stent for the purpose Mr Simon Neequaye Consultant Vascular and - PowerPoint PPT Presentation

Jan 14, 2024 •285 likes •473 views

Target vessel stents how to match stent for the purpose Mr Simon Neequaye Consultant Vascular and Endovascular Surgeon Target Vessel Stents Maintenance of perfusion to visceral arteries with modular EVAR Contained rupture-previous

Target vessel stents – how to match stent for the purpose Mr Simon Neequaye Consultant Vascular and Endovascular Surgeon
Target Vessel Stents Maintenance of perfusion to visceral arteries with modular EVAR
Contained rupture-previous thoracoabdominal surgical • 64 yo female • Perfusion Snake to intercostals • Branch to CA from mid DTA
Chimney to CA Graft, T-Branch plus Bifurcated distally 9 x 59 Atrium
T-Branch
SMA and Right Renal 9 x 59 and 9 x 38 Atrium 7 x 59 plus 7 x38 Atrium
LRA – sacrificed as unable to track bridging stent-angle plus stenosis
Greatest Vascular Surgeon Ever!
• One hundred and fifty consecutive patients underwent f/bEVAR • The technical success rate 99% (520/523 target vessels). • Balloon expandable BSGs were mainly used 95% and in 65% relining stents were combined.
J Vasc Surg 2013;57:926-33. • 650 patients • 9 years followup • 30/1679 (1.7%) Branch stent occlusion • 30 day freedom from re-intervention 98% • 5 year freedom from re- intervention 89%
Long term failure modes- Target vessel stents • Endoleak, • Kink, • Fracture CA Stent • Migration perforation • Occlusion • Stenosis • Perforation. SMA stent dislocation
Control in an unstable world
Happy ending-1 • Graft Planning. – Prioritize stability in seal zone. – Consider Fenestrations for renals c.f Branches • Long term surveillance
Happy Ending-3 Choosing a Target Vessel stent- No stent is perfect! • Robust AND Flexible • Visible And Low profile • Available in a great range of sizes and be economical – Overdilation ( flare and in situ adjustment – Recanulation
Happy ending-3 • Pay special attention to stents that bridge space. • Atrium • Viabahn • Fluency
Happy ending-3 • Pay special attention to stents that bridge ? space. ? • Atrium • Viabahn • Fluency
Happy Ending! • Plan Aortic Graft carefully • Size bridging stent well • Use additional bare stents to manage transition or kinks. • Be wary of bridging space

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