Vascupedia

  • Function: Fellow
  • Speciality: Other

Activities

Webinar

Advanced Atherectomy Techniques for Challenging Lesions in the Leg

Agenda
❶ Lesion Preparation – Why and When
❷ Phoenix Atherectomy in Calcified Common Femoral Artery
❸ Atherectomy of SFA / Popliteal Lesions
❹ Below The Knee Atherectomy
❺ Recanalization of In Stent Occlusions (Phoenix)
❻ LASER Atherectomy in In Stent Restenosis

September 23, 2021 No Comments
Show presentation
Vascupedia VIEWS

Vascupedia VIEWS: Is SELUTION SLR Your Solution in PAD?

Recorded webinar:

Presentation 1: Sustained Limus Release in a nutshell – the tale of SELUTION SLR

Presentation 2: Treatment Options for Long-Term Vessel Patency

 

September 17, 2021 No Comments
Show presentation
Webinar

Pushing the boundaries of minimally invasive procedures in Hybrid Rooms

Recorded webinar

Discover the educational live webinar organized by GE Healthcare with 3 presentations:

  • F BEVAR case in Professor Haulon’s Hybrid OR
  • Carotid stenting procedure in Professor Giovanni Pratesi`s Hybrid OR
  • Key procedures performed in Ass. Professor Bisdas Hybrid OR in less than one year.

 

September 13, 2021 No Comments
Show presentation
Webinar

CLI Management: Bereits klinische Realität?

Moderator: Dr. Lichtenberg Speaker: Dr. Stavroulakis, Dr. Behrendt, Dr. Langhoff

Agenda:
1. Spot-Vortrag “Time for Best Practice” | Dr. Stavroulakis
2. Spot-Vortrag “Time is tissue” | Dr. Behrendt
3. Spot-Vortrag ” Face reality!” (recorded case)| Dr. Langhoff
4. Paneldiskussion

September 6, 2021 No Comments
Show presentation
Webinar

The Nexus aortic arch stent graft system: all you need to know before your first implantation

Recorded webinar 22/7/2

Moderator: Theodosios Bisdas | Athens Medical Center | Greece

Speaker: Michele Antonello | University of Padua, | Italy

Mario Lescan | University Clinic of Tuebingen | Germany

 

July 27, 2021 No Comments
Show presentation
Webinar

Vascupedia Live Webinar: Extreme BTK Interventions

Agenda
❶ Welcome and introduction  – Michael Lichtenberg
❷ Extreme Wiring Techniques  – Lorenzo Patrone
❸ Extreme BTK Atherectomy with Phoenix – Arun Kumarasamy
❹ External Ultrasound Guided Techniques for CLTI  – Fadi Saab
❺ Pedal Acceleration Time (PAT): A Novel Predictor of Limb Salvage – Jill Sommerset
❻ Optimising BTK Angioplasty with TACK Endovascular System – Michael Lichtenberg

June 28, 2021 No Comments
Show presentation
Webinar

Meet the experts for the treatment of Aortoiliac Occlusive Disease: The CERAB technique from A to Z – part 2

The CERAB technique from A to Z – part 1

Hosted by Dr. Peter Goverde, Antwerp – Belgium

Agenda:

CERAB – How it is done

 Dr. Barend Mees, Maastricht – The Netherlands

My CERAB cases and clinical results

Dr. Maria Antonella Ruffino, Turin – Italy

 

 

 

June 23, 2021 No Comments
Show presentation
Webinar

Meet the experts for the treatment of Aortoiliac Occlusive Disease: The CERAB technique from A to Z – part 1

The CERAB technique from A to Z – part 1

Hosted by Dr. Peter Goverde, Antwerp – Belgium

Agenda:

CERAB – The basics

Dr. Çağdaş Ünlü, Alkmaar – The Netherlands

CERAB – Tips & Tricks

Dr. Michel Bosiers, Münster – Germany

 

June 21, 2021 No Comments
Show presentation
Comment on May 30, 2021

Theodosios Bisdas replied to your comment on presentation Vascupedia Webinar: Why E-nside StentGraft has become my first choice in the endovascular treatment of TAA.

