Manual of Thoracic Endoaortic Surgery (eBook)
X, 350 Seiten
Springer London (Verlag)
978-1-84996-296-4 (ISBN)
In today's healthcare environment, the real driver is value. Maximizing outcomes and minimizing costs or providing similar outcomes with lower cost in terms of actual numbers or recovery time will dominate our healthcare delivery system. An excellent example of this evolution is in the ?eld of cardiovascular intervention. Dr. Jacques Kpodonu's Manual of Thoracic Endo-Aortic Surgery is a most timely and descriptive work in this burgeoning ?eld. It provides an excellent overview of current technology and techniques, plus the endovascular expert can drill down into the details of the devices and technologies described and signi?cantly enhance their knowledge and perspective. Procedural detail, excellent graphics, pertinent imaging studies, and relevant instruction are the mainstays of this text. The ?rst chapter comprises the key overview and very comprehensively covers the platform - the hybrid OR, the tools, the accessories, and the medium - superb, state-of-the-art imaging modalities required to perform these advanced procedures. The text then moves into more technical details including options and instruction regarding access approaches and potential pitfalls of such. This is followed in en- ing chapters by dissemination of precise information, techniques, and indications for the most popular and utilized grafts including Boston Relay Stent Graft, Cook TX2 Zenith Stent Grafts, as well as the Gore and Medtronic Aortic Stent Grafts.
Foreword 5
Preface 7
Acknowledgments 8
Contents 9
1 The Cardiovascular Hybrid Room 20
1.1 The New Operative Environment (The Hybrid Surgical Suite) 22
1.2 Basic Equipment and Design of the Hybrid Endovascular Operating Room 23
1.2.1 Size of the Hybrid Operating Room and Radiation 23
1.2.2 Carbon-Fiber Table 24
1.2.3 Flat Screens and Monitors 25
1.3 Patient Monitoring 25
1.4 Fluoroscopy and CT Imaging Systems 25
1.5 Image Acquisition and Display 27
1.6 Other Imaging Modalities 29
1.7 Future Perspectives 29
References 30
Part I Accessories Used in Thoracic Endografting 31
2 Balloons Used in Thoracic Aortic Endografting 32
2.1 General Overview 32
2.2 Selection of Balloon 34
2.2.1 Balloons Used for Thoracic Endografting 34
2.2.2 Adjuncts Techniques Useful in Thoracic Aortic Endografting 35
References 40
3 Catheters Used in Endografting of the Thoracic Aorta 41
3.1 Non-selective Catheters 41
3.2 Selective Catheters 46
References 47
4 Equipment Required for Thoracic Aortic Endografting 48
4.1 Supplementary Equipments 48
4.2 Dilators 49
4.2.1 Percutaneous Entry Needle/Devices 49
4.2.2 Vessel Dilators 49
4.2.3 Guidewires 49
4.2.4 Introducer Sheaths 50
4.2.4.1 Universal Color Coating 51
4.2.5 Flush/Diagnostic/Guiding Catheters 51
4.2.5.1 Types of Catheters 52
4.2.6 Angioplasty Balloons 52
4.2.7 Stents 53
4.3 Endograft Selection 56
4.4 Accessory Tools 58
Reference 58
5 Guidewires Used in Thoracic Aortic Endografting 59
5.1 General Overview 59
5.2 Technical Pearls 61
5.2.1 Advancing a Wire Through Severely Angulated vessel 61
5.3 Guidewires Used in Thoracic Endografting 63
5.3.1 Lunderquist Stiff Wire Guides (LES) 63
5.3.2 LES3 Lunderquist Wire Guide (Curved Tip) 63
5.3.3 Amplatz Stiff Wire 65
References 65
6 Sheaths Used in Thoracic Aortic Endografting 66
References 69
7 Stents Used in Conjunction with Thoracic Aortic Endografting 70
7.1 Stents 70
7.1.1 Self-Expanding Stents 72
7.1.2 Covered Stents 75
References 76
8 Vascular Closure Devices 77
8.1 Manual Compression 77
8.2 Types of Vascular Closure Device 77
