Repair of Ruptured Thoracoabdominal Aortic Aneurysm with ......Fenestrated repair of patients with...
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Repair of Ruptured Thoracoabdominal Aortic Aneurysm with Physician Modified Endograft James Middleton Chang, MD Yazan Duwayri, MD Georgia Vascular Society, 7 th Annual Scientific Sessions September 7 th , 2019 – Greensboro, Georgia Division of Vascular Surgery
Transcript of Repair of Ruptured Thoracoabdominal Aortic Aneurysm with ......Fenestrated repair of patients with...
Repair of Ruptured Thoracoabdominal Aortic Aneurysm with Physician Modified Endograft
James Middleton Chang, MD
Yazan Duwayri, MD
Georgia Vascular Society, 7th Annual Scientific Sessions
September 7th, 2019 – Greensboro, Georgia
Division of Vascular Surgery
Disclosures
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No financial conflicts of interest
This presentation includes the off-label use of an
FDA approved product
Presentation
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70 Female
Incidentally identified thoracoabdominal aneurysm
up to 6.2cm.
PMH: HTN, HLD, Lumbar spinal stenosis
PSH: Appendectomy, BSO, Csection, right
hemicolectomy
Plan: Preoperative Testing and Open Repair
Pre-operative Imaging
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Re-Presentation
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Prior to repair, patient presented to an outside institution
with abdominal pain.
Hemodynamically stable
CT: contained rupture
Transferred to Emory for further management.
Re-Presentation
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Re-Presentation
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Admitted for repair
Initial management with intensive blood pressure
control
Planned for endovascular repair
Proceeded to OR for physician modified
endograft placement with fenestrations for the
celiac, SMA, and both renal arteries using Cook®
Zenith Alpha™ platform
Device Modification
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Pre-operative CT
examined carefully and
fenestrations planned
Cook Alpha deployed on
back table
Planned fenestrations
created with eye cautery,
reinforced with snare
Device Modification
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Diameter reducing ties
placed with chromic
sutures
Device reconstrained and
placed into 22 French
peel-away sheath
Operative Details
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Post-operative Course
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Post-operative Course
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Did well post-operatively
Started on Plavix
Discharged home on POD#4
Patient continues to do well 8 months post-repair, US
performed at 1 month demonstrating patent stents
Conclusion
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Fenestrated repair of patients with
thoracoabdominal aneurysm rupture provides a
viable alternative to open repair in select patients
Surgeon modified endografts can be used for
certain anatomic and physiologic aortic
pathologies
Limited availability of branched technology
creates a need for creative/advanced endovascular
techniques
Conclusion
