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

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

Jan 14, 2024 285 likes •476 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

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SLIDE 1

Target vessel stents – how to match stent for the purpose

Mr Simon Neequaye Consultant Vascular and Endovascular Surgeon

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SLIDE 2

Target Vessel Stents

Maintenance of perfusion to visceral arteries with modular EVAR

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SLIDE 3

Contained rupture-previous thoracoabdominal surgical

  • 64 yo female
  • Perfusion Snake to

intercostals

  • Branch to CA from mid

DTA

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SLIDE 4

Chimney to CA Graft, T-Branch plus Bifurcated distally

9 x 59 Atrium

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SLIDE 5

T-Branch

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SLIDE 6

SMA and Right Renal

7 x 59 plus 7 x38 Atrium 9 x 59 and 9 x 38 Atrium

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SLIDE 7

LRA –sacrificed as unable to track bridging stent-angle plus stenosis

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SLIDE 8
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SLIDE 9

Greatest Vascular Surgeon Ever!

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SLIDE 10
  • 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.

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SLIDE 11
  • 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%

J Vasc Surg 2013;57:926-33.

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SLIDE 12

Long term failure modes- Target vessel stents

  • Endoleak,
  • Kink,
  • Fracture
  • Migration
  • Occlusion
  • Stenosis
  • Perforation.

CA Stent perforation SMA stent dislocation

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SLIDE 13

Control in an unstable world

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SLIDE 14

Happy ending-1

  • Graft Planning.

– Prioritize stability in seal zone. – Consider Fenestrations for renals c.f Branches

  • Long term surveillance
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SLIDE 15

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

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SLIDE 16

Happy ending-3

  • Pay special attention to stents that bridge

space.

  • Atrium
  • Viabahn
  • Fluency
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SLIDE 17

Happy ending-3

  • Pay special attention to stents that bridge

space.

  • Atrium
  • Viabahn
  • Fluency

? ?

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SLIDE 18

Happy Ending!

  • Plan Aortic Graft

carefully

  • Size bridging stent well
  • Use additional bare

stents to manage transition or kinks.

  • Be wary of bridging

space