Endovascular repair of a post- type A dissection aneurysm of the aortic arch with the new Nexus Duo aortic endograft
Step-by-step video presenting endovascular repair of an infrarenal abdominal aortic aneurysm (EVAR) with IMA and sac embolization. The sac embolization was performed using dedicated plugs.
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.
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.
Dr. Bisdas (Athens Medical Center) presents during the 12th Athens Crossroad Congress a short overview of current endovascular techniques for acute and chronic deep vein thrombosis.
This is a current review of the literature regarding the endovascular treatment of the CFA disease presented during the AMP meeting in Chicago. Which treatment modality showed better outcomes: POBA, primary stenting, atherectomy, bioresorbable stents or lithoplasty?
This case demonstrates the recanalization of the femoropopliteal artery in a patient with CLTI. The reason for the solely retrograde approach was a Y-graft for AAA having the anastomoses at both common femoral arteries, the above-knee amputation of the contralateral limb and the extent of the disease. Primary stent implantation was performed by using the Pulsar-18 (Biotronik) bare-metal stent, which has a 4Fr profile and a proven efficacy according to the 4EVER trial.
This is an exclusive interview with the first three authors (Dr. Katsanos, Dr. Spiliopoulos, Dr. Kitrou) of the paper entitled ‘Risk of Death Following Application of Paclitaxel-Coated Balloons and Stents in the Femoropopliteal Artery of the Leg: A Systematic Review and Meta-Analysis of Randomized Controlled Trials’ (J Am Heart Assoc. 2018 Dec 18;7(24):e011245). The authors answered relevant questions about the impact of their findings and the future of PTX-eluting devices.
This video summarizes in 3 minutes all important steps to perform an isolated antegrade aortomesenteric bypass. The patient had a chronic occlusion of the superior mesenteric artery and underwent a primary stenting of a high-grade stenosis of the celiac trunk (CT). The endovascular recanalization of the SMA at that time was not feasible. The CT-stent occluded 8 months postimplantation with a complete thrombosis of the hepatic artery as well. The splenic artery arose from the aorta directly.
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?
This is a recorded case about the treatment of a severely calcified chronic total occlusion (CTO) of the SFA in a patient with critical limb ischemia. In this video, you will see all the important steps of such an intervention: 1. puncture 2. cross-over sheath advancement 3. crossing of the lesion 4. vessel preparation 5. paving and cracking and 6. final treatment.
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
This a case of aspiration thrombectomy of an occluded venous stent after treatment of an iliac vein compression due to ovarian cancer. We used the Indigo thrombectomy catheter (Penumbra) to remove the clot and a Veniti stent (Boston Scientific) to optimize the final result. In this video, you will learn important steps of the procedure, tips and tricks for the use of the Indigo system as well as important features of both devices.
This presentation provides a short overview of the most important features and advantages of the hybrid atherectomy, the main indications as well as important technical tips and tricks.
This is a very advanced case of a total endovascular repair of a post-type A dissection aneurysm of the aortic arch with chimney endografts for the brachiocephalic trunk and the LCCA and a periscope in Sandwich technique for the LSA. See the procedure in chapters for the different steps under: https://vascupedia.com/video/total-endovascular-treatment-of-the-aortic-arch-after-type-a-dissection-with-chimney-and-sandwich-technique/
This short tutorial is the first chapter of an online workshop about the principles of EVAR planning. Herein, you will find all important steps for a successful preparation of your EVAR procedure. What about drawing? What should I draw? What are the anatomic issues need to be addressed and considered? and much more information.
This is a short video with two technical tips for the treatment of severely angulated necks with standard EVAR (Endurant, Medtronic) if an open surgical repair is not indicated. The first tip starts with the release of the top cap before the opening of the contralateral gate and the second tip is a solution to pull safely back the top cap if you have a conflict with the suprarenal stent. However, do not forget that this is an outside the IFU implantation of the device.
This is an overview of the literature about the revascularization of the hypogastric artery (HA) in patients with aortoiliac aortic aneurysms. Should we preserve the HA? If yes, how? If not, which is the best method to avoid complications? Which are the current IBD devices?
This case shows step by step the treatment of a severely calcified lesion in the SFA. The video includes the recanalization of the lesion with use of different support catheters and wires, solutions for the subintimal course of the wire, intraoperative AV fistula, vessel preparation and the use of a balloon-expandable stent with a Supera stent for lumen gain.
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.
