tips and tricks for successful evar · tips and tricks for successful evar prof. fabio verzini ,...

Tips and tricks for successful EVAR

Prof.FabioVerzini,MD,PhD,FEBVS

SectionofVascularSurgeryUniversityofPerugia,

S.Maria della MisericordiaHospital,Perugia,Italy

Disclosure

Speaker name: Fabio Verzini

.................................................................................

qI have the following potential conflicts of interest to report:

q Receipt of grants/research support

q Receipt of honoraria and travel support

from Cook, Gore, Medtronic

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Tostayoutoftroubles

• Patientselection

• Caseplanning

• Operation

• Qualitycontrol

Togetoutoftroubles

• Improvefixation/seal

• Outflowmanagement

• Endoleaks

Tostayoutoftroubles

• Patientselection

• Caseplanning

• Operation

• Qualitycontrol

>17mm, <32mm

Angle <60°-90°

>10mm

>20mm

>7mm<22mm >15mm

Male, 64 y.o.

62 mm AAA

CAD (previous CABG + PTCA)Chronic AF (warfarin)

Respiratory failure waiting for lung transplant

Tostayoutoftroubles

• Patientselection

• Caseplanning

• Operation

• Qualitycontrol

Pre-op planning

• CT-Angio 1 mm (4-6 weeks)

• MPR (Multiplanar reconstruction)

• MIP (Maximum intensity projection)

• Center line analysis

• Thoracic-abdominal Ct-Angio

CRA 10°

RAO 19°

LAO 0°

CRA 5°

Final Angio

6 months CT scan

Tostayoutoftroubles

• Patientselection

• Caseplanning

• Operation

• Qualitycontrol

• Localanesthesia• Percutaneousaccess• Intra-operativeimaging• Knowledgeofspecificgraftcharacteristics

• Localanesthesia

• Percutaneousaccess

• Percutaneousaccess

• Intra-operativeimaging

• Intra-operativeimaging

• Knowledgeofspecificgraftcharacteristics 22-34 mm

86 mm

94 m

m

49 m

m

Everymmofgraft/neckappositioncounts

Tostayoutoftroubles

• Patientselection

• Caseplanning

• Operation

• Qualitycontrol

• Qualitycontrol

• Qualitycontrol

• Qualitycontrol

• Qualitycontrol

Tips and tricks for successful EVAR

Prof.FabioVerzini,MD,PhD,FEBVS

SectionofVascularSurgeryUniversityofPerugia,

S.Maria della MisericordiaHospital,Perugia,Italy