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R9 > Chapter 78 - TAAA endovascular > Flashcards

Chapter 78 - TAAA endovascular Flashcards

1
Q

When was the first TEVAR approved by FDA

A

2005

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2
Q

Approved devices in US for TEVAR

A

1) Gore CTAG (2012) 2) Medtronic valiant (2014) 3) Cook TX2 with proform (2008) 4) Cook Zenith alpha (2015) 5) Bolton relay plus (2012)

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3
Q

Gore CTAG device diameter length delivery profile

A

CTAG = Comformable thoracic aortic graft 21-45 mm 10, 15, 20 cm ID 18-24

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4
Q

Medtronic valiant device diameter length delivery profile

A

22-46 mm 107-224 mm OD 22, 24, 25

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5
Q

Cook TX2 with proform device diameter length delivery profile

A

28-42 120-216 mm proximal 136-207 mm distal ID 20, 22

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6
Q

Cook Zenith alpha device diameter length delivery profile

A

24-46 mm 105-233mm proximal 142-211 mm distal ID 16, 18, 20

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7
Q

Bolton relay plus device diameter length delivery profile

A

22-46 mm 10, 15, 20, 25 cm OD 22, 23, 24, 25, 26 no tapering component

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8
Q

Material of Gore CTAG and key features

A

ePTFE with nitinol deploys from middle of graft passive fixation oversize 7-22%

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9
Q

Material of Medtronic valiant captivia device

A

monofilament woven polyester to sinusoidal nitinol spring (outside of graft) passive fixation 8 peaked bare metal proximal FREEFLO configuration oversize 10-20%

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10
Q

Cook TX2 with proform material

A

Woven dacron with stainless steel z-stents stents on inside at seal zone and outside for rest barbs provide active fixation

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11
Q

Cook zenith alpha material

A

woven polyester and nitinol active fixation bare stents

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12
Q

Bolton relay material

A

woven polyester to nitinol stents active fixation with bare stents (also available with non-bare stents) oversize 10-15%

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13
Q

Ideal access vessel size

A

> 7 mm

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14
Q

Internal iliac conduit

A

Covered stents crack and pave controlled rupture of iliac then use it as conduit for TEVAR

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15
Q

11 zones of SVS TEVAR landing

A

Zone 0 = proximal to innominate Zone 1: proximal to left CCA Zone 2: proximal to left SCA Zone 3: < 2cm from left SCA Zone 4: 3cm distal to SCA to T6 Zone 5: T6 to celiac Zone 6: celiac to top of SMA Zone 7: SMA to suprarenal aorta Zone 8: perirenal aorta Zone 9: infrarenal aorta Zone 10: CIA Zone 11: EIA

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16
Q

Problem with excessive oversizing

A

1) graft infolding 2) gutter formation 3) aortic neck degeneration

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17
Q

How often do TEVAR have to land in zone 2

A

20%

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18
Q

Percentage of people with dominant left vert

A

> 60%

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19
Q

Risk of stroke without and with left SCA revasc

A

5.5 vs 1.2%

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20
Q

European collaborators on stent/graft techniques for aortic aneurysm repair EUROSTAR on spinal ischemia

A

left SCA coverage without revasc is associated with 3.49x more spinal ischemia

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21
Q

Mandatory left SCA revascularization reasons:

A

1) dominant left vert 2) LIMA CABG 3) left arm hemodialysis 4) aberrant right SCA 5) hypoplastic/absent right vert 6) left vert terminate in posterior cerebellar artery 7) occluded IIA 8) anomalous origin of left vert from arch 9) high risk for spinal ischemia (extensive coverage or previous AAA repair)

22
Q

SVS guidelines on left SCA revasc

A

for all elective TEVAR prior to TEVAR

23
Q

TEVAR with celiac coverage outcome mesenteric ischemia paraplegia rate

A

6% mesenteric ischemia 6% paraplegia

24
Q

periscope technique for celiac/sma during TEVAR

A

1) femoral access 2) self-expanding sent into celiac/sma 3) refinforcement maybe needed

25
Q

Complication with spinal drain placement

A

3%

26
Q

MAP associated with spinal cord ischemia

A

< 70 mmHg

27
Q

EUROSTAR on spine level coverage and spinal cord ischemia

A

40% with spinal cord ischemia had T10 coverage not clear no clear recommendations here

28
Q

Overlap between grafts if two are the same diameter

A

7.5-10 cm

29
Q

Post TEVAR care key points

A

CSF < 10 cm H2O MAP > 80 mmHg if neuro deficit, decrease CSF increase MAP to 100

30
Q

Pivotal trials of Cook Gore Medtronic spinal cord ischemia mortality endoleak, tech success long term aneurysm-mortality

A

TABLE 78.2

31
Q

Conduits used in the pivotal trials

A

9.4-21% most to CIA, some to Ao

32
Q

TEVAR mortality

A

1-2% compared to 7% of open

33
Q

one year aneurysm-related survival for TEVAR

A

95% vs 89% open

34
Q

5 year survival TEVAR vs open

A

comparable 63-68%

35
Q

STARZ trial morbidity between TEVAR and open

A

TEVAR 15.6% open 44.3% mostly attributable to pulmonary complications

36
Q

Vascular complication rate of TEVAR

A

5-7%

37
Q

EUROSTAR factors in risk of stroke after TEVAR

A

1) female 2) prolonged procedure > 160 min

38
Q

Stroke rate after TEVAR

A

3-7%

39
Q

Rate of paraplegia and paraparesis between TEVAR and OPEN

A

6.2 vs 13% permanent paraplegia 1.6 vs 5.1 higher centres of open say 2.5-3% only for open but bias

40
Q

Percentage contribution to spinal cord perfusion of lumbar and pelvic collaterals

A

25%

41
Q

Risk factors associated with spinal cord ischemia after TEVAR

A

1) prev AAA repair 2) extensive thoracic aortic coverage 3) renal insufficiency 4) intraoperative hypotension (SBP < 80mmHg) 5) coverage of hypogastric artery and left SCA

42
Q

Endoleak from the pivotal trials

A

Talent had highest leak 10% persistent Tag had higher type 1 and 3 leaks lots of bias not sure what it means

43
Q

1 year sac enlargement > 5 mm in TEVAR

A

7-14% higher in old TAG because porous PTFE

44
Q

Endograft migration

A

0.7-3.9% with current devices

45
Q

Revision after TEVAR

A

higher than open repair higher in the talent grafts

46
Q

Hybrid visceral debranching and TEVAR key results

A

Complication 19-59% Graft thrombosis 6-11% 30d mortality: 13-14%

47
Q

Predictors of mortality in hybrid procedure

A

1) 3+ vessel revasc 2) CAD 3) CHF 4) high SVS clinical comorbidity score 5) CKD

48
Q

1 years survival after hybrid TAAA repair

A

77%

49
Q

Branch devices for visceral TAAA

A

1) Cook off-shelf t-branch 2) Cook custom-made device 3) Cook ZFEN 4) Gore 4 downward cuff 5) Gore 2 up 2 down cuff 6) medtronic moedular graft

50
Q

Thoracic arch branch devices

A

1) Medtronic valiant mona LSA 2) Gore tag thoracic branch endoprosthesis 3) cook zenith arch branched device 4) Endospan nexus aortic arch system 5) bolton medical ascending thoracic

R9 (200 decks)

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