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„2 in 1“ Stentgraft
to reduce aortic coverage
in T-Branch
P.M. Kasprzak
University of Regensburg
Disclosures (grants, speaker fee, development, patents):
Cook, Gore, Vascutek, Bard, Atrium, Aptus, Maquet, UCB
Neurologic Complications after TEVAR
• Spinal cord ischemia (SCI) 0 - 12,5%(1)
• Stroke 0 - 9,5%(2)
Literaturquelle n Device Aortenpathologie 30-Tages Ğ
MortalitŠt (%)
SCI
(%)
Stroke
(%)
Mitchell et al
1999
103 Home-made DA/Diss/PAU 9 2 6,8
Greenberg et al
2000
100 Zenith DA/Diss 7 1 3
Cambria et al
2002
105 k.A. k.A. 7,6 4,8 9,5
Bortone et al
2004
110 TAG/Talent DA/Diss/PseudoA 3,6 0 1
Wheatly et al
2006
156 TAG DA/Diss/PseudoA/PAU 3,8 0,6 4,5
Fattori et al
2006
457 Talent/Zenith DA/Diss/Trauma 5 1,7 3,7
Lee et al
2007
121 TAG/Zenith/Talent DA/Diss/PAU 5 6,6 4,1
Bavaria et al
2007
140 TAG DA 2,1 2,9 3,6
Zipfel et al
2008
337 E-vita/Relay DA/Diss/Trauma 12,7 1,5 2,6
Morales et al
2008
160 Zentith DA/Diss 6,9 3,1 3,1
Fairman et al
2008
195 Talent DA 2,1 8,7 3,6
Maximalwerte:(1)Schlösser et al 2009(2)Stone et al 2006, Cambria et al 2002
D.E., 68 years - temporary paraplegia postoperativ
Universitätsklinikum Regensburg
• Risk of paraplegia during BEVAR
varies between 10 – 25 %
Thorakoabdominal aortic aneurysms (TAAA)
O´Callaghan A et al., J Vasc Surg 2015; 61:347-354.
Dias NV et al. Eur J Vasc Endovac Surg 2015; 49: 403-409.
Kasprzak PM et al. Eur J Vsc Endovasc Surg 2014: 48: 258-265.
Verhoeven ELG et al. Eur J Vasc Endovasc Surg 2015; 49: 524-531.
Bisdas T et al. J Vasc Surg 2015; 61: 1408-1416.
Risk factors for paraplegia:
- Overstenting LSA
- Infrarenal surgical graft (Tube, Y) or Stentgraft
- Length of aortic coverage
- Immediate thrombosis of aneurysm
- Hypotension peri- / postoperativ
- No Spinaldrainage ?
T-Branch (Cook®)
proximal diameter 34mm
distal diameter 18mm
„Thoracic Reducing Union“
CMD Cook®
External stent graft - 38-44 mm
Internal - 32 mm
2015 - 16 implantations in 4 Vascular Centers
preoperative CTA scan
M, 60, symptomatic TAAA
Regular setup in BEVAR for TAAA
- Transposition of LSA if covered
- Spinal drainage for 3-4 days (until postop. CTA) - Orbita-US
(LiquoGard7)
- open perfusion branch (TASP) and staged procedure - MEP´s
- perfusion of internal ilac arteries - Iliac-Branch
- limited coverage of the aorta
- preserving intercostal arteries
- preoperativ ASA 100mg/daily – intraoperativ Heparin with ACT>300“
Conclusion
„2 in 1“ Stentgraft allows
T-Branch seal in the distal descending aorta
with diameter 30-38mm
without extension of the aortic coverage
„2 in 1“ Stentgraft
to reduce aortic coverage
in T-Branch
P.M. Kasprzak
University of Regensburg
Disclosures (grants, speaker fee, development, patents):
Cook, Gore, Vascutek, Bard, Atrium, Aptus, Maquet, UCB
