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Vascular and Endovascular Surgery Division University of Florence chirvasc-unifi.it

Vascular and Endovascular Surgery Division University of Florence www.chirvasc-unifi.it. Ateromasia emboligena dell’aorta toracica. R. PULLI. Patologia spontanea In corso di procedure invasive Trattamento endovascolare Tronchi epiaortici Aorta toracica.

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Vascular and Endovascular Surgery Division University of Florence chirvasc-unifi.it

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  1. Vascular and Endovascular Surgery Division University of Florence www.chirvasc-unifi.it Ateromasia emboligena dell’aorta toracica R. PULLI

  2. Patologia spontanea In corso di procedure invasive Trattamento endovascolare Tronchi epiaortici Aorta toracica Ateromasia emboligena dell’aorta toracica

  3. Patologia spontanea Stroke Embolia periferica Embolia viscerale In corso di procedure invasive Stroke Paraplegia Ateromasia emboligena dell’aorta toracica

  4. Embolia periferica o viscerale… …is a rare clinical syndrome requiring a high index of suspicion.

  5. Ateromasia emboligena dell’aorta toracica

  6. IMPORTANZA DELLO STUDIO CON TEE

  7. Trattamento endovascolareTronchi epiaortici

  8. Trattamento endovascolareTronchi epiaortici

  9. Volume 331:1729-1734 December 29, 1994 Number 26 Transluminal Placement of Endovascular Stent-Grafts for the Treatment of Descending Thoracic Aortic Aneurysms Michael D. Dake, D. Craig Miller, Charles P. Semba, R. Scott Mitchell, Philip J. Walker, and Robert P. Liddell

  10. Trattamento degli aneurismi toracici ESPERIENZA EUROPEA

  11. Registro Italiano di Chirurgia VascolareSICVEREG

  12. Aneurismi toracici Dissecazioni di tipo B (acute e croniche) Rotture traumatiche dell’aorta Pseudoaneurismi Ulcere penetranti Fistole (aorto-bronchiali, aorto-esofagee) Trattamento endovascolare:spettro di applicabilità

  13. Ecocardiografia transesofagea • Permette una rapida diagnosi differenziale con l’IMA, il tamponamento cardiaco e l’embolia polmonare • Può essere eseguito al letto del paziente e non richiede più di 15 minuti • Operatore dipendente; lunga learning curve • Specificità elevata; sensibilità minore “TEE is the study of choice in non trauma patients with possible aortic abnormalities” Erbel L et al., Lancet 1989

  14. Department of Vascular Surgery University of FlorenceENDOVASCULAR TREATMENT OF THORACIC AORTA(2000 – 2007) 100 cases

  15. Department of Vascular Surgery University of FlorenceCOMPLEX LESIONS(2000 – 2008) 36 cases 36 males; mean age 73 years (range 65-81)

  16. Ishimaru S, 2002 HYBRID TREATMENT OFAORTIC ARCH 1 case Ascending aorta to left common carotid and subclavian artery bypass 1 case Subclavian to subclavian artery bypass with carotid transposition 2 case Carotid to carotid to subclavian artery bypasses Zone 1 Zone 2 Zone 0 3 caseAscending aorta to innominate and left common carotid artery bypass + carotid to subclavian artery bypass 5 casesCarotid to subclavian artery bypass 1 caseSubclavian artery transposition

  17. HYBRID TREATMENTOF AORTIC ARCH

  18. HYBRID TREATMENTOF AORTIC ARCH

  19. HYBRID TREATMENT OFAORTIC ARCH: RESULTS (N=13) • Mortality: 1 (7.5%) • Stroke: - • Complications: - frenic nerve paralisis 1 (7.5%) • Endoleak: - type II 1 (7.5%) • Secondary procedures: - Follow-up [mean (range)]: 12 months (1-24)

  20. HYBRID PROCEDURESFOR AORTIC ARCH

  21. Spinal cord angiogram

  22. HYBRID TREATMENT OF THORACOABDOMINAL AORTA:Spinal angio-MRI evaluation

  23. HYBRID TREATMENT OFTHORACOABDOMINAL AORTA

  24. HYBRID TREATMENT OFTHORACOABDOMINAL AORTA

  25. HYBRID TREATMENT OFTHORACOABDOMINAL AORTA

  26. Mortality: - perioperative (MOF, 2 bleeding) 3 (30%) - follow-up (MI) 1 Endoleak: - type II 1 Secondary procedures: - Paraplegia: - Renal insufficiency: - Bypass graft patency: 96% HYBRID TREATMENT OFTHORACOABDOMINAL AORTA: RESULTS (N=10) Follow-up [mean (range)]: 9 months (1-21)

  27. HYBRID PROCEDURESFOR THORACOABDOMINAL AORTA

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