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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
Case report

Complex multi stage thoracoabdominal aneurysm correction. Branched endograft with forced femoral access and flap perforation

acute type B aortic dissection with thoracic aortic aneurysm. no proximal sealing zone for TEVAR landing and dilated ascending aorta.

-Car-car-sub by pass
-Ascending aortic replacement, ascending to innominate by pass and TEVAR

@ control CTA fast aneurysm enlargement

4 inner branches (two antegrade and two retrograde) custom made endograft.
access to RRA through hole performed in the lamella
forced femoral access (no arch vessel available) with steerable sheat

April 13, 2019 4 Comments
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.

Review of the literature

Treatment results of descending thoracic aortic graft and endograft infection: a systematic review

Dr. Andrea Kahlberg (Milan, Italy) provides a comprehensive overview of their paper about the treatment strategies and outcomes of openr repair in case fo infected graft and endograft infections in the descending aorta.

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

Percutaneous large bore axillary artery access technique for complicated EVAR

This video demonstrates step by step the technique of percutaneous axillary artery access for the endovascular repair of complex aortic aneurysms. The technique includes the ultrasound-based identification of the vessels and the nerve, the introduction of the closure system, the performance of the intervention and the angiographic control after closing the puncture site.

November 11, 2018 No Comments
Recorded video case

Use of the Ankura stent-graft for the treatment of thoracic aortic aneurysms

Dr. Kratimenos (Interventional Radiologist, Athens, Greece) presents a new thoracic endograft (Ankura, Lifetech) for the treatment of a challenging thoracic aortic aneurysm. In this recorded case, you will see the features of the device, the intraoperative steps and the performance of the endograft. At the end of the video, the panelists discuss the features and the benefits on the endoprosthesis and Dr. Kratimenos answers the questions of the audience.

October 15, 2018 No Comments
Review of the literature

Thoracoabdominal aortic aneurysm: when to treat open and when endo?

Professor Dr. Böckler (Vascular Surgeon, Heidelberg, Germany) provides an overview of the current evidence regarding decision making in the treatment of TAAA. Which patients’ characteristics should influence your decision, do we have head-to-head comparisons between open surgery and endo-repair, what about the risk of spinal cord ischemia, and many other relevant questions will be answered in this presentation and discussed between the panelists.

October 5, 2018 No Comments
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?

September 28, 2018 No Comments
Recorded video case

The new low-profile Valiant Navion TEVAR endograft

Dr. Lovato (Interventional Radiologist, Bologna, Italy) presents exclusively in Vascupedia and discusses with the experts his first experience with the brand new low-profile thoracic endograft from Medtronic (Valiant Navion) for the treatment of different thoracic aortic pathologies. In the recorded case you will see the case planning, the new characteristics of the device, the comfortable deployment mechanism, and the intra- and postoperative performance of the endograft.

September 20, 2018 No Comments
Review of the literature

Paraplegia after endovascular TAAA-repair:

Why does the endovascular TAAA repair increase the risk of spinal cord ischemia (SCI)? Which are the challenges? How can you prevent SCI during complex endovascular TAAA repair? Do we have enough evidence for the prohylactic use of cerebrospinal fluid drainage in the endovascular treatment of complex TAAAs?

September 18, 2018 No Comments
Case report

Treatment of a large thoracoabdominal aneurysm with narrow access vessels

This case report describes the treatment of a thoracoabdominal aneurysm with narrow access vessels and an upward facing right renal artery. The use of a flexible self expanding covered stent facilitates the attachment of the target vessel with your branch. To reduce the risk of paraplegia, a staged procedure was performed.

August 12, 2018 1 Comment
Case report

TAAA: Back table surgeon-modified stent-graft with internal branches

We report some cases performed with a stent-graft modified by the surgeon with internal branches for the treatment of TAAAs. In total, we have 34 cases performed with this technique and we developed and patented a low profile device to be used in almost all anatomical types of TAAAs. This device may be considered off-the-shelf graft. See also: https://vascupedia.com/presentation/an-off-the-shelf-and-low-profile-stentgraft-for-treatment-of-thoracoabdominal-aneurysms/

June 18, 2018 1 Comment
Experimental investigation

An off the shelf and low profile stentgraft for treatment of thoracoabdominal aneurysms

I recently developed an off the shelf stentgraft for treatment of thoracoabdominal aortic aneurysms involving the visceral branches. With this off the shelf device, aneurysms can be treated with any anatomical configuration of the visceral vessels, such as only 1, 2, 3 or 4 branches. I began to have the idea of developing this device from a technique of internal branches that I developed for treatments of thoracoabdominal aneurysms. We performed almost 40 patients with this technique.

June 4, 2018 3 Comments
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.

June 1, 2018 1 Comment
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.

May 27, 2018 1 Comment
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.

May 24, 2018 6 Comments