This presentation provides an overview of the interim analysis of the CRITISCH registry comparing the endovascular therapy and the bypass surgery as first-line treatments in CLI patients. Original publication: Bisdas et al. JACC Cardiovasc Interv. 2016 Dec 26;9(24):2557-2565.
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.
In this case, the patient is a poor candidate for an open surgical endarterectomy of the common femoral artery (CFA) due to a post radiation hostile groin. The lesion was treated by performing a directional atherectomy with antirestenotic therapy. Check all the steps of the procedure and important technical tips for this challenging lesion.
This case presents a step by step endovascular repair of an aortic arch aneurysm with a branched endograft (COOK Medical)
Herein, we present the follow-up examination and reinterventions after treatment of the popliteal artery with a bare-metal stent. It is interesting, the decision making and the durability of the different procedures until the final treatment with a vein surgical bypass. A very interesting case, which could raise a discussion about the current first-line treatment strategies in patients with popliteal lesions as well as in-stent stenosis.
In this case report, we present the endovascular treatment of a malperfusion syndrome of the left limb as a consequence of an acute type B dissection. Additionally, to the technical details regarding the procedure, we also demonstrate our strategy regarding the assessment of the CT-angiography for the planning of the procedure.
Overview of current techniques and evidence regarding the treatment of severely calcified lesions in the SFA. In this presentation, an algorithm for those challenging lesion is presented.
Treatment of a challenging case of acute limb ischemia (external iliac, common femoral and popliteal artery) with the Indigo thrombectomy system – Step by step procedure and description of decision making for this case
41 years old female patient presenting with swelling of both limbs, diffuse aching, heaviness and tiring of both extremities since 5 years from a previous deep vein thrombosis on both limbs. At the time of presentation, the patient showed severe dermatoliposclerosis on the right extremity and ulceration at the level of the left internal malleolus. The patient had no other risk factors except Factor V Leiden mutation.
Age: 72 years old
Comorbidity: Arterial hypertension, hypercholesterinemia, previous smoker
Previous operations: None
Vascular Imaging of the left internal carotid artery: Duplex ultrasound with peak systolic velocity (PSV)> 230 cm/sec
Age: 79 years old
Comorbidity: Arterial hypertension, hypercholesterinemia, chronic kidney disease (GFR: 53 ml/min/1,73m²), NYHA II, Coronary artery disease, previous CABG
Symptoms: Toe ulceration of the left limb
Previous operations: None
ABI: incompressible, Toe pressure: 32 mmHg
Vascular Imaging – Duplex ultrasound: Isolated tibial vessel disease
45 years old female patient presenting with painful swelling of the right limb during the last 24 hours. Wells score on admission was 4 points. The duplex ultrasound scanning revealed a femoropopliteal and iliac deep vein thrombosis. No other risk factors were present. No previous operations. No thrombophilia documented.
A 79-year-old diabetic male patient with no history of coronary disease is referred to you to undergo angioplasty for tissue loss on the tips of the hallux and second toe. He is taking Aspirin 75mg. From preoperative imaging he needs a 20cm SFA occlusion stopping before the adductor hiatus recanalizing as well as multilevel tibial disease which appears to be a combination of short occlusions and stenoses. The dorsal pedal is seen in the foot and is in continuity with the arch. The PT artery appears occluded through it’s whole length.
Age: 73 years old
Comorbidity: Arterial hypertension, hypercholesterinemia, coronary artery disease, previous CABG
Symptoms: Claudication, Rutherford stage 3
Previous operations: None
Age: 65 years old
Comorbidity: Arterial hypertension, Dyslipidemia
Symptoms: Acute onset of claudication (<2 weeks), Rutherford class 3 of the left limb
Previous operations: None
DUS: Occlusion of the left popliteal artery
Age: 69 years old
Comorbidity: Arterial hypertension, Dyslipidemia, coronary heart disease (DES deployment 2 years ago)
Symptoms: Postprandial pain
Previous abdominal operations: None
DUS: Occlusion of the superior mesenteric artery
Age: 75 years old
Comorbidity: End-Stage Renal Disease, Diabetes, Arterial hypertension, Dyslipidemia, on hemodialysis in the last 5 years
Symptoms: Acute occlusion of a surgically created left-sided brachial cephalic AV fistula
Age: 75 years old
Comorbidity: Arterial hypertension, hypercholesterinemia, previous aortocoronary bypass grafting, previous myocardial infarction, previous smoker, peripheral arterial disease, atrial fibrillation
Previous operations: None
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