»Thank you Markus! 1. We have not seen it yet and I do not think that this can happen. The device is completely released and fixed to the wall before the use of the through-n-through wire 2. Theoretically yes. I have personally done it but this is not recommended by the manufacturer. 3. So far I know, this is not described in the IFU as a clear number. I will ask for a recommendation the manufacturer and I will let you know.«
Comment on May 29, 2021

Markus Köster commented on presentation Vascupedia Webinar: Why E-nside StentGraft has become my first choice in the endovascular treatment of TAA.

»Great presentation! I would like to know from your experience: 1. Retrograde cannulation: did you experienced any dislocation of the Enside-graft, due to traction of the through-and-through-wire? 2. Is it possible to remove the T-a-T-wire after deployment of the bridging stent, in order to keep the stabil position of the steerable sheet for e.g. additional lining-stent? 3. Which angle in the visceral segment is possible with this graft?«
Webinar

Vascupedia Webinar: Why E-nside StentGraft has become my first choice in the endovascular treatment of TAA

Agenda

The Enside stent-graft: design and technical considerations – T. Bisdas

My experience with the Enside stent-graft | Live in the box – G. Simonte & G. Isernia

My experience with the Enside stent-graft | Live in the box  – A. Zimmermann

 

May 26, 2021 2 Comments
Show presentation
Webinar

Bildgebung in der pAVK: Mehr als nur eine Angiographie – Vascupedia Webinar 12/4/21 (German language)

Referenten: T. Bisdas, M. Lichtenberg, M. Katoh

  • Warum brauchen wir zusätzliche Bildgebung in der modernen Behandlung der pAVK Patienten?
  • 🎥 Case in the box I – pAVK + IVUS
  • Bildgebende Optionen zur Gefäßanalyse und Perfusionsbeurteilung
  • 🎥 Case in the box II – pAVK – smart perfusion

 

 

April 14, 2021 No Comments
Show presentation
Webinar

Recorded webinar: A new percutaneous approach for low-profile EVAR

Speaker: Prof. G. Torsello & Dr. A. Schwindt

Topics:

  • Explore how there are no tradeoffs while using the low-profile INCRAFT™ AAA Stent Graft System and should be considered as your workhorse device.
  • The PerQseal® fully absorbable closure device offers a safe and intuitive solution to the challenge of large arteriotomy percutaneous closure
March 8, 2021 No Comments
Show presentation
Technical note

CLINICAL DECISION MAKING IN AV FISTULA MAINTENANCE: STEP BY STEP SALVAGE PROCEDURE

Learn how to approach a procedure of AV Fistula complex restenosis step-by-step through taped case demonstrations featuring vessel prep with HP Balloons followed by DCB. Recorded webinar by Vascupedia.

November 18, 2019 1 Comment
Show presentation
Basic vascular surgery skills

Knee Disarticulation (Major Amputation)

Unfortunately, sometimes happens that we can not save a leg with our interventions. Here only the amputation remains. In this short film from the series “Basic vascular surgery skills” – you can follow the individual steps for disarticulation in the knee joint as a major amputation of the lower leg.

November 8, 2019 No Comments
Show presentation
Awareness

Aortic dissection – VRTD Aortic Disease Awareness Day

Aortic dissection – Vascupedia Virtual Round Table 2019 09 19

Type B aortic dissection Current guidelines, G. Torsello –
Endovascular treatment options of type B aortic dissection, K. Stavroulakis –
Open surgery for type A aortic dissection, M. Pichlmaier –
Endovascular treatment options for type A & residual type A aortic dissection, N. Tsilimparis

September 24, 2019 No Comments
Show presentation
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
Show presentation
Technical note

