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.

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 1 Comment
Technical note

Surgeon Modified Fenestrated EVAR 2.0

Clinical case video describing urgent correction of a proximal type I endoleak, in previous standard EVAR procedure, which caused a rapid growth of the residual aneurysmal sac. The patient was unfit for open surgery due to multiple severe comorbidities. Considering the urgency setting, the use of a market available custom-made device was not reasonable. For this reason, the patient underwent endovascular correction using a “surgeon modified” endograft (Medtronic Valiant Navion Thoracic Endograft) designed with four custom fenestrations for visceral and renal vessels.

April 5, 2020 4 Comments
Recorded video case

Transaxillary TEVAR with an in situ fenestrated Endurant tube endograft for a ruptured thoracoabdominal aortic aneurysm

This patient was admitted at Athens Medical Center with a contained rupture of the thoracoabdominal aorta. The CT scan revealed complete occlusion of the infrarenal aorta with collateralisation of the profunda arteries at both sites through the SMA and the Riolan anastomosis. In his previous history, the patient was treated with an aortobifemoral bypass for Leriche syndrome (2008) with graft infection (2010) and replacement of the aorta with femoral veins (2010). We planned a transaxillary TEVAR (diameter of proximal left axillary artery: 6.5cm) and triple puncture of the right axillary artery.

March 17, 2020 1 Comment
Technical note

35 Years of Progress in Aortic Surgery

Over the past 35 years, there has been extensive progress in aortic surgery for people with Marfan, Loeys Dietz, and other genetic aortic condition. Dr. Joseph Coselli, Professor, Vice-Chair, Department of Surgery & Chief, Cardiothoracic Surgery, Baylor College of Medicine, and a member of The Marfan Foundation Professional Advisory Board, discussed the advances and the options currently available for these patients. The presentation was made at The Marfan Foundation’s 35th Annual Conference in Houston, Texas,  on July 13, 2019

September 18, 2019 No Comments
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