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Novel Interventions for the Treatment of Aortic Disease

Novel Interventions for the Treatment of Aortic Disease. Ross Milner, MD and Mark Russo, MD Co-Directors, Center for Aortic Diseases February 4, 2012. Disclosures. WL Gore – Consultant Medtronic - Consultant. TEVAR. Thoracic Endovascular Aneurysm Repair. TEVAR.

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Novel Interventions for the Treatment of Aortic Disease

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  1. Novel Interventions for the Treatment of Aortic Disease Ross Milner, MD and Mark Russo, MD Co-Directors, Center for Aortic Diseases February 4, 2012

  2. Disclosures • WL Gore – Consultant • Medtronic - Consultant

  3. TEVAR • Thoracic Endovascular Aneurysm Repair

  4. TEVAR • Thoracic Endovascular Aneurysm Repair • Comparison to Open Repair

  5. All-Cause Mortality Through Five Years

  6. Freedom from Aneurysm-Related DeathThrough Five Years Modified TAG Device 98% Original TAG Device 98% Open Surgery 90%

  7. Freedom from Major Adverse EventsThrough Five Years Modified TAG Device 60% Original TAG Device 37% Open Surgery 21%

  8. Cumulative Major Adverse EventsThrough Five Years

  9. Interesting Cases

  10. Ruptured Descending Thoracic Aortic Pseudoaneurysm

  11. HPI • 82 yr old male • Acute onset of chest, abdominal, and back pain

  12. HPI • 82 yr old male • Acute onset of chest, abdominal, and back pain • Hx of LLE DVT – Coumadin – INR 2.2 • Jehovah’s Witness – No Blood Products

  13. HPI • 82 yr old male • Acute onset of chest, abdominal, and back pain • Hx of LLE DVT – Coumadin – INR 2.2 • Jehovah’s Witness – No Blood Products • Hx of Aortobifem, Fem Fem – occluded

  14. HPI • 82 yr old male • Acute onset of chest, abdominal, and back pain • Hx of LLE DVT – Coumadin – INR 2.2 • Jehovah’s Witness – No Blood Products • Hx of Aortobifem, Fem Fem – occluded • Hx of multiple abdominal surgeries • Total Gastrectomy • Small bowel resection, LOA • Colectomy

  15. Right Axillary Artery Exposure • Exposure of Right Axillary artery – vessel loop control • Heparinize • Suture conduit with 5-0 Prolene • 10 mm x 30 cm Dacron Graft

  16. R Axillary Artery Conduit

  17. 22 Fr Dry Seal Sheath

  18. 22 Fr Dry Seal Sheath in Conduit

  19. CTAG 34 x 10

  20. Penetrating Aortic Ulcer

  21. Completion Angiogram

  22. Completion Images

  23. Aortic Arch Debranching

  24. Pararenal Aneurysms

  25. History • 76 year old woman who suffered a MVC • PMH: HTN • PSH: Appendectomy (midline) • Extensive w/u at another institution • CTA of the abdomen and pelvis

  26. CTA Images

  27. CTA Images (cont)

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