complicated type b dissection. case management€¦ · 2014 esc guidelines on the diagnosis and...
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Complicated type B dissection. Case management
Jorge Chavarría. M.D
Vascular Surgery
Hospital México, Costa Rica
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Disclosure
Speaker name: Jorge Chavarría M.D
.................................................................................
I have the following potential conflicts of interest to report:
Consulting
Employment in industry
Stockholder of a healthcare company
Owner of a healthcare company
Other(s)
X I do not have any potential conflict of interest
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Case
• 59 year old male.
• Long time HTA.
• JULY 2013
• Chest pain.
• MARCH 2015
• Chest pain
• Postprandial abdominal Pain
• Left leg no pulse and Ischemic pain
• ABI: Right 0.9 Left 0.3
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TL
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DeBakey 3b with malperfusion Sd.
Marvin D. Atkins Jr, MD. Aortic dissection: Perspectives in the era of stent-graft repair . Journal of Vascular
Surgery, Vol. 43, Issue 2, A30–A43 February 2006.
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OPEN SURGERY?
ENDOVASCULAR?
HYBRID?
BEST OPTION???
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LANDING ZONE??
2014 ESC Guidelines on the diagnosis and treatment of aortic diseases European Heart
Journal (2014) 35, 2873–2926
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Marvin D. Atkins Jr. Aortic dissection: Perspectives in the era of
stent-graft repair . 2006 by The Society for Vascular Surgery
MALPERFUSION SYNDROME
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2 Times Surgery
FirstCarotid-carotid and
subclavian bypass.
SecondTEVAR + EVAR + FEM-FEM
BYPASS.
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F
F
T
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RESULTS
1) No neurological events
2) Early extubation.
3) 2 Days in ICU
4) ABI post procedure
1) Right 1
2) Left 0.9
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2015
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2017
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2015 2017
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HOSPITAL MEXICO
# PTES TEVAR HYBRID DEBRANCHING
+ TEVAR
TECHNICAL SUCCESS
MORTALITY (LESS 30 DAYS)
20 5 15 95% 1
HOSPITAL MEXICO
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SUMMARY
“IN OUR EXPERIENCE, LONG LANDING ZONES,WITH HYBRID (DEBRANCHING) PROCEDURES,HAVE THE BEST RESULTS IN MANAGEMENT OFCOMPLICATED AND NO COMPLICATED TYPE BDISSECTIONS”
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Complicated type B dissection. Case management
Jorge Chavarría. M.D
Vascular Surgery
Hospital México, Costa Rica