Menu Expand
Endovascular Treatment of Aortic Aneurysms

Endovascular Treatment of Aortic Aneurysms

Konstantinos P. Donas | Giovanni Torsello | Ken Ouriel

(2018)

Additional Information

Book Details

Abstract

Focusing on the latest safe and effective techniques, Endovascular Treatment of Aortic Aneurysms: Standard and Advanced Techniques provides step-by-step, comprehensive coverage of endovascular repairs of complex aneurysms of the aorta, from basic to advanced.

  • Explains how to perform the techniques in a step-by-step manner, using high-quality images and practical tips and tricks to optimize results.
  • Contains chapters devoted to the repair of leaks that may occur after a repair and the best ways to minimize radiation exposure.
  • Presents information in a consistent, standardized format: introduction, indications for the technique, how to perform the technique, complications and techniques for rescue, and concluding thoughts.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Endovascular Treatment of Aortic Aneurysms i
Endovascular Treatment of Aortic Aneurysms: Standard and Advanced Techniques iii
Copyright iv
Dedication v
List of Contributors vii
Foreword ix
Preface xi
Contents xiii
I - INFRARENAL AORTIC ANEURYSMS: STANDARD ENDOVASCULAR ANEURYSM REPAIR1 1
1 - The Percutaneous Approach of Endovascular Aortic Aneurysm Repair 1
PRECLOSE TECHNIQUE 1
LITERATURE REVIEW 2
SUMMARY 3
REFERENCES 4
2 - The Standard Endovascular Aneurysm Repair Procedure 5
PROCEDURAL STEPS 5
PROCEDURAL ISSUES 5
Some challenging and technically demanding issues can arise during EVAR. Challenging Access 5
Challenging Neck: the Angulated Aortic Neck 6
Severe Pararenal Thrombus Formation 7
LITERATURE REVIEW 7
REFERENCES 9
3 - Use of EndoAnchors in Endovascular Treatment of Aneurysms with Short Neck 11
ENDOANCHOR DEPLOYMENT 11
INDICATIONS 11
INITIAL EXPERIENCE (STAPLE TRIALS) 11
ANCHOR TRIAL 12
SINGLE-CENTER EXPERIENCE 13
FUTURE PERSPECTIVES 13
REFERENCES 14
4 - Use of Contrast-Enhanced Ultrasound in Follow-up of Endovascular Aneurysm Repair 15
LITERATURE REVIEW 15
San Giovanni di Dio Hospital Experience 16
SUMMARY 21
ACKNOWLEDGMENT 21
REFERENCES 21
5 - Logistics in the Hybrid Operating Room for Complex Endovascular Aneurysm Repair 23
REFERENCE 25
II - JUXTARENAL AORTIC ANEURYSMS: CHIMNEY ENDOVASCULAR TECHNIQUE 27
6 - Overview of Chimney Endovascular Technique 27
LITERATURE REVIEW 27
CURRENT STATUS 28
REFERENCES 29
7 - Sizing of Aortic Endografts in Chimney Technique 31
PREOPERATIVE IMAGING 31
NEW SEALING LENGTH 31
PLANNING THE PROCEDURE 32
Aortic Neck Sizing 32
Aortic Neck Diameter 32
Aortic Neck Angulation and Thrombus 32
SIZING OF CHIMNEY GRAFTS 32
AORTIC BRANCH STENOSIS OR ANGULATION 32
OVERSIZING OF ABDOMINAL ENDOGRAFT 32
Standard Oversizing 32
Mathematical Formula 33
In Vitro Testing 33
Custom-Made Oversizing Technique 33
APPROPRIATE COMBINATION OF ABDOMINAL ENDOPROSTHESIS AND CHIMNEY GRAFT 34
LIMITATIONS AND SOLUTIONS 35
DISCUSSION AND CONCLUSIONS 39
REFERENCES 40
8 - Procedural Steps in Chimney Technique 41
LITERATURE REVIEW 41
REFERENCES 43
III FENESTRATED ENDOGRAFTING TECHNIQUE 45
9 - Sizing of Fenestrated Endografts 45
REFERENCES 46
10 - Fenestrated Endografting for Pararenal Aneurysms 47
CASE PRESENTATION 47
DISCUSSION 50
REFERENCES 50
IV -\rTHORACOABDOMINAL AORTIC ANEURYSMS 51
11 - Custom-Made Thoracic Endograft 51
INDICATIONS 51
PROCEDURE 51
Case Presentation 51
First Stage 51
Deployment of the thoracic device 51
Second Stage 51
Step 1. Anesthesia and approach 51
Step 2. Small or stenotic iliac vessels 51
Step 3. Advance of 22F sheath to assess trackability of access vessels 52
Step 4. Release of reducing ties and deployment of device 52
Techniques to facilitate cannulation of renovisceral vessels 52
Step 5. Placement of additional devices 53
Step 6. Closure of access in the groin 53
Step 7. Cannulation of target vessels 53
Step 8. Connection of the branches with target vessels 53
Step 9. Completion angiography 55
POSTOPERATIVE MANAGEMENT 55
LIMITATIONS OF CUSTOM-MADE ENDOGRAFT 56
