ThoracoAbdominal Aneurysms Endovascular Approach

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Thoraco-Abdominal AneurysmsEndovascular Approach

• Chirurgie Vasculaire - Hôpital Cardiologique
• CHRU de Lille - France

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HYBRID PROCEDURES
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CONCEPT

• Endovascular repair of complex aortic aneurysms
  involving
• Visceral vessels (juxtarenal, pararenal, TAAA)
• Both common iliac arteries

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CONCEPT

• Sealing zones determined on pre operative CT
  length of aorta to be covered
• Endograft designed with fenestrations and / or
  branches to perfuse vessels covered by fabric

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Endovascular Options to Perfuse Target Vessels

• REINFORCED FENESTRATIONS

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BRANCHES

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PRELOADED CATHETER
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Bridging Stentgraft
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SIZING 3D-Volume Rendering
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Bone Removal
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CPR
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LEFT RENAL at 2.45
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Short neck AAA,Juxta and Pararenal Aneurysms
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PROCEDURE
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POST-OPERATIVE CT
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Type IV TAAA
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ANGULATION OF AORTIC BRANCHES
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Contemporary Retrospective Comparative Analysis

• Consecutive elective TAAA repair over 5 years
• Retrospective review
• All films pre and post procedure evaluated
• All patients classified using identical criteria
• Outcomes evaluated
• 30 day mortality
• 12 month survival
• Paraplegia
• Timing
• Severity

Greenberg R, Lu Q, et al, Circ In Press 2008
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Comparison of Patients (N734)
SR (n372)
ER (n352)
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Paraplegia
Greenberg R, Lu Q, et al, Circ In Press 2008
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LIMITS

• PRICE
• EMERGENCIES
• TRAINING

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CONCLUSIONS

• Endoprothèses multibranches alternative à la
  chirurgie conventionnelle
• LIMITES
• Patients à haut risque chirurgical
• Résultats à moyen et long terme ?