSURE AND ANASTOMOSIS IS THE
RIGHT RENAL ARTERY;
1- EXTENSIVE DISSECTION
2-VERY DISTAL ANASTOMOSIS DUE TO VCI (4-5 MM RENAL ARTERY)
3-TUNNELING OF THE GRAFT TO THE INFLOW SITE IS DIFFICULT
4-SURGEON SOULD BE AWARE OF EARLY BRANCHING OR MULTIPLE RENAL
ARTERIES
13. 1-CEREBRO SPINAL FLUID DRAINAGE
-POSTOP DAY 1 AND 2 ACTIVE DRAINAGE
- POSTOP DAY 3 JUST PRESSURE MONITORING
- POSTOP DAY 4 NO MONITORING BUT IT STAYS
1-CEREBRO SPINAL FLUID DRAINAGE
-POSTOP DAY 1 AND 2 ACTIVE DRAINAGE
- POSTOP DAY 3 JUST PRESSURE MONITORING
- POSTOP DAY 4 NO MONITORING BUT IT STAYS
SPINAL CORD PROTECTION STRATEGYSPINAL CORD PROTECTION STRATEGY
2-MEAN ARTERIAL PRESSURE SHOULD BE
≥ 90-100mmHG
2-MEAN ARTERIAL PRESSURE SHOULD BE
≥ 90-100mmHG
3- HYPOXIA AND ACIDOSIS SHOULD BE
AVOIDED
3- HYPOXIA AND ACIDOSIS SHOULD BE
AVOIDED
4- HEMOGLOBIN SHOULD BE ≥ 10-12 mg/dl4- HEMOGLOBIN SHOULD BE ≥ 10-12 mg/dl
14. EGE UNIVERSITY CARDIOVASCULAR SURGERY EXPERIENCEEGE UNIVERSITY CARDIOVASCULAR SURGERY EXPERIENCE
88 11 4422 33
PATIENTS : 18 (16 MALE)
CONTAINED RUPTURE: 4
MEDIAN AGE: 72±
CSF DRAINAGE: 16
INFLOW SITE:
-INFRARENAL AA :2
-COMMON ILIAC: 16
FOLLOW UP:40±6 MONTHS
PATIENTS : 18 (16 MALE)
CONTAINED RUPTURE: 4
MEDIAN AGE: 72±
CSF DRAINAGE: 16
INFLOW SITE:
-INFRARENAL AA :2
-COMMON ILIAC: 16
FOLLOW UP:40±6 MONTHS
NO MORTALITYNO MORTALITY
15. WHAT ABOUT GRAFT DURABILITY?WHAT ABOUT GRAFT DURABILITY?
WE ARE SURPRISED THAT EARLY AND MIDTERM GRAFT
THROMBOSIS RATE REMAINS VERY LOW
WE ARE SURPRISED THAT EARLY AND MIDTERM GRAFT
THROMBOSIS RATE REMAINS VERY LOW
16. RIGHT
RENAL
8/8(4 chimney)
RIGHT
RENAL
8/8(4 chimney)
SMA
14/14
SMA
14/14 LEFT
RENAL
7/5
LEFT
RENAL
7/5
COMMAN
HEPATIC
16/16(1 snorkel)
COMMAN
HEPATIC
16/16(1 snorkel)
LEFT İLİAC
ARTERY
LEFT İLİAC
ARTERY
COMMON
TRUNK
2/2
COMMON
TRUNK
2/2
SMA
HEPATİC
SPLENIC
RESULTS: GRAFTS PATENCY: 95%RESULTS: GRAFTS PATENCY: 95%
TOTAL 42 GRAFTS
2 OCCLUSION
TOTAL 42 GRAFTS
2 OCCLUSION
17. PATIENT 1: 78 YEARS OLD MEN.TYPE 4 TAAA AND
RENAL FUNCTIONS MODERATLY ELEVATED.
ONE STAGE OPERATION
CSF DRAINAGE +
PATIENT 1: 78 YEARS OLD MEN.TYPE 4 TAAA AND
RENAL FUNCTIONS MODERATLY ELEVATED.
