dr r h stables cardiothoracic centre liverpool, uk thoracic aortic stent grafting
TRANSCRIPT
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
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
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
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
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
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
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
Sizes 26, 28, 30, 32, 34, 38, 42, 44, 46 mm
Nitinol rings
Dacron graft
Talent LPS Thoracic Stent Graft System
Thoracic Stent Grafting
• Complications
• Problems with peripheral vascular access
• Low incidence of paraplegia
• Migration
• Endo-leaks and perforation
• Multiple stents common
• Post implant syndrome
Thoracic Stent Grafting
• Initial case series reports
• Many cases surgical contraindication ? Risk
• Acute success 80 - 90%
• 3 year event-free survival 50 - 70%