8.2.1 Active Devices 78
8.2.2 Passive Devices 78
8.3 Active Vascular Closure Devices 78
8.3.1 Prostar XL10 and Perclose A-T 78
8.3.1.1 Prostar XL10 78
8.3.1.2 Perclose A-T 79
8.3.2 Angioseal Closure Device 79
8.3.2.1 Device Deployment 80
8.3.3 StarClose System 81
8.3.4 Passive Vascular Closure Devices (VCD) 81
8.3.4.1 Boomerang Closure Wire 81
8.3.4.2 Patch Technology 83
8.3.4.3 Syvec Patch 83
8.3.4.4 D-Stat 83
8.3.4.5 ChitoSeal 83
8.4 Benefits of VCDs 83
8.5 Drawbacks of VCDs 84
8.6 Outcomes 84
8.7 Conclusions 85
Suggested Readings 85
Part II Imaging Required for Thoracic Endografting 86
9 Fluoroscopy and Angiographic Imaging in Thoracic Aortic Endografting 87
9.1 Contrast Power Injection Versus Hand Injection 87
9.2 Basic Fluoroscopic Projections 88
9.2.1 Angiography for Evaluation of Access Vessels 88
9.2.2 Fluoroscopy as Applied to the Thoracic and Arch Aorta 89
9.2.3 Normal Arch Aorta 89
9.2.4 Variations of Aortic Arch 89
9.3 Thoracic Aneurysms 91
9.4 Thoracic Arch Aneurysms 92
9.5 Aortobronchial Fistula 94
9.6 Coarctation of the Aorta 94
9.7 Type B Dissections 94
9.8 Penetrating Aortic Ulcers 96
9.9 Aortic Pseudoaneurysm 97
9.10 Mycotic Pseudoaneurysm 98
References 98
10 Case-Specific CT Imaging to Evaluate Thoracic Aortic Pathologies 99
10.1 Coarctation of the Thoracic Aorta 100
10.2 Penetrating Aortic Ulcer 103
10.3 Thoracic Aortic Aneurysm 105
10.4 Type B Aortic Dissection 106
10.4.1 AcuteType B Aortic Dissection 106
10.4.2 Chronic Type B Dissection 107
10.5 Saccular Arch Pseudoaneurysms 109
10.6 Innominate Artery Pseudoaneurysm 111
10.7 Thoracic Arch Aneurysm 112
10.8 Thoracoabdominal Aneurysms 114
10.9 CT Imaging of the Thoracic Aorta for Pre-operative Planning 115
Reference 118
11 Intravascular Ultrasound Applications to the Thoracic Aorta 119
11.1 Universal IVUS Applications 120
11.2 Selective Applications of IVUS to the Abdominal Aorta 122
11.3 Selective Application of IVUS in the Management of Thoracic Aortic Aneurysms 124
11.4 IVUS Application to Thoracic Aortic Dissections 125
11.5 IVUS Application for the Management of Coarctation of the Aorta 126
11.6 IVUS Management for the Management of Penetrating Aortic Ulcers 128
Reference 129
12 Endovascular Imaging, Planning, and Sizing for Treatment of Thoracoabdominal Aortic Aneurysms 130
12.1 Introduction 130
12.2 Patient Selection 130
12.3 Pre-operative Data Acquisition and Reconstructions 131
12.4 Planning 134
12.4.1 Plan the Seal Zone 135
12.4.2 Select Side for Graft Body Introduction 135
12.4.3 Choose Fenestration and Branch Configuration 135
12.4.4 Determine Inner Aortic Vessel Diameter 137
12.4.5 Choose Proximal Graft Length 137
12.4.6 Choose Distal Body Length 138
12.4.7 Choose Ipsilateral Leg Length 138
12.4.8 Choose Ipsilateral Leg Diameter 138
12.4.9 Choose Contralateral Leg Length 138
12.4.10 Choose Ipsilateral Leg Diameter 138
12.5 Limitations of Branched Grafts 138
12.6 Summary 139
References 139
Part III Access Techniques Required for Thoracic Endografting 140
13 Brachial Access Techniques Used in Thoracic Aortic Endografting 141
13.1 Case Scenario 143
13.2 Endovascular Technique 143
References 145
14 Transfemoral Access Techniques in Thoracic Aortic Endografting 146
14.1 Retrograde Percutaneous Access 146
14.2 Percutaneous Retrograde Femoral Artery Access 146
14.3 Contraindication to Percutaneous Femoral Access 149
14.4 Open Retrograde Access 149
14.5 Complications of Femoral Access 151
Reference 151
15 Retroperitoneal Access for Thoracic Aortic Endografting 152
15.1 Introduction 152
15.2 Indications and Pre-operative Planning 152
