0920_Parodi.pdf

1、Expanding Endovascular Options for Treatment of Arch PathologyF.Ezequiel Parodi MDAssociate Professor UNCDisclosures Centerline Biomedical:Consultant,Stock options Cook Medical:Research support,Training Gore:ConsultantProblems Unique to the Arch Increased pressure and migration forces Coronary Arter

2、ies Dealing with the aortic valve and working in LV Need for overdrive pacing for deploymentAortic Arch-Debranching-Laser-Branch/FenestratedDebranching+TEVAR Numerous options available for hybrid procedures Carotid-Subclavian bypass Carotid-Carotid bypass Ascending arch based bypassesGreat Vessel In

3、volvement Most commonly requires coverage of the L SCA Most patients can tolerate L SCA covering without pre-operative revascularization Exceptions LIMA L Vertebral arising from the arch LUE AV fistula Dominant L vertebral artery Vertebral ends in PICA L SCA should be revascularized in elective surg

4、eryL CCAClip Retrospective review of 60 patients Complicated type B dissections,Ruptures,IMH and Chronic dissections Zone 0 in 2 patients,Zone 1 in 5 and Zone 2 in 51 patientsResults Mean follow up 2.44 years In hospital Morality 8.3%Stroke rate 3.3%100%primary patency on follow up Three type IC end

5、oleaks requiring re interventionConclusion:Laser fenestration is a durable,has high technical success and primary patency with low re intervention rate 1011In-Situ Laser fenestration121314GORE TBETBE DeviceAortic ComponentSide Branch(SB)ComponentAortic Extender1617L radial access.4Fr 75cm sheathN=40

6、,Male 52%9 Patients zone 0/1 31 Patients zone 2No device migration,fracture,or ruptureTwo side branch occlusions,both on zone 2Freedom from re-intervention 97%zone 2,100%zone 0/1Endoleaks I&IIIOne type 1A treated with another TBE to Zone 0One type III not treatedTwo strokesEur J Vasc Endovasc Surg 2