4/16/2015 The Aortic Case I Wish I Had Not Started Aka - - PowerPoint PPT Presentation

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4 16 2015
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4/16/2015 The Aortic Case I Wish I Had Not Started Aka - - PowerPoint PPT Presentation

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4/16/2015 The Aortic Case I Wish I Had Not Started Aka Disclosures: Research and educational grants paid to Stanford from The Case I wish I never would have Cook, Medtronic, WL Gore done No personal financial disclosures

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VASCULAR SURGERY

Jason T. Lee UCSF Vascular Symposium 2015

The Aortic Case I Wish I Had Not Started Aka The Case I wish I never would have done…

VASCULAR SURGERY

Disclosures:

  • Research and educational grants paid to Stanford from

Cook, Medtronic, WL Gore

  • No personal financial disclosures
  • Off Label use of devices

VASCULAR SURGERY

Disclosures: Not my idea…..

VASCULAR SURGERY

Well, I guess that’s not true….

Disclosures: Not my idea…..

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  • 75 year old almond farmer presented in 2010

with syncope/chest pain/pneumonia

  • Noted to have 3.5cm ascending aortic dilation
  • In followup in 2013 had recurrent chest

pain/SOB issues

  • Imaging now shows ascending increased to 5.8cm
  • Remainder of aorta scanned also showed 5.5cm dilation

at hiatus and 7.2 cm juxtarenal

  • Cardiopulmonary reserve limited
  • 269 pounds, BMI 40, sleep apnea 72% saturation
  • FEV1 0.84L (29% predicted)
  • Dilated left atrium, mild MR, TR, moderate AI, normal EF
  • Discussed numerous times in clinic and

conference about risk/benefit

VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY

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A.

  • pen repair

B.

hybrid debranching

C.

sandwich/snorkel/parallel

  • D. octopus

E.

PMEG

F.

IDE device

  • G. do nothing
  • p

e n r e p a i r h y b r i d d e b r a n c h i n g s a n d w i c h / s n

  • r

k e l / p a r a l l e l

  • c

t

  • p

u s P M E G I D E d e v i c e d

  • n
  • t

h i n g 21% 9% 15% 33% 9% 3% 9% VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY

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VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY

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VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY

Now What????

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VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY

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Lessons

  • Octopus configuration
  • Parallel viabahns in gate
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VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY