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Technical note

Complex endovascular repair

Dr. Gustavo Oderich summarizes in his presentation all important aspects of the endovascular repair of complex aortic aneurysms. The evolution from EVAR to more complex techniques, the upcoming trials, the different stent designs, the current strategies regarding the reduction of SCI, first data about the quality of life in these patients and the impact of simulation on the outcomes of complex endovascular repair are some key issues that are discussed in this paper.

Milano Aortic Surgery | Peripheral & Venous “How To Do It
March 2, 2019 No Comments
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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 10x37 in SMA, 8x27 for left renal and 7x18 in right renal.

Giacomo Isernia
November 21, 2018 No Comments
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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

Gioele Simonte
November 18, 2018 3 Comments
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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.

W. Michael Park
September 30, 2018 1 Comment
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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.

khaled elhendawy
September 29, 2018 No Comments
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Experimental investigation

In-vitro experimental investigation of different bridging stent-grafts for fEVAR

Giovanni Torsello (Vascular Surgeon, GER) presents and discusses with the experts the latest results from an experimental head-to-head investigation of different bridging stent-grafts (BSG) used in fenestrated aortic endografting.
How does the material respond to balloon dilatation? Which are the forces that might lead to the dislocation of the BSG from a fenestration? Endoleak of unknown origin after fEVAR: could be associated with material fatigue?

Muenster Master Class
September 28, 2018 No Comments
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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.

Konstantinos Stavroulakis
September 19, 2018 No Comments
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Recorded video case

Open surgical repair of a pararenal AAA

In this video case, we present our standard practice of open surgical repair for pararenal AAA. In general, we performed open repair with the “clamp and sew” technique, and the application of cold renal perfusion is limited to the cases with renal revascularization. Sometimes, division of left renal vein is imperative for better access to the suprarenal aorta. Retrospective analysis of our series revealed no negative impact of the division on long-term renal function - J Vasc Surg 2018;67:1042-1

Masayuki Sugimoto
August 29, 2018 1 Comment
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Question to the Vascupedians

Results – Polling Station June 18

This presentation summarizes the results of the first topic of the polling station about asymptomatic juxta- and suprarenal aortic aneurysms.
Total number of votes: 103.
The results are now open for discussion.

. Vascupedia
July 2, 2018 No Comments
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Review of the literature

Gutters after Chimney EVAR: How „PERICLES and PROTAGORAS“ can protect ACHILLES heel?

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.

Konstantinos Donas
July 1, 2018 3 Comments
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Recorded video case

Treatment of a TAAA with a low-profile branched endograft

This is a case of a thoracoabdominal aortic aneurysm treated by a low-profile branched endograft. In this video, you will find our algorithm for staging the aortic procedures, to reduce the risk of spinal cord ischemia, the steps of the procedure, important tips and tricks for a successful outcome and finally, the impact of the totally percutaneous approach for the quick recovery of the patient.

Martin Austermann
June 1, 2018 1 Comment
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Technical note

Zenith t-branch for the treatment of TAAAs: planning and algorithm

This presentation is a snapshot of the main characteristics of the t-branch endograft for the treatment of thoracoabdominal aortic aneurysms (TAAA). Moreover, we present our institution's algorithm regarding the steps of the procedure and the OP setting in order to achieve the best outcome for the patient and to prevent spinal cord ischemia.

Theodosios Bisdas
May 27, 2018 1 Comment
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Recorded video case

Treatment of a type Ia endoleak with chEVAR: steps and materials

In this case, a type Ia endoleak after migration of a Talent endograft was treated successfully by chimney endografting. This case shows all steps of the procedure and describes the required materials (catheters, balloon catheters, bridging stent-grafts etc). The big challenges, in this case, were the angulated neck, the renal artery stenoses and the stent struts at the origin of the renal arteries.

Konstantinos Donas
May 26, 2018 1 Comment
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Recorded video case

Percutaneous thrombectomy of bridging stent-grafts after chEVAR

This case demonstrates the percutaneous transluminal thrombectomy of a bridging stent-graft after chEVAR. The clot removal was performed with the Indigo thrombectomy catheter (Penumbra) through a transaxillary approach. In this video, you will find important technical aspects as well as all relevant characteristics of the device.

Theodosios Bisdas
May 24, 2018 6 Comments
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Review of the literature

Chimney Reconstructions for Juxtarenal Aneurysms: Indications, Optimal Technique and Outcome Data

In this presentation, you will find important information about the chimney technique (chEVAR) for the treatment of juxtarenal or pararenal aortic aneurysms.

Giovanni Torsello
May 22, 2018 No Comments
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Poll 13/04/2018 – 30/06/2018

Topic: Asymptomatic juxta- and pararenal aortic aneurysms

Patient’s characteristics

Gender: Female
Age: 75 years old
Comorbidity: Arterial hypertension, hypercholesterinemia, previous aortocoronary bypass grafting, previous myocardial infarction, previous smoker, peripheral arterial disease, atrial fibrillation
Symptoms: None
Previous operations: None

 

Aneurysm characteristics:

Max. aneurysm diameter: 54 mm

Length of proximal infrarenal neck: 0 mm

Distance between SMA and LRA: 20 mm

Diameter of renal arteries: RRA: 5,3 mm, LRA: 6 mm

Suprarenal angulation: 60°

Diameter of distal neck: 30 mm

Minimum diameter of common iliac arteries: R: 11 mm, L:9 mm

Maximum diameter of common iliac arteries: R: 11 mm, L: 14 mm

Minimum diameter of external iliac arteries: R: 7 mm, L: 6,2 mm

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