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.
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.
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.
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
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?
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 10x37 in SMA, 8x27 for left renal and 7x18 in right renal.
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
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.
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.
"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.
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.
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.
This presentation deals with three important issues:
(1) What is the real incidence of limb occlusion post-EVAR?
(2) Which are the key points and risk factors behind limb occlusion?
(3) How to manage different clinical scenarios?
This is a case report describing the different steps of the implantation of a fenestrated preloaded endograft to treat a juxtarenal aneurysm with calcified and tortuous iliacs.
This is the second chapter of the EVAR tutorial about planning and sizing of the endovascular AAA repair. Following topics are included:
- How to measure exactly the right diameter of our proximal landing zone?
- How to oversize in angulated necks?
- Which ancillary products should be available in challenging cases?
- How to select the length and diameter of the iliac limbs?
- Specific scenarios
One of the main topics at each meeting is the discussion about the importance and clinical relevance of gutter-related endoleaks after ch-EVAR. Herein, we present you an overview of the most important causative mechanisms for the development of persistent gutters and tips to treat and minimize the risk of appearance.
What are the factors predisposing to migration of endografts after EVAR? How are the stresses, pressure and forces distributed postiperatively? Can the geometric parameters predict future adverse effects? How are mechanical, hemodynamic and geometrical changes interconnected postinterventionally? This presentation introduces some basic hemodynamic pronciples and terminology as a means to comprehend the phenomena taking place after endograft implantation.
This is a case report of a custom iliac branch device for the treatment of an aortoiliac aneurysm. In this video, you will learn the features of the device, the most relevant steps of the procedure and how to recognize the markers of the endograft.
This is a recorded case of bilateral hypogastric artery aneurysm treated by coil embolization on the one side and an iliac-side branch device on the other side. In this video, you will learn about access vessels, decision making, how to embolize the aneurysm of the hypogastric artery, how to implant the iliac-side branch device as well as further relevant technical aspects and features of the device.
This is a current overview of the evidence and techniques regarding the time and type of endoleak treatment as well as information about postoperative anticoagulation. Moreover, we provide our institution's algorithm about the surveillance protocol of endoleaks after EVAR procedures.