15.2.1 Patient Selection 152
15.2.2 Construction of a 10 mm Retroperitoneal Conduit 154
15.3 Direct Iliac Artery Access via a Retroperitoneal Approach 155
References 157
16 Techniques for Constructing an Endoconduit 158
16.1 Case Scenario 160
16.2 Endovascular Technique 161
References 163
Part IV Bolton Relay Thoracic Endovascular Stent Graft Device 164
17 Bolton Relay Thoracic Stent Graft System 165
17.1 Device Description 165
17.2 Brief Clinical Results 167
Reference 171
Part V Cook Zenith Thoracic Stent Graft Device 172
18 Zenith TX2 Thoracic Endograft 173
18.1 Zenith TX2 Stent Graft System 174
18.1.1 Device Description 175
18.2 Deployment of TX2 Cook Endoluminal Graft 178
18.2.1 General Cautions 178
18.2.2 Deployment Overview 178
18.2.2.1 Position Stiff Lunderquist Wire in Aortic Arch 178
18.2.2.2 Position Proximal Component 178
18.2.2.3 Unsheath Proximal Component 180
18.2.2.4 Release Proximal Component Trigger Wires 180
18.2.2.5 Remove Introducer Sheath for Proximal Component 180
18.2.2.6 Position Distal Component 182
18.2.2.7 Unsheath Distal Component 182
18.2.2.8 Release Distal Component Trigger Wires 182
18.2.2.9 Optional: Molding Balloon 183
18.2.2.10 Perform Final Flush Aortogram 184
18.3 Case Study 184
18.4 Endovascular Procedure 186
References 188
19 Cook Zenith Dissection Endovascular Stent 189
19.1 Cook Zenith Dissection Endovascular System Deployment Overview 189
19.1.1 General Precautions 189
19.1.2 Position Extra Stiff LunderquistTM Wire Guide in Aortic Arch 193
19.1.3 Position Proximal Component to Cover Entry Tear 194
19.1.4 Unsheath Proximal Component 194
19.1.5 Release Proximal Component Trigger Wires 195
19.1.6 Remove Gray Positioner from Proximal Component Introducer Sheath 198
19.1.7 Position Dissection Endovascular Stent(s) 198
19.1.8 Unsheath Dissection Endovascular Stent 199
19.1.9 Release Dissection Endovascular Stent Trigger Wires 199
19.2 Final Angiogram 201
19.3 Case Study 202
19.3.1 Zenith DissectionTM Case Study 204
20 COOK Medical Accessories Used for Deployment of the TX2 COOK Stent Graft 207
20.1 Wire Guides 207
20.2 Lunderquist Wire 207
20.3 Catheters 211
20.4 Embolization 212
20.5 Access Needle 215
Reference 216
21 Clinical Data Using the Zenith TX2 Thoracic Graft 217
21.1 The STARZ Trial 217
21.2 International Controlled Clinical Trial of Thoracic Endovascular Aneurysm Repair with the Zenith TX2 Endovascular Graft: 1-Year Results 218
21.2.1 Trial Design 218
21.2.2 Follow-Up 220
21.2.2.1 Repair Techniques 220
21.2.3 Results 221
21.2.4 Patient Characteristics 221
21.2.5 Aneurysm/Ulcer Characteristics 223
21.2.6 Mortality 223
21.2.7 All Morbidity 225
21.2.8 Neurologic Morbidity 225
21.2.9 Stroke 226
21.2.10 Paraplegia 226
21.2.11 Paraparesis 226
21.2.12 Rupture 226
21.2.12.1 Secondary Interventions 226
21.2.13 Change in Aneurysm or Ulcer Size 227
21.2.14 Endoleak 227
21.2.15 Migration 227
21.2.16 Device Integrity 228
21.2.17 Device Patency 228
21.3 Conclusion 228
References 229
Part VI W.L. Gore TAG Thoracic Endovascular Stent Graft Device 230
22 The Gore TAG Endoprosthesis 231
22.1 Gore TAG Delivery System 233
22.2 Patient Selection 233
22.3 Pre-procedural Planning and Imaging 235
22.4 Thrombus in Proximal Neck 236
22.5 Calcium in Proximal Neck 236
22.6 Deployment Optimization Techniques 237
22.7 Procedural Steps for Deployment of Gore Device 237
22.8 Patient Follow-Up and Recommendation 243
22.9 Preference Card 243
22.9.1 Sheaths 243
22.9.2 Catheters 243
22.9.3 Guidewires 244
22.9.4 Balloons 244
22.9.5 Miscellaneous 244
References 244
23 Gore TAG Multicenter Phase II Trial 246