Vascular Ehlers-Danlos Syndrome

Vascular Ehlers-Danlos syndrome (vEDS) is a condition that is quite variable. People are often diagnosed when they have easy and frequent bruising that is not explained by other causes, a spontaneous bowel, or arterial tears, or because other family members are affected. Some people have characteristic facial features, thin skin, and tissue fragility, while in others the diagnosis is only made after the identification of an alteration in the type III collagen gene, COL3A1. Many people have a difficult time getting diagnosed and getting appropriate management. Dr. Peter Byers,  Professor of Pathology and Medicine, UW Medical Center and a member of The Marfan Foundation’s Professional Advisory Board, who is one of the leading experts on vEDS, provided an overview at The Marfan Foundation’s 35th Annual Conference in Houston, TX, July 13, 2019.

September 18, 2019 No Comments
Show presentation
Review of the literature

VRTD: The use of PTX coated devices in everyday clinical practice following the late mortality signal

Vascupedia Round Table broadcasted on September 2nd through the Vascupedia Live App about the use of PTX coated devices in everyday clinical practice following the late mortality signal

September 6, 2019 No Comments
Show presentation
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
Show presentation
Recorded video case

Right visceral rotation

Dr. Alan B Lumsden (Houston Methodist, DeBakey Heart and Vascular Center) presents in a unique video step by step how to perform a right visceral rotation for the removal of an IVC filter penetrating the aorta and creating aortic dissection.

May 6, 2019 No Comments
Show presentation
Recorded video case

Left visceral rotation

Dr. Alan B Lumsden (Houston Methodist, DeBakey Heart and Vascular Center) presents step by step how to perform a left visceral rotation for the treatment of aortic diseases

May 6, 2019 No Comments
Show presentation
Comment on Apr 03, 2019

Martin Schroeder replied to your comment on presentation AV Fistula – Basic vascular surgery skills.

»Thank you for your question, but the answer to this is : no, neither. We don´t saw any problems after the anastomosis suture and in the intraoperative flow measurement with good results at the follow up. But the vein material is very elastic , so im totaly agree that you can give the vene more length if you would. Best regards Martin«
Basic vascular surgery skills

Aortic aneurysm repair

This is a step by step video of the open surgical of an abdominal aortic aneurysm with a tube Dacron graft through a median laparotomy. In this video, you will learn the surgical exposure of the aneurysm, the clamping and opening of the aneurysm sac, how to deal with the lumbar arteries, the proximal and distal anastomosis and how to close the abdomen by the right way.

April 2, 2019 2 Comments
Show presentation
Basic vascular surgery skills

AV Fistula – Basic vascular surgery skills

In this video you will learn to create an AV fistula in the area of the elbow:
from skin incision to vessel preparation, anastomosis and wound closure.

March 24, 2019 4 Comments
Show presentation
Comment on Aug 08, 2018

Michel Bosiers commented on presentation Treatment of a juxtarenal aneurysm with heavily calcified iliac arteries using a fenestrated endograft.

»Thanks Kostas, to give you a simple answer: because FEVAR was feasible. This patient would have required at least a double chimney, because the renal artery orifices are on the same level. As you can see on the image of the SMA, there is also some plaque/thrombus burden on the aortic wall, so an adequate treatment would not be possible without using a triple chimney. From the data published we know that the outcome of triple chimneys is not so good.«
Comment on Aug 01, 2018

Fernando Gallardo replied to your comment on presentation How to deal with a limb occlusion after EVAR?.