LITERATURE REVIEW 56
REFERENCES 57
12 - Off-the-Shelf Multibranched Endograft 59
ANATOMIC REQUIREMENTS 59
INDICATIONS 59
PROCEDURE 59
Case Presentation 59
Procedural Step 59
Step 1. Anesthesia and approach 59
Step 2. Small or stenotic iliac vessels 59
Step 3. Advancement of 22F sheath to assess trackability of access vessels 60
Step 4. Advancement of device at least 10 to 20 mm above orifice of respective target vessel 60
Step 5. Release of reducing ties and 61
Step 6. Cannulation of target vessels 61
Step 7. Connection of the branches with target vessels 61
Step 8. Completion angiography 63
Step 9. Evaluation of perfusion of hypogastric arteries 63
Summary 63
POSTOPERATIVE MANAGEMENT 64
LIMITATIONS OF OFF-THE-SHELF ENDOGRAFT 64
LITERATURE REVIEW 65
REFERENCES 65
13 - Sandwich Endovascular Technique 67
INDICATIONS 67
PROCEDURE 67
Case Presentation 67
Procedural Steps 67
1. Exposure of left axillary artery 67
2. Percutaneous transfemoral access 67
3. Deployment of thoracic endograft 67
4. Placement of infrarenal aortic stent-graft 67
5. Cannulation of renovisceral vessels 67
Cannulation of Visceral Arteries. Puncture of the left axillary artery is performed, or bilateral transbrachial cannulation from... 67
Transfemoral Cannulation of Renal Arteries from Right and Left Groin. A Vertebral or Shepherd Hook catheter can be used to intro... 69
6. Deployment of abdominal tube endografts 69
7. Placement of chimney grafts to the visceral arteries 70
LIMITATIONS OF SANDWICH TECHNIQUE 70
Need for Upper Extremity Access 70
Absence of Dedicated Chimney Graft in Combination with Thoracic Device 71
LITERATURE REVIEW 71
REFERENCES 71
V - AORTIC ARCH AND DESCENDING AORTIC ANEURYSMS 73
14 - Thoracic Endovascular Aortic Repair 73
INDICATIONS 73
PROCEDURE 73
Case Presentation 73
Preoperative Assessment 73
Endograft Planning 74
Access vessels 74
Deployment Preparation 75
Stent-Graft Deployment 75
Stent-graft conformability in tortuous aortic morphology 75
POSTOPERATIVE CARE 76
REFERENCES 76
15 - Branched Stent-Grafts in the Aortic Arch 79
INDICATIONS 80
PROCEDURE 80
Case Presentation 80
Performance of Left Carotid–Subclavian Bypass 80
Insertion and Deployment of Branched Stent-Graft 80
Insertion of Stents 80
Completion and Follow-up Imaging 81
LIMITATIONS OF BRANCHED STENT-GRAFT 81
LITERATURE REVIEW 83
REFERENCES 83
16 - Chimney Thoracic Endovascular Technique 85
PROCEDURE 85
Case Presentation 85
Exposure of left axillary/proximal brachial artery 85
Puncture of left brachial artery and cannulation of subclavian artery 85
Percutaneous transfemoral access 85
Deployment of the thoracic endograft 85
Modification of chimney technique in aortic arch by placement of self-expanding covered stents in left subclavian artery as peri... 86
LITERATURE REVIEW 88
LIMITATIONS OF CHIMNEY TECHNIQUE 89
REFERENCES 89
17 - Bridging Devices in Complex Endovascular Aneurysm Repair 91
STAINLESS STEEL BALLOON-EXPANDABLE COVERED STENTS 91
Features 91
Radial force 91
Fluoroscopic visibility 91
Limitations 92
Literature Review 92
Chimney technique 92
Fenestrated endovascular technique 93
NEW STAINLESS STEEL BALLOON EXPANDABLE COVERED STENT 93
SELF-EXPANDING COVERED STENTS 93
Features 94
Radial force 94
Fluoroscopic visibility 94
Flexibility and availability in lengths up to 250 mm 95
Literature Review 95
Lining 96
REFERENCES 96
18 - Management of Type Ia Endoleaks 97
REFERENCES 98
19 - Management of Type II Endoleaks with Ethylene-Vinyl-Alcohol Copolymer Liquid Embolic Agent 99
PREOPERATIVE EVALUATION 99
SURGICAL APPROACH 100
PROCEDURE 100
LITERATURE REVIEW 101
ADVANTAGES AND DISADVANTAGES 102
REFERENCES 102
20 - Fusion Techniques in Advanced Endovascular Repair 105
INDICATIONS 105
TECHNIQUE 105
Segmentation 105
Planning 105
Registration 106
3D/3D registration 106
2D/3D registration 107
Live Image Guidance 108
LITERATURE REVIEW 108
CONCLUSION 113
REFERENCES 115
21 - Conclusion and Future Perspectives 117
Index 119
A 119
B 119
C 119
D 120
E 120
F 120
G 120
H 120
I 120
J 120
L 120
M 120
N 120
O 120
P 120
R 121
S 121
T 121
U 121
V 121
W 121
Z 121