Library

Welcome to the Library of Vascupedia. Use our filters on the left side of the page to quickly find the content of your interest. You may select an area of interest and the respective indication or the media type.

Technical note

Zero Contrast EVAR Round Table

This is a round table discussion about CO2 during EVAR and complex EVAR in the framework of the annual meeting of Angiodroid in Bologna, Italy. In this round table discussion, 5 European experts present current evidence and their experience about the use of CO2 in the treatment of aortic diseases (s. chapters). Moreover, the panellists discuss all important benefits and drawbacks of the technique and present for the first time the study protocol of the prospective CO2 EVAR registry.

June 28, 2019 No Comments
Awareness

The power of surgical drawings

This presentation aims to highlight the usefulness of surgical drawing in practice. It sums up experiences, planning and real cases of the past 5 years of practice in vascular surgery. As I got tremendous positive feedback from patients, colleagues, GP’s, relatives and artists, I decided to share this experience with the vascular community.

June 13, 2019 1 Comment
Basic vascular surgery skills

Aortic aneurysm repair

This is a step by step video of the open surgical of an abdominal aortic aneurysm with a tube Dacron graft through a median laparotomy. In this video, you will learn the surgical exposure of the aneurysm, the clamping and opening of the aneurysm sac, how to deal with the lumbar arteries, the proximal and distal anastomosis and how to close the abdomen by the right way.

April 2, 2019 No Comments
Live case

Step by step implantation of the first EVAR stent-graft with divided main body

This is a recorded case of the new Altura stent graft (Lombard). The device has kept well-known features of previous EVAR devices such as active suprarenal fixation, a fabric graft, and a robust nitinol stent. The flexibility produced by the division of the main body has the potential to significantly improve many issues of EVAR performance.

March 25, 2019 No Comments
Review of the literature

Abdominal compartment syndrome after EVAR: a serious issue

Dr. Martin Björck (Uppsala University, Sweden) summarizes in this presentation all important clinical and therapeutic aspects of abdominal compartment syndrome after EVAR for ruptured abdominal aortic aneurysms (AAA). Moreover, the author discusses the clinical consequences of ACS and provides important recommendations about monitoring techniques and treatment.

Technical note

Open Conversion for Failed EVAR: Increasing Need and Different Strategies

Late open conversion after EVAR shows an increasing incidence and is mostly related to arterial degeneration and/or material fatigue. Dr. Michael Makaroun provides a unique overview of different techniques for the challenging open conversion for failed EVAR.

Awareness

Ruptured Aneurysm Protocol: Lessons From a Busy Aortic Center

Dr. Benjamin Starnes (Seattle, WA, USA) demonstrates all important features of a well-organized and ‘busy’ aortic center and analyzes the added value of centralization of the aortic treatment. Moreover, Dr. Starnes summarizes all lessons learned during the establishment of the aortic center, which may help physicians to further optimize the EVAR outcomes in the treatment of ruptured AAAs.

Recorded video case

Use of endoanchors for EVAR sealing in case of ruptured AAA

63 y.o. patient treated in the emergency setting for ruptured AAA
Endovascular repair planned despite proximal hostile anatomy and left iliac aneurysm with thrombus.
procedure details:
-bilateral percutaneous access
-bifurcated endurant endograft implant (left hypogastric embolization)
-partial left renal artery coverage @ control angio (intentional aggressive deployment)
-renal stenting
-type Ia endoleak after renal stenting, persistent after re-ballooning
-endoleak correction with endoanchors

December 2, 2018 No Comments
Case report

Decision making by a complex case of iatrogenically created A-V fistula with concomitant AAA and fem-pop bypass occlusion

This is a complex case of a 74-year-old female with an acute onset of rest pain of the right limb. Previous Rx: primary stenting of both renal arteries, endovascular repair of both CIA in CERAB technique and fem-pop 1 bypass right limb.
During her current readmission, the CT-scan revealed a high-flow AV fistula of the right CFA, an abdominal aortic aneurysm (4.7 cm), an occluded stent in the right renal artery as well as an occluded fem-pop bypass. What would you do in this case?

November 29, 2018 No Comments
Recorded video case

Preloaded custom-made fEVAR. Step by step procedure

Preloaded custom-made fEVAR (Cook) in a 63 y.o. male with pararenal abdominal aortic aneurysm 55 mm. This video shows all the procedural steps and the CT scan at 1 month.

– Chronic ischaemic heart disease with left ventricular apex aneurysm
– Left mild intermittent claudication 500 mt (Left common iliac artery chronic occlusion)
– COPD
– Chronic celiac artery occlusion

We used Begraft 10×37 in SMA, 8×27 for left renal and 7×18 in right renal.

November 21, 2018 No Comments
Recorded video case

Emergency triple chimney in a patient with giant symptomatic pararenal pseudoaneurysm and subsequent gutter embolization

We report a case of pararenal pseudoaneurysm endovascular correction with triple chimney technique and the following gutter embolization procedure

Key points:

-Previous fEVAR attempt (failed because of extremely tortuous accesses)
-Emergency procedure during the night
-Bilateral percutaneous femoral access
-Double axillary puncture on both sides
-Challenging endograft advancement on through and through guidewire
-Triple ChEVAR (SMA, RRA, LRA)
-Subsequent gutter embolization

November 18, 2018 3 Comments
Recorded video case

Step by step bilateral common iliac aneurysm endovascular repair with Gore IBE (iliac branched endograft) and C3 device.

Bilateral common iliac aneurysm endovascular repair with an iliac branched device in a 63 years old patient. This video demonstrates the procedural steps and the CT scan at 3 years of surveillance.
Notice: Intentional cross-leg because of short lowest renal to hypogastric distance.

November 14, 2018 No Comments
Recorded video case

Use of the TREO stent-graft for the treatment of AAA

Dr. Bisdas (Vascular Surgeon, Athens, Greece) performs a live implantation of the new TREO stent-graft (Terumo Aortic) for the treatment of an infrarenal AAA. In this video, you will see all the new features of the device and important intraprocedural steps for a successful EVAR. Furthermore, the panelists will discuss the need for a new EVAR endograft and they express their opinion about the TREO stent-graft. In the end, the operator answers questions about the aim and scope of Vascupedia.

October 22, 2018 No Comments
Technical note

Removing stent grafts and implications for putting them in

“Who will do my aortic surgery when my time comes” was a common refrain among my mentors, only half jokingly. Now, the question has gained a sharpness. I think the tide will turn and the kids will do fine, but we all have to do a bit of reclamation, or open surgery will become the habit of strange eccentric artisans. I recommend calling up the retired surgeon and inviting them in for conferences and cases. Reprint masterwork atlases like Wiley’s. Connect with likeminded. Before it’s too late.

September 30, 2018 1 Comment
Review of the literature

A brief history of surgical repair of the abdominal aortic aneurysm

Since India’s Sushruta (800-600 BC) first reported that “aneurysms can be cured only with the greatest difficulty”, the majority of surgeons shared a fear of aortic surgery till the first half of the 20th century. The surgical treatment of AAA became available only in the second half of the 20th century. This presentation summarizes the most important historical milestones in AAA surgery.

September 29, 2018 No Comments
Case report

Periscope and Chimney-EVAR for a ruptured AAA following infrarenal EVAR

Despite the latest advances in both endovascular field and open repair, a ruptured AAA still remains one of the most challenging situations in vascular medicine. This case shows the use of chimney and periscope grafts for the treatment of a Type Ia Endoleak in patient presenting with a ruptured AAA.

September 19, 2018 No Comments