23.1 Gore TAG Thoracic Endoprosthesis 246
23.2 Device Design 246
23.3 Feasibility Study 247
23.4 Pivotal (Phase II) Trial 248
23.4.1 Objectives and Hypotheses 248
23.4.2 Study Design 248
23.4.3 Follow-Up 248
23.4.4 Results of the Pivotal Study 249
23.4.4.1 Clinical Material 249
23.4.5 Operative Data 251
23.4.6 Early Adverse Events 251
23.4.6.1 Mortality 251
23.4.7 Spinal Cord Ischemia 251
23.4.8 Cerebrovascular Accidents 252
23.4.9 Endoleaks 252
23.4.10 Other MAEs 252
23.4.11 Hospital Length of Stay 252
23.4.12 Late Outcome 252
23.4.12.1 Late Survival 252
23.4.12.2 Major Adverse Events 253
23.4.13 Device-Related Events 253
23.4.14 Confirmatory Study 255
23.4.14.1 Objectives and Hypotheses 255
23.4.14.2 Design 255
23.4.14.3 Results of the Confirmatory Study 255
References 257
24 Five-Year Results of Endovascular Treatment with the Gore TAG Device Compared with Open Repair of Thoracic Aortic Aneurysms 258
24.1 Follow-Up 259
24.2 Mortality 260
24.3 Adverse Events 262
24.3.1 Endoleaks, Reinterventions, and Secondary Procedures 262
24.4 Sac Diameter 265
References 266
25 Technique of Thoracic Endografting for Thoracic Aneurysm Using the Approved Gore TAG Device 267
25.1 Preference Card 273
25.1.1 Equipment 273
25.1.2 Procedure Pearls 275
Reference 277
Part VII Medtronic Talent/Valiant Thoracic Endovascular Stent Graft 278
26 Talent Thoracic Stent Graft 279
26.1 The Talent Device 279
26.2 Talent Graft Dimensions 281
26.3 Stent Graft Sizing Guidelines 281
26.4 Delivery System Insertion of the Talent Stent Graft System 282
26.5 Stent Graft Positioning 283
26.6 Deploy Proximal End 284
26.7 Deploy Remaining Stent Graft 284
26.8 Remove Delivery System 284
26.9 Model Graft to Vessel 287
26.10 Final Angiogram 287
Reference 287
27 Valiant Thoracic Stent Graft 288
27.1 Device Implantation 293
27.2 Deploying Proximal End 293
27.3 Removal of Delivery System 295
27.4 Balloon Angioplasty 295
28 Pivotal Results of the Medtronic Vascular Talent Thoracic Stent Graft System: The VALOR Trial 298
28.1 Results 300
28.1.1 Demographics 300
28.2 Procedure and Hospital Course 300
Reference 308
Part VIII Endografting for Thoracic Aortic Aneurysms 309
29 Endovascular Management of Thoracic Aortic Aneurysm Using a Cook Zenith TX2 Endograft 310
Cook Zenith TX2 Thoracic Endovascular Graft 310
29.1 Introduction 310
29.2 Case Scenario 311
29.3 Endovascular Procedure 312
References 314
30 Management of a Patient with Thoracic Aortic Aneurysm Using Gore TAG Device 315
30.1 Case Scenario 315
30.2 Recommendation 316
30.3 Procedure 316
30.4 Discharge CT Scan 319
30.5 Discussion 320
References 320
31 Management of a Thoracic Aortic Aneurysm Using a Talent Stent Graft 322
31.1 Case Scenario 323
31.2 Intravascular Ultrasound and Angiogram 323
31.3 Surgical Planning 324
31.4 Endovascular Procedure 326
Reference 327
32 Endovascular Management of a Thoracic Aortic Aneurysm Using a Retroperitoneal Conduit 328
32.1 Introduction 328
32.2 Case Scenario 329
32.3 Hybrid Endovascular Technique 329
32.4 Construction of Retroperitoneal Conduit 331
32.5 Discussion 335
References 335
Part IX Endografting for Thoracic Aortic Dissections 336
33 Endovascular Management of Acute Type B Dissection 337
33.1 Current Trials 338
33.1.1 VIRTUE 338
33.1.2 ADSORB 338
33.1.2.1 Zenith Dissection Endovascular System 339
33.1.2.2 Endovascular Technique for Type B Dissections 339
33.2 Discussion 342
References 344
34 Endovascular Management of Chronic Type B Thoracic Aortic Dissection 345
34.1 Endovascular Techniques 346
34.2 Discussion 349
References 351
