tips & tricks with taaa ots branched...
TRANSCRIPT
![Page 1: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/1.jpg)
Gustavo S. Oderich MDProfessor of SurgeryDirector of Vascular Training Programs
Director of Endovascular Therapy
Division of Vascular and Endovascular Surgery
TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFT
CO N T RO VE RS I E S & U P DATE S I NV A S C U L A R S U R G E R Y
![Page 2: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/2.jpg)
FACULTY DISCLOSURES
• Consulting*Cook Medical Inc., WL Gore, Bolton Medical, GE, Syncthax
• Research grants* Cook Medical Inc., WL Gore, GE Healthcare
• Investigational, off-label use of devicesCook Fenestrated and Branched Grafts, Gore Branched Technology
* All consulting fees and research educations grants paid to Mayo Clinic
![Page 3: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/3.jpg)
OTS BRANCH CONCEPT
2001
In Oderich Atlas of Fenestrated, Branched and Parallel Techniques, Springer 2016
2007- Present
Tim Chuter (UCSF)
• Brachial access• Down-going branches• First prototypes
Cook manufactureddevices
Anatomical studies
t-Branch
![Page 4: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/4.jpg)
COOK t-BRANCH®34mm
20
2m
m
Celiac Br8mm1:00” 99mm
SMA Br8mm12:00” 117mm
Renal Br6mm10:00” 3:00” 135mm18mm
• Off-the-shelf
• 4 branches
• Luminal diameter >25mm
• Suitable targetsRenal (4-8mm)Mesenteric (6-11)
![Page 5: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/5.jpg)
CASE SELECTION
• Good access (22Fr)• Large aortic diameter
(>30mm)• Down-going oriented
vessels• 4 renal-mesenteric
targets with diameter 4-11mm
![Page 6: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/6.jpg)
‘Shaggy’ Aorta
Excessive angulation
Multiple, small renal arteries
CASES TO AVOID
![Page 7: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/7.jpg)
![Page 8: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/8.jpg)
![Page 9: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/9.jpg)
SMA Branch
SMA Sheath
![Page 10: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/10.jpg)
![Page 11: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/11.jpg)
![Page 12: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/12.jpg)
![Page 13: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/13.jpg)
![Page 14: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/14.jpg)
![Page 15: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/15.jpg)
81-F with expanding, symptomatic Extent III TAAANovember 2, 1016
![Page 16: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/16.jpg)
HIGH-DEFINITION CONE BEAM CT
* GE Discovery 740 (7 sec Spin)
![Page 17: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/17.jpg)
STAGGERED DEPLOYMENT
CELIAC0.014”
SMA0.018”
RRA0.035” Rosen
LRA0.035” Rosen
![Page 18: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/18.jpg)
![Page 19: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/19.jpg)
![Page 20: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/20.jpg)
CA
SMA
RRALRA
IVD:37mm
IVD:47mm
84 y/o men with rapidly enlarging 6.4-cm TAAA and new type Ia endoleak
![Page 21: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/21.jpg)
Palmaz Stent
RRA Stent
7Fr Sheath
RRA cuff
![Page 22: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/22.jpg)
Pre-dilatation
RRA BranchViabahn+iCAST+SES
LRA BranchViabahn+SES
![Page 23: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/23.jpg)
SMA BranchFluency+SES
CA BranchFluency+SES
![Page 24: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/24.jpg)
![Page 25: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/25.jpg)
TAMBE OTS BRANCH SUITABILITYAnalysis of 520 patients
Mendes et al. J Vasc Surg 2014
![Page 26: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/26.jpg)
31-37mm
20mm
170mm
GORE TAMBE® DESIGN
• Off-the-shelf
• 4 branches
• Pre-loaded wires
• VBX® stent
![Page 27: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/27.jpg)
Pre-loaded wires & controlled proximal deployment
![Page 28: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/28.jpg)
Sequential vessel catheterization using pre-loaded wires
![Page 29: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/29.jpg)
Sequential VBX stenting
![Page 30: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/30.jpg)
![Page 31: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/31.jpg)
TAMBE® ANTEGRADEFirst In-Man Implant TeamMarch 8th, 2016
![Page 32: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/32.jpg)
TAMBE EARLY FEASIBILITY TRIALMayo ClinicG Oderich
UNCM Farber
DartmouthM Fillinger
U PittsburghM Makahroun
Site Principal Investigator Patients
Mayo Clinic Gustavo Oderich MD 5
UNC Mark Farber MD 3
U Florianopolis Pierre Silveira MD 3
U Pittsburgh Michel Makaroun MD 1
Mount Sinai Michael Marin 1
Dartmouth Mark Fillinger MD 0
Mount SinaiM Marin
• 13 patients enrolled• 5 US and 1 non-US center
![Page 33: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/33.jpg)
EARLY RESULTS
• No 30-day or in-hospital mortality• 51/52 target vessels stented (98%)• 1 early Type Ic endoleak (Renal stent seal)• No stroke, spinal cord injury or dialysis
• 3-month follow up completed in all patients• No Type I or III endoleaks• No target vessel occlusions• 2 of 25 renal arteries required redo stenting for
restenosis
![Page 34: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/34.jpg)
CONCLUSIONS
• Strengths are branch specific bridging stents, use of pre-loaded wires, repositionable stents and conformable technology
• OTS TAAA devices offer the advantages of immediate availability, versatility and standardized design and approach
• Techniques are safe, effective, and have the potential to significantly reduce morbidity and mortality compared to conventional open surgical repair
• Branch vessel outcomes need to be compared to patient-specific designs
• Important considerations are learning curve, need for optimal imaging and familiarity with advanced endovascular techniques
![Page 35: TIPS & TRICKS WITH TAAA OTS BRANCHED GRAFTcacvsarchives.org/archivesite/2017/pdf/presentations-2017/01-thursday19/1830...COOK t-BRANCH® 34mm m Celiac Br 8mm 1:00” 99mm SMA Br 8mm](https://reader035.vdocuments.net/reader035/viewer/2022081409/607246125433d656e248659d/html5/thumbnails/35.jpg)