»Hi Philipe, Thanks for your comments and questions. Yes, I have realized that is when you are performing high volumen of aortic procedures when problems appear, and the importance of review carefully the planning, not just saying "it was just a limb occlusion due to bad stentgrafts limbs" as I have heard many many times...and it is also our responsibility remain educational and share with other colleagues our experience and failures. 1. Yes, at this case we observed the immediate occlusion of the limb, with a pigtail we delivered a bolus of 300000 UI urokinase inside the aorta and the beginning of the occluded limb, and it worked. No distal embolization was observed, as probably it was a very recent thrombus it was totally disolved. Anyway we assumed this risk. 2. About ACT measurements, I have to be honest with you and our colleagues, I don't use it for standard infrarenal EVAR, usually less 90 mins procedures, I use a 5000 UI doses after proglide deployment (pre-closure), (about 60UI/kg). And sometimes 20 UI Protamine when closing access. For complex EVAR/ FEVAR, we measure ACT with a target pick value <250 sc. 3. Yes It could happen, thrombosis due to heparin-resistance, but in my humble experience there is usually a mechanical cause during the deployment or a failure in the planning or graft selection that could explain the limb occlusion. HIT is quite unfrequent, about 0.3%, in this publication (J Cardiothorac Vasc Anesth. 2017 Oct;31(5):1751-1757. Incidence and Outcomes of Heparin-Induced Thrombocytopenia in Patients Undergoing Vascular Surgery. Chaudhry R1 et all), but at other reports (1-5%). Best regards, Fernando«
Comment on Jul 28, 2018

commented on presentation How to deal with a limb occlusion after EVAR?.

»Hi Fernando, thank you very much for this nice presentation. Often people publish success stories, but rather rarely problems they have to manage. This is very much appreciated as it gives direct impact into learning how to get out of trouble in different situations. It also demonstrates how important is the initial planning process and the choice of stentgrafts. In one case you mentioned thrombolysis, intra-aortic, with a PigTail catheter. Did this work? No distal embolisation? Also how do you manage intraoperative ACT measurement? What is your target ACT? Do you think some occlusions may occur in the context of Heparin-resistance or even HIT? (I had 2 in the past 2 1/2 years over a volume of 170) Very Best, P«
Comment on Jul 19, 2018

Theodosios Bisdas replied to your comment on presentation Principles of EVAR planning and sizing – Chapter 2: Sizing & Oversizing.

»Dear Dr. Rashaideh, thank you for the kind words. There is no specific way to measure the real deployment neck diameter in the case of angulation. Thus, the angulated necks are challenging and the poor outcomes of the literature in such necks can be correlated, in my opinion, to wrong oversizing. In the majority of the cases, the markers will stay at the level of the deployment on the side of the attachment of Lunderquist on the aortic wall. If the endograft is undersized, the proximal markers on the other side will be placed underneath of this level and if the endograft is oversized will stay at that level. It makes also no difference if the wire is from the right side or the left side because this is not something that you can influence. It has to do with the angulation of the neck (right- or left-sided). In any case, I will suggest going for at least 30% oversizing in angulated necks. If the 30% oversizing indicates an endograft with a diameter between the pre-specified diameters (28, 32, 36) of the available endografts (e.g. 33 mm), select then the endograft with the bigger diameter (36 mm).«
Comment on Jul 17, 2018

mohammed rashaideh commented on presentation Principles of EVAR planning and sizing – Chapter 2: Sizing & Oversizing.

»very nice teaching presentation . is there a specific way to measure the real deployment neck diameter in case of angulation .. i mean how to predict where and how the graft will deploy depending on the stiff wire . and will it make a difference if the wire is from the right or left side? thanks a lot am very impressed on how you present the data in very interesting way.«
Comment on Jul 05, 2018

Konstantinos Donas replied to your comment on presentation Gutters after Chimney EVAR: How „PERICLES and PROTAGORAS“ can protect ACHILLES heel?.

»Thank you Michel for your comment. The current body of evidence suggests indeed the use of chimney grafts in juxtarenal pathologies with involvement of one or max. 2 target vessels. Triple chimneys can have several risks and not only more type IA endoleaks. As we published together, use of bilateral access is associated with significant risk of cardiac and cerebrovascular events for those patients. Additionally, we have a risk of persistent type IA endoleak due to the risk of inadequate oversizing to wrap up around the chimney grafts. This possibility was obvious in the new Classification of gutter-related endoleaks based on the causative mechanisms, published last year in J. Endovascular Therapy. In summary, triple chimneys should be considered only in case of anatomical or clinical contraindications for f-EVAR. I hope that soon we will be able to evaluate this cohort of patients from the PERICLES group and provide more scientific impetus for this indication.«
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.

