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Vascupedia VIEWS 2.0

VascupediaVIEWS Part 2 Episode 1: Elective AAA – From imaging to decision making & planning

Objectives:

  • To learn how to interpret CT-angiography in different AAA scenarios
  • To learn how to assess the underlying anatomy and plan the treatment
  • To discuss how to decide between EVAR and open surgery
  • To discuss the best treatment options for patients presenting with AAA
September 15, 2020 1 Comment
Recorded video case

TEVAR WITH PROXIMAL SCALLOP CUSTOM MADE STENT-GRAFT FOR CHRONIC POST-TRAUMATIC ANEURYSMS OF THE AORTIC ISTHMUS

This is a case of 46 years old man with a grade II blunt traumatic aortic lesion 21 years ago, without any treatment and follow up.
Today 85 mm aortic isthmus pseudoaneurysm. Obesity, moderate-severe dyspnea, refusing sternotomy for FET.
Strategy: Custom-made scalloped stent-graft (Terumo Aortic Bolton Relay 30-26-180 mm) for Zone 1 (left common carotid artery). Waiting for the stent graft customization (3 weeks), car-subcl bypass and plug in the subclavian artery (allowing more accurate fusion imaging during TEVAR: redo fusion). Dynamic four-dimensional CT (4D CT) was performed pre- (showing the left main bronchus dynamic compression by the sac) and post- operatively (showing the free flow and first stent working during the cardiac cycle). TEVAR under fusion imaging technique, rapid pacing. Cone-bone CT scan showed a good aortic lesion exclusion, confirmed at 1 month 4D CT scan.

September 14, 2020 No Comments
Live case

The GORE cTAG conformable thoracic stent-graft with ACTIVE CONTROL system for the endovascular repair of a challenging thoracic aortic aneurysm

This is a case of 63 yrs old female with a very challenging TAA (7.8 cm, massive elongation of the aorta, short proximal neck and type III aortic arch), who was treated endovascularly with the new cTAG endograft. The proximal landing zone was extended through a left carotid subclavian bypass up to the LCCA and the device showed an excellent conformability to this challenging anatomy. In this video, all the important steps of TEVAR as well as of cTAG implantation are illustrated.

April 5, 2020 3 Comments
Technical note

How to use a 20 mL-syringe to explant an infected stentgraft with suprarenal fixation?

Suprarenal fixation of aortic stentgraft can be left in place when explantation is performed in uninfected situations such as ruptured endoleak or acute thrombosis. In case of infections and especially in stentgraft-enteric fistula, this strategy can promote reinfection and recurrence of the fistula. Total control of the suprarenal aorta and visceral arteries revascularisation can be achieved through a left retroperitoneal approach but with poor access to repair the bowel in case of fistula. In this situation midline laparotomy is the best approach to perform the repair of the bowel and syringe extraction represents a valuable option to explant the stentgraft

February 26, 2020 1 Comment
Recorded video case

Kommerell’s diverticulum in right-sided aortic arch treatment

This video case-report show a case of debranching-TEVAR in our hybrid room on fusion imaging and final procedure CBCT, with a CT scan at 2 years follow up.

September 18, 2018 2 Comments
Case report

Endovascular treatment of in-stent restenosis of right ICA using dual layer micromesh Roadsaver stent

This is an interesting and unusual case of in-stent restenosis after CAS.

The patient had been stented on both ICA , left side with dual layer micro mesh stent and right side with an open cell design, Protege, Medtronic.

Restenosis occured on the right side where open cell stent was placed, even though leftside was stented before.

We decided to go for a “stent in stent” solution in order to achieve better result, and Roadsaver stent was chosen for this purpose.

Final result was satisfaying.

 

August 5, 2020 No Comments
Experts opinion
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IVUS vs Angio – Plaque Burden

Dr Stavroulakis discusses how angiography can often underestimate severity of PAD, and how IVUS can accurately measure and quantify percent stenosis and plaque burden.