ONE STAGE OPERATION
CSF DRAINAGE +
PREOP CTPREOP CT
20. PATIENT 2: 75 YEARS OLD MALE PATIENT. TYPE 1 TAAA.
PREVIOUS MULTIPLE PCI AND LOW EF.
TWO-STAGE OPERATION
CSF DRAINAGE +
PATIENT 2: 75 YEARS OLD MALE PATIENT. TYPE 1 TAAA.
PREVIOUS MULTIPLE PCI AND LOW EF.
TWO-STAGE OPERATION
CSF DRAINAGE +
PREOP CTPREOP CT
22. POSTOP CT (5 YEAR)
ENLARGEMENT OF DISTAL LANDING ZONE
POSTOP CT (5 YEAR)
ENLARGEMENT OF DISTAL LANDING ZONE
EXTENSION OF
CHIMNEY
EXTENSION OF
CHIMNEY
EXTENSION OF STENT GRAFT
AND RIGHT RENAL ARTERY
CHIMNEY
EXTENSION OF STENT GRAFT
AND RIGHT RENAL ARTERY
CHIMNEY
24. PATIENT 3: 65 YEARS OLD WOMEN. BEHÇET’S DISEASE WITH
VASCULAR INVOLVEMENT. TYPE 3 TAAA
3 MONTHS AGO BENTALL OPERATION
TWO STAGE OPERATION - CSF DRAINAGE +
PATIENT 3: 65 YEARS OLD WOMEN. BEHÇET’S DISEASE WITH
VASCULAR INVOLVEMENT. TYPE 3 TAAA
3 MONTHS AGO BENTALL OPERATION
TWO STAGE OPERATION - CSF DRAINAGE +
PREOP CTPREOP CT
25. COMPLETE VISCERAL AND RENAL ARTERY DEBRANCHING
** right renal artery very small
COMPLETE VISCERAL AND RENAL ARTERY DEBRANCHING
** right renal artery very small
27. COMPLICATIONS:COMPLICATIONS:
GRAFT OCCLUSION: 2 (RENAL ARTERY)
DELAYED PARESTHESIA: 1(COMPLETE RECOVERY )
PROLONGED VENTIALATION: 1 (1 WEEK)
SMA DISSECTION AND TYPE II ENDOLEAK: 1
GRAFT OCCLUSION: 2 (RENAL ARTERY)
DELAYED PARESTHESIA: 1(COMPLETE RECOVERY )
PROLONGED VENTIALATION: 1 (1 WEEK)
SMA DISSECTION AND TYPE II ENDOLEAK: 1
28. GRAFT TO ENTERIC FISTULA:1GRAFT TO ENTERIC FISTULA:1
TYPE II ENDOLEAK : 4 ( 3 of them due to delayed occlusion of celiac trunk)TYPE II ENDOLEAK : 4 ( 3 of them due to delayed occlusion of celiac trunk)
GRAFTS WERE SOAKED WITH
RIFAMPIN AND COVERED BY OMENTUM
GRAFTS WERE SOAKED WITH
RIFAMPIN AND COVERED BY OMENTUM
29. CONCLUSIONCONCLUSION
-There are no pure comparative reports that demonstrate a definite
advantage
of hybrid TAAA repair. It may offer advantages in a selected population
who are considered high risk for open repair.
-There are no pure comparative reports that demonstrate a definite
advantage
of hybrid TAAA repair. It may offer advantages in a selected population
who are considered high risk for open repair.
Technology of fenestrated and branched stent grafts is still emerging. Imaging,
sizing and graft construction all require time. In addition, the high cost of these
stent grafts are prohibitive to many centers.
Technology of fenestrated and branched stent grafts is still emerging. Imaging,
sizing and graft construction all require time. In addition, the high cost of these
stent grafts are prohibitive to many centers.
Similar to conventional repair, results are likely to be better in higher volume
centers with the necessary infrastructure.