July 2, 2018 No Comments
Show presentation
Comment on Jun 15, 2018

Theodosios Bisdas replied to your comment on presentation Total endovascular treatment of the aortic arch after type A dissection with chimney and sandwich technique.

»Hi Michel! Thank you for your question. Regarding your first question. I did not use for example the Endurant limb because of the length (82mm) and the difference of the materials compared to the cTAG (Dacron vs PTFE). I think the gutter could be an issue. The IIA-branch of the IBD device is tapered (16 to 12mm) and shorter (70mm). Regarding your second question, the downwards orientated branch for the LSA allows access for a branched endograft and principally for a transbrachial approach.«
Comment on Jun 15, 2018

Theodosios Bisdas replied to your comment on presentation Total endovascular treatment of the aortic arch after type A dissection with chimney and sandwich technique.

»Thank you, Martin! Well, we are far away from a well-established protocol for CSI protection. Especially, in that case, you have to be very quick after deploying the thoracic endograft over the aortic arch. There are some new filters for the brachiocephalic trunk and the LCCA but these are applicable only in TEVAR cases. When you have to get access for the supraaortic vessels you have no option to protect the brain. My measures are: 1. Remove very carefully the air from the devices 2. Check multiple times your angiographic catheters to avoid air embolisation 3. Avoid a lot of manipulations with your thoracic endograft 4. Introduce the large-bore sheaths (12F), when you really need them and not from the beginning of the procedure 5. Check the quality of your arch at the angio-CT before planning your procedure.«
Comment on Jun 15, 2018

MARTIN MARESCH commented on presentation Total endovascular treatment of the aortic arch after type A dissection with chimney and sandwich technique.

»Amazing case Theo! Great tutorial from many points of view. Great discussion. Meticulous planning is the key to success in these cases! That's why they didn't use C-S bypass, Michael even so it would make sense, but this would have closed the door for further interventions distally if needed. Theo, can you comment on your CSI protective measures in complex TEVAR cases and what's the incidence of stroke and how to minimize it? Thanks«
Comment on Jun 12, 2018

Hirofumi Ohtani replied to your comment on presentation Fully Percutaneous Transaxillary Transcatheter Aortic Valve Implantation in patients with a patent left internal mammary graft.

»Thank you for the questions. 1) selfexpandable stents as viaban or fluency are definitely preferable. At the moment of the interventions we did not have the correct size. Corrective action: Now we have them on the shelf!!! 2) to puncture under eco and fluoro+contrast guidance in the more distal portion of the axillary artery. Also, theoretically, the proglide pre-closure is little traumatic to the vessel.«
Comment on Jun 11, 2018

Konstantinos Stavroulakis commented on presentation Fully Percutaneous Transaxillary Transcatheter Aortic Valve Implantation in patients with a patent left internal mammary graft.

»Excellent presentation of a challenging case. I have only 2 questions: 1) Do you have any concerns regarding the deployment of a balloon expandable covered stent in an area exposed to high mechanical stress? 2) Median nerve injury can be a major complication of a percutaneous transaxillary access. Which is your strategy/approach in order to avoid it?«
Comment on Jun 11, 2018

Özgün Sensebat commented on presentation Fully Percutaneous Transaxillary Transcatheter Aortic Valve Implantation in patients with a patent left internal mammary graft.

»Thank you Hirofumi Ohtani for your tremendous presentation. I totally agree with the potential for a valuable arterial access. Your experience is also important for CMD-BEVAR or T-branch Devices. One question: would it be possible to use Prostar XL instead of ProGlide if the vessel diameter is big enough? Regards«
Comment on Jun 11, 2018

Özgün Sensebat replied to your comment on presentation Total endovascular treatment of the aortic arch after type A dissection with chimney and sandwich technique.