35 Retrograde Type A Dissection After Endovascular Management of Type B Dissection 353
35.1 Case Scenario 354
35.2 Technical Details of Endoluminal Graft Deployment 355
35.3 Post-operative Surveillance (Retrograde Type A Dissection) 356
35.4 Discussion 356
References 360
Part X Endografting for Varied Thoracic Aortic Pathologies 362
36 Aorto-bronchial Fistula 363
36.1 Endovascular Techniques 364
36.2 Discussion 367
References 367
37 Endovascular Management of Penetrating Aortic Ulcer 368
37.1 Endovascular Procedure 369
37.2 Case Scenario 372
37.3 Endovascular Technique 373
37.4 Discussion 375
References 376
38 Endovascular Approach to Coarctation of the Thoracic Aorta 377
38.1 Endovascular Techniques 378
38.2 Discussion 382
References 383
39 Endovascular Management of Traumatic Aortic Disruption 384
39.1 Introduction 384
39.2 Endovascular Techniques 386
39.3 Discussion 389
References 389
40 Thoracic Aortic Endografting for Traumatic Transection 391
40.1 Endovascular Techniques 392
40.2 Discussion 395
References 396
41 Hybrid Management of the Thoracic Aorta: Extending Proximal Landing Zones 397
41.1 Transposition of Left Subclavian to Left Carotid Artery Bypass/Left Subclavian to Left Carotid Artery Bypass Graft with Deployment of Endoluminal Graft1,2 398
41.2 Carotid to Carotid Bypass with Deployment of Endoluminal Graft1,2 398
41.3 Aorto to Left Carotid Bypass with Deployment of an Endoluminal Graft1,2 402
41.4 Thoracic Debranching Hybrid Procedure1,2 402
41.5 Discussion 405
References 405
42 Complications of Thoracic Aortic Endografting 407
42.1 Endoleaks 407
42.2 Post-operative Image Surveillance for Endoleaks 408
42.3 Type 1 Endoleak 408
42.3.1 Management of a Type I Endoleak 410
42.3.1.1 Balloon Angioplasty 410
42.3.1.2 Placement of a Proximal or Distal Cuff 411
42.3.1.3 Coil Embolization 411
42.3.1.4 Open Conversion 411
42.3.2 Management of a Distal Type 1 Endoleak 411
42.3.3 Retrograde Type I Endoleak Associated with the Treatment of Type B Aortic Dissections 412
42.4 Type II Endoleaks 412
42.4.1 Management of Type II Endoleak by Coil Embolization 414
42.4.2 Management of a Type II Endoleak by Injection of Thrombin in Sac 414
42.4.3 Thoracoscopic Ligation of Intercostal Artery 415
42.5 Type III Endoleak 416
42.5.1 Stent-Related Maldeployment 416
42.6 Complications Related to Vascular Access 417
42.6.1 General Complications 417
Reference 417
Part XI Future Technology 418
43 Endovascular Management of Ascending Aortic Pathologies 419
43.1 Introduction 419
43.2 Case Scenario 420
43.3 Endovascular Approach 421
43.4 Discussion 422
References 425
44 Use of a Remote Wireless Pressure Sensor for Post-operative Surveillance of Thoracic Endoluminal Grafts 426
44.1 Introduction 426
44.2 Case Scenario 427
44.3 Technical Details 427
44.4 Discussion 431
References 431
Index 433
| Erscheint lt. Verlag | 18.8.2010 |
|---|---|
| Zusatzinfo | X, 350 p. 330 illus., 230 illus. in color. |
| Verlagsort | London |
| Sprache | englisch |
| Themenwelt | Medizinische Fachgebiete ► Chirurgie ► Herz- / Thorax- / Gefäßchirurgie |
| Medizinische Fachgebiete ► Innere Medizin ► Kardiologie / Angiologie | |
| Medizinische Fachgebiete ► Radiologie / Bildgebende Verfahren ► Radiologie | |
| Studium ► 1. Studienabschnitt (Vorklinik) ► Biochemie / Molekularbiologie | |
| Schlagworte | anatomy • Aneurysm • Angiography • Cardiovascular • Computed tomography (CT) • Stent • Surgery • Ultrasound |
| ISBN-10 | 1-84996-296-0 / 1849962960 |
| ISBN-13 | 978-1-84996-296-4 / 9781849962964 |
| Haben Sie eine Frage zum Produkt? |
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