Similar to conventional repair, results are likely to be better in higher volume
centers with the necessary infrastructure.
30. Disadvantages of one stage operation are
1-longer duration of operation
2-increased risk of renal failure due to renal ischemia and contrast
Administration.
Hinweis der Redaktion
WE HAVE TREE TREATMENT MODALITIES FOR MANAGEMENT OF TAAA.IT HAS BEEN DOING FOR FIFTY YEARS Perioperative mortality rate for patients who undergo any type of taaa repair ranges from 2%- 20%. Also retrospectively evaluated functional outcomes after TAAA and 20-30 % of patients being discharged to another instution rather than home.
IN ANOTHER WORDS Approximatly one third of patients who underwent elective TAAA and two thirds of patients who underwent urgent repair did not achieve positive functional outcomes
AVAILABİLİTY LIMITED . IT TAKES TIME ALSO IT NEEDS ADVANCED ENDOVASCULAR SKILLS AND A COMPREHENSIVE İNVENTORY WİTH A WIDE RANGE OF CATHETERS,BALLOONS AND COVERED,UNCOVERED STENTS.
WHAT IS OUR ALTERNATIVES? IT CAN BE PERFORMED İN TREE DİFFİRENT WAYS
THE RESULTS ARE VERY CONTROVERSIOL FOR FLOW MODULATER STENTS
MY SUBJECT IS VISCERAL DE BRANCHING
WHAT IS THE KEY PRINCIPLE OF THIS PROCEDURE?
WHEN WE COMPARE OPEN SURGERY;
THIS TECHNIQUES HAS SOME THEORETICAL ADVANTAGES INCLUDING REDUCES VISCERAL ISCHEMIC TIME, SPINAL CORD ISCHEMIA, NO AORTIC CROSS CLAMP, REDUCES PULMONARY COMPLICATION DUE TO AVOİDANCE OF THORACOTOMY.
THIS PROCUDURE EASLY PERFORMED IN EMERGENCY CASES, BECAUSE
IT İS VERY İMPORTANT DETERMINATION OF INFLOW SITE BEFORE OPERATION. DETERMINATION OF INFLOW SİTE DEPENDS 1-EXTEND OF ANEURYSMAL DİSEASE , 2-İLİAC ARTERY DİAMETER AND 3-ILIAC ARTERY KINKING AND ELONGATIONS
ALL THESE IMPORTANT INFORMATIONS OBTAINED FROM PREOP CT
IN CASE OF ANY COMPLİCATİON İNFLOW İLİAC ARTERY MAY CAUSE DEBRANCHING GRAFTS FAİLURE
THE X RAY OUR DEBRANCHING GRAFT RESEMBLES “TREE AND BRANCHES”
ALSO WE BELIEVE THAT DELAYED OCCLUSION OF CELİAC TRUNK MAY PREVENT ACUTE SPİNAL CORD İSCHEMIA
THE OPERATION IS PERFORMED WITH MIDLINE LAPAROTOMY EXTENDING FROM XIPHOID PROCESS OF THE STERNUM TO SYMPHISIS PUBIS.. THIS INCISION ALLOW FULL ACCESS TO CELİAC TRUNK,SMA , RENAL ARTERIES AS WELL AS THE ABDOMİNAL AORTA AND İLİAC ARTERİES.
WE USED COMMEN HEPATIC ARTERY AS A OUTFLOW FOR CELİAC REVASCULARIZATION
GRAFT İS ROUTED DOWNWARD BETWEEN THE PANCREAS AND STOMACH , BEHIND THE TRANSVERS COLON TO RETROPERİTONEUM.
After mobilization of duedonum and treizts ligament, duedonum elevated and retracted to the right side
AFTER FINISHING OUT-FLOW ANASTOMOSIS, THE CORRECT ROUTING AND POSITIONING OF THE GRAFTS IS CRUSIAL TO AVOID EARLY THROMBOSIS . SMA GRAFT İS FASHIONED LAZY C CONFIGURATION AS SHOWNED IN THE PICTURE. THIS SHAPING IS ESSENTIONAL TO AVOID KINKING AFTER REPOSITIONING THE SMALL BOWEL.
