dr r h stables cardiothoracic centre liverpool, uk
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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 - PowerPoint PPT PresentationTRANSCRIPT
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Dr R H Stables
Cardiothoracic CentreLiverpool, UK
Thoracic Aortic Stent Grafting
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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
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‘Liverpool cardiologist dies in drive-by shooting’
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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
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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
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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
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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
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MRI Image – Thoracic Aneurysm
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MRI Image – Thoracic Aneurysm – Post Stent
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Angio Images – Thoracic Aneurysm
Slides courtesy of Prof. Rousseau
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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
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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
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Peripheral Vessel Anatomy
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Leaking (x2) Thoracic Aneurysm
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Sizes 26, 28, 30, 32, 34, 38, 42, 44, 46 mm
Nitinol rings
Dacron graft
Talent LPS Thoracic Stent Graft System
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Thoracic Delivery System
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Stent Device (TALENT) Before Deployment
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Acute Result
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Subacute EndoLeak / Perforation
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Use of Forming Balloon
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Deployment of Additional Proximal Stent
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Deployment of Additional Distal Stent
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Final Result
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Thoracic Stent Grafting
• Complications• Problems with peripheral vascular access• Low incidence of paraplegia• Migration• Endo-leaks and perforation
• Multiple stents common• Post implant syndrome
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Thoracic Stent Grafting
• Initial case series reports
• Many cases surgical contraindication ? Risk
• Acute success 80 - 90%
• 3 year event-free survival 50 - 70%
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Questions and Discussion
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Angio Images – Thoracic Aneurysm
Slides courtesy of Prof. Rousseau