»Thank you for your answer Theo! My question was not precise, sorry. It is obvious, that you've done a great case with this chimney/periscope exclusion and not with a CMD. I am sure the planning was complex. My question is your general opinion about CM-branched-devices for the arch if indicated. You answered my question why it was not possible in this particular case. Maybe it is possible in the future to see a CMD-case for the arch at Vascupedia. Your opinion about the indication and characteristics would be valuable for the vascular public. Again, great job!«
Comment on Jun 11, 2018

Theodosios Bisdas replied to your comment on presentation Total endovascular treatment of the aortic arch after type A dissection with chimney and sandwich technique.

»Thank you Arne for your questions. 1. We decided against a 3 chimney for 2 reasons: (a) to avoid a bigger gutter and (b) to have the option for an antegrade (transbrachial) access to the descending aorta (e.g. further endovascular repair with fenestrated or branched endograft) 2. See my comment to Dr. Sensebat 3. The patient will receive dual antiplatelet treatment for 3 months and afterwards only ASA. However, I cannot support this with any kind of evidence. The advantage is that we have large bridging stent-grafts (12 mm for the brachiocephalic trunk and 10mm for LCCA and LSA).«
Comment on Jun 11, 2018

Theodosios Bisdas replied to your comment on presentation Total endovascular treatment of the aortic arch after type A dissection with chimney and sandwich technique.

»Thank you Özgün for your question. This was not a custom-made device, but an off-the-shelf treatment with chimney and sandwich technique. A custom-made device was not indicated in that case due to the short length of the replaced ascending aorta. There are strict inclusion and exclusion criteria for those cases. We decided to go forward with an endovascular approach due to the comorbidity of the patient and the redo operation.«
Comment on Jun 09, 2018

Özgün Sensebat replied to your comment on presentation Diagnostic algorithms for endoleaks.

»Prof. Verzini, Thank you for your answer. I hope that MR scans will get more and more important in the future, parallel to the regular use of non-steal grafts. Personally, I am a bit concerned about the radiogenic consequences for a patient younger than 70 y/o, who passed an EVAR procedure. Not because of the EVAR, more because of the follow-up by regular CT scans. I think the MR based follow-up will reduce this risk dramatically. Again, thank you for your answer. I hope we will join more vascular knowledge from Perugia at Vascupedia.«
Comment on Jun 09, 2018

Fabio Verzini replied to your comment on presentation Diagnostic algorithms for endoleaks.

»Dear friend Thanks for your comments. I agree with you, MR scannings of stainless steel endografts suffer from artifacts that usually render the exams unreliable. I think MR will not gain widespread use in the next future. Pts. with stainless steel endografts will decrease in the future anyway, since nowdays the vast majority of the grafts are in nitinol or cobalt-chrome.«
Comment on Jun 09, 2018

Özgün Sensebat commented on presentation Diagnostic algorithms for endoleaks.

»Dear Fabio Verzini, Thank you very much for this tremendous presentation. It is a valuable navigation-tool for everybody who treats endoleaks. One question. Which role the MR diagnosis will become for the detection and interpretation of endoleaks after implantation of stainless grafts? Do you think this technique will overtake the CT scan? Warm regards«
Comment on Jun 05, 2018

Fernando Gallardo commented on presentation Two technical tips for severely angulated infrarenal necks during EVAR.

»Thanks for sharing your tricks. For this maniouver I have used as Pr Efstratios comments a Relliant Ballon partially inflated to straight the neck is much us possible, but also using the contralateral limb sistems works, and probably a long big sheat or anything that could make righter the neck could works... Anyway for more 70 angulation we should be careful, my option now for this neck is more Aorfix or even Gore with Aptus, more comfortable grafts. The battle stentgrafts VS hostile anatomy will be always won by the anatomy at mid-long term!! Also consider that Endurant suprarrenal stent is totally straight, difference with COOK suprarrenal stent, and in cases with severe angulations I have seen total apposition of the suprarrenal stent one half side and the half of the suprarrenal stent free in the aorta without wall contact... Best regards Fernando«
Comment on Jun 03, 2018

Theodosios Bisdas replied to your comment on presentation Two technical tips for severely angulated infrarenal necks during EVAR.