İF ORİGİNE OF THE LEFT RENAL ARTERY ON THE ANEURYSMAL AORTA , WE PERFORM MATOX MANEUVAR, WNE WE EXPOSE TO RENAL ARTERY BEFORE İT DIVIDES AT HE HILUM.
, THE EXPOSURE AND ANASTOMOSIS OF THE RIGHT RENAL ARTERY İS THE MOST DIFFİCULT AMONG THE FOUR ARTERIES BASED ON OUR EXPERIENCE.
THEREFORE WE PREFER CHINNEY OR SNORKEL TECQ FOR REVASCULARIZATION OF RRA.
1-CEREBRO SPİNAL CATHETER İS İNSERTED THE DAY BEFORE SURGERY.
2- WE USE İNTERMİTTANT DRAİNAGE.(MORE SURGEONS USE FREE DRAİNİNG SYSTEM
İF Celiac vessels and sma originaTES FROM THE same trunk İT İS CALLED COMMON TRUNK.. ıt is very important to determine this vascular variation before THE operation.
Hasta ismi ibrahim yaprak 2013, volume rendering görüntü lazım
I WOULD LIKE YOU TO SHOW OUR CASES
THE ANEURYMS STARTED JUST ABOVE THE DIAFRAGM AND TERMINATED BELOW THE RENAL ARTERIES.
First we always check the de-branching grafts. We did 3 vessel de-branching. We did not de-branched rra. Right renal artery revascularization was performed with snorkel technique. First stent graft deployment was finished, rra was cannulated from the left axillar artery, and second stent graft ready for deployment
İBRAHİM YAPRAK VOLUME RENDERING GÖRÜNTÜ LAZIM
When we look at the preop ct, the aneurysm is started at mid desending aorta and its finished at the level of renal arteries. This is the MPR view of the aneurysm
What we did? First abdominal de branching was performed. The inflow is left comman iliac artery. The right renal artery revascularization was performed with using chimney technique. 7mm viabanh stent graft was used. As you see it was bended very sharply therefore we put an another uncovered stent
WE DETERMINED DISTAL LANDING ZONE ENLARGED DURING FOLLOW UP PERİOD . WE MEASURED 5.9 CM DIAMETER. WE DECIDED TO EXTEND THE STENT GRAFT AND RIGHT RENAL ARTERY CHIMNEY STENT GRAFT. UNTIL 2 CM ABOVE THE AORTIC BIFURCATION. THE ANGIOGRAPY ON THRE RIGHT SIDE SHOWING THIS PROCEDURE.
This is the final ct . The extended viabanh and stent graft looks ok In axial segment and mpr
THORACIC ANEURYSM EXTENDED BETWEEN THE FIFTH THORACAL VERTEBRA AND RENAL ARTERIES. MAXİMAL DIAMETER OF THE ANEURYSM 9 X 12 CM .
Right and left renal artery are very small. Therefore We used 5 mm diameter ptfe graft for revascularization of renal arteries.
This is final angiography ,after stent deployment.
Aneurysm sac is completely thrombosed and all de-branching graft were patent.
This is not a complication free procedure. We have complications but in acceptable range.
When we look at the whole procedure the most devastating complication are sma graft occlusion and graft to enteric fistula based on our experience. Because this complications usually not compatible with survival
Olabilecek en kötü komplikasyonlar
POSOP CT İN 6 MONTH, DEMONSTRATED TYPE 2 ENDOLEAK AND FALSE LUMEN ANEURYSM IN SMA AS RESULT OF SMA DISSECTION.
PATIENT ADMİTTED TO EMERGENCY UNIT DUE TO LOWER GI BLEEDING. SHE HAS FEVER AND INCREASED WHITE BLOOD CELLS
CT DEMONSTRATED AİR BUBLES AROUND THE GRAFTS.
