血管内手术心脏外科医生不断演变的角色英文
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▪ Remote history of MVA
Standard vs. Innovative
Postoperative CT
Case: Arch Aneurysm
▪ 79 yo male ▪ PHx:
▪ Prior Cardiac Sx ▪ Prostate Cancer ▪ HTN
Endovascular Solution?
Postoperative CT: 1 month
Potential for Thoracic Stenting
Aneurysm Asymptomatic Contained rupture
Acute Type B dissection Chronic dissection with
aneurysm Penetrating ulcer Intramural hematoma Aortic coarctation Pseudoaneurysm associated
Traumatic Aortic Transection
17 yo male struck by minivan ▪ Traumatic aortic
transection ▪ Close head trauma ▪ Spleen & liver
injuries ▪ Open fractures
Preoperative CT
Left subclavian
Aortic neck diameters
(range 23mm-37mm)
Principles:
▪ Adequate vascular access
▪ Adequate proximal and distal landing zones
▪ non-aneurysmal aortic segment
6-10cm in 4 months
Ascending Aortic Stent Graft
Postoperative CT: 1 year
The Future is Bright!
THE FUTURE IS NOW!!!
Thoracic Endografts
Gore TAG
Medtronic Talent
SFA
TheNo hveessaelristsaagne d most vessels are accessible via percutaneous approaches.`
And Below
Traditional Approach
Or This?
Left common carotid
20mm
Байду номын сангаас
Cook TX2
▪ diameter 24-38 mm ▪ length > 20 mm
20mm to celiac
Z2 Z1
Z3 Z0
Z4
Initial thoracic ELG Coverage of LSCA Extra-thoracic debranching Intra-thoracic debranching
The Workshop
Image Intensifier
Fixed surgical
table
X-ray tube assembly
Surgical Tools
The Tools
Intravascular Ultrasound
Renal Iliac
Subclavian Coronary
Aorta
with previous repair Aortic transection Aortobronchial fistula
Case: Innominate artery aneurysm
▪ 41 yo male
▪ Incidentally discovered during hospitalization for pneumonia
Future of Thoracoabdominal Aortic Surgery
Ascending Aorta Safe from Endovascular Approaches?
Not Anymore!!!!
Initial Experience with Endovascular Repair of the
Future of Arch Endografting
Innovative Endovascular Approaches to the Arch
J. L. Andersen, Australia
J. L. Andersen, Australia
J. L. Andersen, Australia
Ascending Aorta
Pseudoaneurysm of Ascending Aorta
Right coronary artery bypass occluded
Preoperative CT
Coils failed to close entry point
Aneurysm expanded from
Standard vs. Innovative
Postoperative CT
Case: Arch Aneurysm
▪ 79 yo male ▪ PHx:
▪ Prior Cardiac Sx ▪ Prostate Cancer ▪ HTN
Endovascular Solution?
Postoperative CT: 1 month
Potential for Thoracic Stenting
Aneurysm Asymptomatic Contained rupture
Acute Type B dissection Chronic dissection with
aneurysm Penetrating ulcer Intramural hematoma Aortic coarctation Pseudoaneurysm associated
Traumatic Aortic Transection
17 yo male struck by minivan ▪ Traumatic aortic
transection ▪ Close head trauma ▪ Spleen & liver
injuries ▪ Open fractures
Preoperative CT
Left subclavian
Aortic neck diameters
(range 23mm-37mm)
Principles:
▪ Adequate vascular access
▪ Adequate proximal and distal landing zones
▪ non-aneurysmal aortic segment
6-10cm in 4 months
Ascending Aortic Stent Graft
Postoperative CT: 1 year
The Future is Bright!
THE FUTURE IS NOW!!!
Thoracic Endografts
Gore TAG
Medtronic Talent
SFA
TheNo hveessaelristsaagne d most vessels are accessible via percutaneous approaches.`
And Below
Traditional Approach
Or This?
Left common carotid
20mm
Байду номын сангаас
Cook TX2
▪ diameter 24-38 mm ▪ length > 20 mm
20mm to celiac
Z2 Z1
Z3 Z0
Z4
Initial thoracic ELG Coverage of LSCA Extra-thoracic debranching Intra-thoracic debranching
The Workshop
Image Intensifier
Fixed surgical
table
X-ray tube assembly
Surgical Tools
The Tools
Intravascular Ultrasound
Renal Iliac
Subclavian Coronary
Aorta
with previous repair Aortic transection Aortobronchial fistula
Case: Innominate artery aneurysm
▪ 41 yo male
▪ Incidentally discovered during hospitalization for pneumonia
Future of Thoracoabdominal Aortic Surgery
Ascending Aorta Safe from Endovascular Approaches?
Not Anymore!!!!
Initial Experience with Endovascular Repair of the
Future of Arch Endografting
Innovative Endovascular Approaches to the Arch
J. L. Andersen, Australia
J. L. Andersen, Australia
J. L. Andersen, Australia
Ascending Aorta
Pseudoaneurysm of Ascending Aorta
Right coronary artery bypass occluded
Preoperative CT
Coils failed to close entry point
Aneurysm expanded from