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EVAR/TEVAR ÇALIŞTAY

EVAR/TEVAR ÇALIŞTAY. Prof.Dr. Fürüzan Numan Girişimsel Radyoloji Bilim Dalı Bşk. İstanbul Üniversitesi Cerrahpasa Tıp Fakültesi. 2014 9.GİRİŞİMSEL RADYOLOJİ YILLIK TOPLANTISI ANTALYA. AORTİK FİSTÜLLER. AORTO-ÖZEFAGİYAL AORTO-BRONŞİYAL AORTO-ENTERİK.

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EVAR/TEVAR ÇALIŞTAY

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  1. EVAR/TEVARÇALIŞTAY Prof.Dr. Fürüzan Numan Girişimsel Radyoloji Bilim Dalı Bşk. İstanbul Üniversitesi Cerrahpasa Tıp Fakültesi 2014 9.GİRİŞİMSEL RADYOLOJİ YILLIK TOPLANTISI ANTALYA

  2. AORTİK FİSTÜLLER • AORTO-ÖZEFAGİYAL • AORTO-BRONŞİYAL • AORTO-ENTERİK

  3. UNUSUAL WAY TO TREATAORTO-EOSPHAGEAL FISTULA Prof. Furuzan Numan,M.D Chief of Interventional Radiology Department IstanbulUniversity CerrahpasaMedical Faculty,TURKIYE VEITH 2009 NY

  4. Background: History: A 68-year-old male HT,CRF, TAA ABF by-pass surgery (AAA) 2004, Patient refused to haveTEVAR, While hewas followed atanother center.

  5. Follow-up 2005 non-cotrast CT and MR ABF by-pass graft

  6. Follow-up February 12th, 2006non-contrast MR

  7. March 07,2006 Recentsymptoms; Intense backpain & discomfort, no hematemesis, had been treated for unknown source of infection last 3-4months Diagnosis; contained rupture Choice of treatment; TEVAR

  8. r-TEVAR

  9. May 11th, 2006 2nd month follow-up after TEVAR

  10. Infected Aneurysm Sac he admitted tohospitalwith recent Symptoms of; high fever,sweating, nausea, vomiting, weight-loss and backpain

  11. Endoscopic view of the fistula

  12. AEF: a catastrophiccomplication Outcomes of thoracicendovascularaorticrepairforaortobronchialandaortoesophagealfistulas. Jonker et all.J EndovascTher. 2009 Aug;16(4):428-40 CONCLUSION:TEVAR management of AEF is associated with poor results and should not be considered definitive treatment. TEVAR could serve as a bridge to surgery for emergency cases of AEF only, with definitive open surgical correction of the fistula undertaken as soon as possible. .

  13. Aortoesophageal fistula after thoracic aortic stent-graft placement: a rare but catastrophic complication of a novel emerging technique; AEF: a catastrophiccomplication Surgical repair was performed in only 1 patient and declined in the remaining because of comorbidities and multiorgan system failure. Despite this, all patients died due to fatal rebleeding (n = 4) or mediastinitis (n = 2). CONCLUSION: AEF is a rare and unusual complication of TEVAR that occurs relatively early after the procedure and is almost invariably fatal. Eggebrecht H et all, JACC CardiovascInterv. 2009 Jun;2(6):570-6 .

  14. New option to treat AEF • Medical !! • TEVAR !! • Surgery!! • Percutaneous drainage of infected aneurysm sac

  15. CT guidance percutaneous drainage of infected aneurysm sac • prone position • general anesthesia • left endobronchial intubation to stop ventilation and collapse of the right lung to insert drainage catheter without damaging right lung.

  16. Procedure:Twostep technique • 19 G TLA Needle to confirm the infected material,(Staphylococcus auricularis,Streptoccus viridans, Candida albicans),soft outer sheat stayed at position till the end of procedure (not to contaminate mediastinum & pleura) • Insertion of the 10F pig-tail external drainage catheter from another level

  17. Aspiration :TLA needle

  18. Trocar Technique:Pig-tail external drainage catheter

  19. Trocar Technique:Pig-tail external drainage catheter

  20. Drainage catheter was removed after 2 weeks while CT-scan showed total regression of collection in aneurysm sac with improvement in patient’s clinical condition

  21. Follow-up June 18 th ,2006 Control CT with oral contrast & eosphagraphy

  22. Follow-up July 03 rd,2006 eosphagraphy & non contrast CT

  23. Follow-up • The patient was under antibiotic therapy(Duocid,Tavanic,Triflucan) for a year • MI was the cause of death at 2008 , 2 years after percutaneous drainage

  24. Conclusion Percutaneous drainage of infected anuersym sac can be a life saving option of patients having rare and unusual complication of AEF after TEVAR at suitable conditions.

  25. AORTO-BRONŞİYAL FİSTÜL • 1996 da torkal aort cerrahi girişimi • 2004 te hemoptizi • CT • DSA? • TEVAR • 10 senelik takip altında, progresiv aterosklerotik anevrizma nedeni ile TEVAR disalde ÇT seviyesine kadar uzatıldı,AAA çap nedeni ile takipte.

  26. AORTO-BRONŞİYAL FİSTÜL

  27. AORTO-BRONSİYAL FİSTÜL

  28. 28/06/2013Mezenter iskemi? MSCTOpere AAA, SKİA Oklüde,fem-fem bypass

  29. 09/07/2013Mezenter iskemi?DSA(-),proksimal anastomoz hhattıda psödöanevrizma

  30. 24/07/2013Masiv GİS kanaması,MSCT, AORTO-ENTERİK FİSTÜL

  31. 24/07/2013 ACİL EVAR,AUI AORTO-ENTERİK FİSTÜL

  32. 29/07/2013 Kontrol MSCT

  33. AORTİK FİSTÜLLER • Hasta öyküsü,klinik ve radyolojik dikkat ile • gereğinde nonvasküler yaklaşımlarla tedavi edilebilecek ender ancak mortal olgulardır.

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