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Updates on management of late complications after endovascular aortic stent grafting Endovascular therapy Team New Heart Watanabe Institute, Tokyo, Japan Hiroshi Ohtake M.D ,Ph.D Vietnam and me Visiting to BACH MAI Hospital, 2011 Supported by Mr Ryotaro Sugi Special Ambassador of Vietnam and Japan Vietnam and me Clinical & Research Relationship between E-hospital, 2011 Supported by Mr Ryotaro Sugi Special Ambassador of Vietnam and Japan Vietnam and me TEVAR for a young patient of aortic injury in Hanoi Medical Univ., 2013 Supported by Mr Ryotaro Sugi Special Ambassador of Vietnam and Japan Introduction • Endovascular aortic repair (EVAR) and Thoracic endovascular aortic repair (TEVAR) changed the indication for aneurysms Previously, only open surgery was performed elder patients, not healthy patients, patients after thoracic or abdominal surgery were out of the indication My TEVAR cases 80 70 60 50 40 30 20 10 TEVAR 1998 2000 2002 2004 2006 2008 2010 2012 2014 Open Surgery Indications of TEVAR/EVAR including various aortic pathologies aneurysm dissection atherosclerotic ulcer traumatic injury inflammation / infection fistula mural thrombus / plaque tumor invasion However… • EVAR and TEVAR are – non-invasive – without the heart-lung machine – not clarified the management of late complications Late complications • • • • Rupture of aneurysms Dissection by the edge of stentgrafts Infection of the stentgrafts Thrombus in the stentgrafts 1-2% 0-2% 0-1% 0-0.5% / 3years Late complications • • • • Rupture of aneurysms Dissection by the edge of stentgrafts Infection of the stentgrafts Thrombus in the stentgrafts 1-2% 0-2% 0-1% 0-0.5% / 3years inferior mesenteric artery (inflow) embolization inferior mesenteric artery (inflow) embolization inferior mesenteric artery (inflow) embolization Endoleak • Type Device problems – Fracture of devices – Connection of devices # should be treated immediately Endoleak • Type – 1-3% – Treatment • Re-stentgrafting Endoleak • Type Device problems – Blood oozing through the graft • Thin wall graft # Observation in many cases, disappear! Endoleak • Type Device problem ?? – No blood oozing – Only pressure spread • CT shows no endoleak • However, the diameter expand # should be treated Endoleak • Type – Unknown – Treatment • Re-stentgrafting Late complications • • • • Rupture of aneurysms Dissection by the edge of stentgrafts Infection of the stentgrafts TEVAR cases Proximal > Distal Thrombus in the stentgrafts Stanford A Open surgery Stanford B Observation 1-2% 0-2% 0-1% 0-0.5% / 3years Late complications • • • • Rupture of aneurysms Dissection by the edge of stentgrafts Infection of the stentgrafts Antibioticsin the stentgrafts Thrombus Open surgery 1-2% 0-2% 0-1% 0-0.5% / 3years Rare complication months later massive hemo-sputa Rare complication Fistula between Aneurysmal sac and Bronchus Rare complication Coil embolization Follow-up protocol for minor Endoleak Endoleak(+) Over year, CT Angio Endoleak(-) CT plain CT plain CT Angio CT plain CT Angio CT Angio Operative findings Endoleak(-) Endoleak(+) CT plain CT Angio < 1month
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