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Thoracic Aortic Stent Grafting. Dr R H Stables Cardiothoracic Centre Liverpool, UK. Introduction. Pathology of the thoracic aorta Referred to cardiologists / cardiac surgeons Investigated and treated in cardiac units Conventional surgical treatment associated with High mortality
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Thoracic Aortic Stent Grafting • Dr R H Stables • Cardiothoracic Centre • Liverpool, UK
Introduction • Pathology of the thoracic aorta • Referred to cardiologists / cardiac surgeons • Investigated and treated in cardiac units • Conventional surgical treatment associated with • High mortality • Significant morbidity (including paraplegia) • ? improved Tx with endovascular techniques • Requires genuine collaborative working
Collaborative Working • Cardiologists / Interventional radiologists • Interventional radiologists have much to offer • Equipment and techniques • More related to peripheral intervention • (Unlike carotid stenting !) • Experience with abdominal aortic procedures
Collaborative Working • Cardiologists / Interventional radiologists • Vascular surgeons / Cardiothoracic surgeons • Vascular surgical skills • Issues of vascular access • Femoral / Iliac / Aorta • Complications related to device passage • Iliac vessels • Cardiothoracic techniques • Conversion to open procedure
Collaborative Working • Cardiologists / Interventional radiologists • Vascular surgeons / Cardiothoracic surgeons • MRI / CT Imaging specialists • Radiographic and surgical facilities • Availability of open surgical conversion • Anaesthesia ITU Post op - care • Industrial partners
Thoracic Stent Grafting • Developing treatment strategy • Mainly descending aorta • Indications • Aneurysm • Dissection • Transection • Perforation • Open surgical graft procedures (may include Type A) • Coarctation of the aorta
Angio Images – Thoracic Aneurysm Slides courtesy of Prof. Rousseau
Mrs MB • Female 56 years • CRF - Failing renal transplant (after 20 years) • Recent return to haemodialysis • Subclavian dialysis line - septicaemia • Staph Aureus - Tx Antibiotics through line • Readmitted with back pain Ix Osteoporosis • Vomits bright red blood • Endoscopy and CT scan • Transfer to CTC Liverpool
Mrs MB • 3 x simultaneous blood infusions • Hb 5.4 g/dl • Left haemothorax PaO2 = 8 kPa on 40% O2 • Infected dialysis line in situ • No immediate evidence of septic shock • CT scan imaging • Emergency thoracic stent procedure
Talent LPS Thoracic Stent Graft System Sizes 26, 28, 30, 32, 34, 38, 42, 44, 46 mmNitinol ringsDacron graft
Thoracic Stent Grafting • Complications • Problems with peripheral vascular access • Low incidence of paraplegia • Migration • Endo-leaks and perforation • Multiple stents common • Post implant syndrome
Thoracic Stent Grafting • Initial case series reports • Many cases surgical contraindication ? Risk • Acute success 80 - 90% • 3 year event-free survival 50 - 70%
Angio Images – Thoracic Aneurysm Slides courtesy of Prof. Rousseau