repair of ruptured thoracoabdominal aortic aneurysm with ......fenestrated repair of patients with...
TRANSCRIPT
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Repair of Ruptured Thoracoabdominal Aortic Aneurysm with Physician Modified Endograft
James Middleton Chang, MD
Yazan Duwayri, MD
Georgia Vascular Society, 7th Annual Scientific Sessions
September 7th, 2019 – Greensboro, Georgia
Division of Vascular Surgery
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Disclosures
Division of Vascular Surgery
No financial conflicts of interest
This presentation includes the off-label use of an
FDA approved product
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Presentation
Division of Vascular Surgery
70 Female
Incidentally identified thoracoabdominal aneurysm
up to 6.2cm.
PMH: HTN, HLD, Lumbar spinal stenosis
PSH: Appendectomy, BSO, Csection, right
hemicolectomy
Plan: Preoperative Testing and Open Repair
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Pre-operative Imaging
Division of Vascular Surgery
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Re-Presentation
Division of Vascular Surgery
Prior to repair, patient presented to an outside institution
with abdominal pain.
Hemodynamically stable
CT: contained rupture
Transferred to Emory for further management.
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Re-Presentation
Division of Vascular Surgery
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Re-Presentation
Division of Vascular Surgery
Admitted for repair
Initial management with intensive blood pressure
control
Planned for endovascular repair
Proceeded to OR for physician modified
endograft placement with fenestrations for the
celiac, SMA, and both renal arteries using Cook®
Zenith Alpha™ platform
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Device Modification
Division of Vascular Surgery
Pre-operative CT
examined carefully and
fenestrations planned
Cook Alpha deployed on
back table
Planned fenestrations
created with eye cautery,
reinforced with snare
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Device Modification
Division of Vascular Surgery
Diameter reducing ties
placed with chromic
sutures
Device reconstrained and
placed into 22 French
peel-away sheath
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Operative Details
Division of Vascular Surgery
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Post-operative Course
Division of Vascular Surgery
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Post-operative Course
Division of Vascular Surgery
Did well post-operatively
Started on Plavix
Discharged home on POD#4
Patient continues to do well 8 months post-repair, US
performed at 1 month demonstrating patent stents
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Conclusion
Division of Vascular Surgery
Fenestrated repair of patients with
thoracoabdominal aneurysm rupture provides a
viable alternative to open repair in select patients
Surgeon modified endografts can be used for
certain anatomic and physiologic aortic
pathologies
Limited availability of branched technology
creates a need for creative/advanced endovascular
techniques
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Conclusion