»Exactly Stratos! You could not describe it by a better way. The risk of angulated necks is the poor apposition of the proximal stents on the wall. This is a good solution. Your suggestion is also good and works fine. I have tried it in the past. The only advantage of my tip is that you win some time because you do not need to remove the sheath of the contralateral extension. After implanting the ETLW you do not remove it but you further open the main body. Then, you connect the top cap and you advance the sheath of contralateral extension at the height of the top cap. In any case, both work fine.«
Comment on Jun 03, 2018

Efstratios Georgakarakos commented on presentation Two technical tips for severely angulated infrarenal necks during EVAR.

»Nice information and demonstration. If i get it right, the philoshophy of the “pushing-up”maneuver of the mainbody after the top-cap release (and before the contralateral limb release) is to shrink the fabric between the 1st and 2nd covered stent, thereby reducing the distance between these covered stents and aproximating them in order to achieve the optimal position of these within the infrarenal neck length; therefore, you should start pushing-up the whole device just after the deployment of the 1st stent-top cap release and before the deployment of the 2nd covered stent, so that the latter could actually be positioned as close as it gets to the 1st one, leaving perhaps extra place for the third stent etc., isn’t it? Regarding the 2nd excellent tip of yours i.e., engagement of cap with suprarenal stent, an alternative maneuver would be to inflate a Relay molding balloon mildly leaving a pathway through which the top cap could withdraw safely without the aforementioned problem.«
Comment on Jun 03, 2018

Theodosios Bisdas commented on presentation Two technical tips for severely angulated infrarenal necks during EVAR.

»Thank you, Philippe, for your comment. Of course, you need experience with this maneuver. The trick here is to 'cram' the prosthesis into the angulated neck. I have not seen an upward migration yet, but there is sure a risk for this. Thus, you have to do smooth movements and to use some landmarks of the vertebral bodies for your renal arteries. An important issue is also the oversizing in those cases: we recommend at least 30%.«
Comment on Jun 03, 2018

commented on presentation Two technical tips for severely angulated infrarenal necks during EVAR.

»Hi Theo, very nice case! By what means you judge the pushing-up manoueuvre of the main body once the struts are opened? I'm sure in your hands this reflects experience, but is it not a quite risky step for some less experienced operators? I like a lot the move with the contralateral limb, never thought about this! Very smart indeed!!! Best, P«
Comment on Jun 03, 2018

commented on presentation Percutaneous thrombectomy of bridging stent-grafts after chEVAR.

»Hi Theo, sorry I answered initially to the post of Arne on LinkedIn.. Very interesting to know that relining an Advanta is rather not so Good. The video is very helpful to learn how to do it!!! Thank you very much! Points taken! Best from Baden, Phil«
Comment on Jun 02, 2018

Theodosios Bisdas replied to your comment on presentation Percutaneous thrombectomy of bridging stent-grafts after chEVAR.

»Hi Philippe! You mean probably Theo! :-) We have seen several occlusions with the bridging stent-grafts after both chimney and branched endografting and the majority of them were observed at the renal arteries. The incidence is lower with fenestrated endografts. The oversizing was 1 mm as usually. We think that the problem was the relining with the bare-metal stent. In the video (7:31), after the Indigo thrombectomy, someone has the feeling that the distal end of the bare metal stent has almost perforated the native vessel wall. We have studied this issue in a previous paper (Panuccio et al. Eur J Vasc Endovasc Surg. 2015 Jul;50(1):60-70) and we found that relining of the Advanta with a self-expanded bare-metal stent was a risk factor for occlusion in the renal arteries after brEVAR.«