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THE ROLE OF OPEN SURGERY FOR AAA IN THE · PDF fileChief: Franco Grego M.D. Surgery in the Past Surgery Today Surgery in the Future Low risk patients Low and high risk patients Low

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Text of THE ROLE OF OPEN SURGERY FOR AAA IN THE · PDF fileChief: Franco Grego M.D. Surgery in the...

THE ROLE OF OPEN SURGERY FOR AAA IN THE ENDOVASCULAR ERA

Prof. Franco GregoVascular and EndovascularSurgery

University of Padua

www.chirurgiavascolarepadova.it

http://www.chirurgiavascolarepadova.it/informazioni_pazienti.htmhttp://www.unipd.it/

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Disclosure of Interest

Speaker name: FRANCO GREGO

I do not have any potential conflict of interest

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MODERN AAA REPAIR: Open or EVAR?

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EVAR represents the first choice today

When is OPEN REPAIR recommended?

1. Selected cases, in elective AAA repair

2. Challenging cases for EVAR / FEVAR

3. Infections

4. Post-EVAR complications ,with no otherendovascular options

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AAA

High risk Low risk

Favourable

Anatomy for EVARFavourable

Anatomy for EVAR

Conventional surgery

after evaluation of: age

and predisposition to type

II endoleaks

Unfavourable

Anatomy for EVAR

EVAR

Unfavourable

Anatomy for EVAR

Conventional

surgery

Conventional surgery

Accepting increased

surgical risk

FEVAR or

other endovascular

solution

EVAR

AAA repair: our flow chart today

Selected cases in elective AAA repair

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Challenging cases for EVAR

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Exclusion Criteria:

Severe aorto-iliac occlusive disease, tortuosity or calcification;

Circumferential thrombus/ateroma in the sealing region;

Unsuitable artery anatomy -Inability to maintainpatency of onehypogastric-Inadequate (50%

Not feasible because of:-angulation of thoracic descending aorta and abdominal subrenal aorta;

-median arcuate ligament compression on celiac trunk;

-diameters and morpholgy of renal arteries.

Challenging cases for FEVAR

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Juxta-renal aneurysm

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Juxta-renal aneurysm

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Para-renal aneurysm

Aortic blister

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Horsehoe kidney

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Ectopic kidney

Posterior viewAnterior view

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Graft or Endograft infections

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Graft or Endograft infections

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Aorto-enteric fistula

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Aorto-enteric fistula

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Post-EVAR complications

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Endoleak type I:Open coversion

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Endoleak type I:Open coversion

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Conversion to open repair:Neoneck technique

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Early conversion

Aortic rupture caused by endografts hooks

AngioTC pre AngioTC post Angiography post

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Early conversion

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Open repair maintains its role in the treatment of abdominalaneurysms, thanks to its efficacy and long term durability.

o It is the primary choice in young patients.

o It represents the preferential choice in low risk patients withcomplex aorto-iliac anatomies

o It is the only solution in infected cases

o It is the only solution in cases with EVAR complications,otherwise untreatable with other endovascular options.

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Conclusions

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TAKE-HOME MESSAGE

THIS MUST NOT BE OUR DESTINY

Vasc and Endovasc Surg Clinic Padua University

Chief: Franco Grego M.D.

www.chirurgiavascolarepadova.it

Surgery in the Past

Surgery Today

Surgery in the Future

Low risk patients

Low and high risk patients

Low and high risk patients

High risk patients

Open Surgery

EVAR

Unfit for endovascular

EVAR

Open Surgery

EVAR

Unfit for endovascular INOPERABLE

THANK YOU FOR THE ATTENTION

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