Connection of Celiac Artery to Branched Stent-Graft by Retrograde Access through … · Zipfel B...
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Gefäßzentrum Berlin-Brandenburg Connection of Celiac Artery to Branched Stent-Graft by Retrograde Access through SMA: A Case Report Burkhart Zipfel MD, PhD; Andreas Gussmann MD, Jens Kühn MD Helios Kliniken Berlin Buch, Bad Saarow LINC 2018
Transcript of Connection of Celiac Artery to Branched Stent-Graft by Retrograde Access through … · Zipfel B...
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Gefäßzentrum Berlin-Brandenburg
Connection of Celiac Artery to Branched Stent-Graft by Retrograde Access through SMA:
A Case Report
Burkhart Zipfel MD, PhD; Andreas Gussmann MD, Jens Kühn MD
Helios Kliniken Berlin Buch, Bad Saarow
LINC 2018
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Zipfel B
The case
• 62 year old woman
• TAAA Crawford V • 56 mm diameter
• Risk factors• Obesity (BMI 36)
• Art. Hypertension
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Zipfel B
The plan
LINC 2018Retrograde acces to CA in BrTEVAR 3
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Zenith CMD:
2 branches
2 fenestrations
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Zipfel B
The challenge
LINC 2018Retrograde acces to CA in BrTEVAR 4
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CA origin 90° angulation
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1st Procedure 18.04.2017Implant the Graft – Stent the RA Fenestrations
SMA and CA branch left open for temporary sac perfusion
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Zipfel B LINC 2018Retrograde acces to CA in BrTEVAR 6HELIOS Gefäßzentrum Berlin-Brandenburg
2nd Procedure 06.06.2017Connect SMA and CA branch– right axillary approach
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Zipfel B LINC 2018Retrograde acces to CA in BrTEVAR 7HELIOS Gefäßzentrum Berlin-Brandenburg
2nd Procedure 06.06.2017Access to CA failed
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3rd Procedure 11.08.2017Connect CA branch – double right axillay approach
Microcatheter through SMA
Hepato-duodenal arteryentered
Collateral to CA
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3rd Procedure 11.08.2017
0,018” wire enters aorta through CA
Wire snared through CA branch.7 F Flexor sheath advanced into CA.Sheath to
protect SMA
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3rd Procedure 11.08.2017
Advanta V12 8x59 mm
Good inflow
Perforation of collateral
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3rd Procedure 11.08.2017
Injection through SMAdemonstrates extend of perforation
Balloon to control bleeding
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3rd Procedure 11.08.2017
Catheters in hepato-duodenal artery from both sides
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3rd Procedure 11.08.2017
Coiling ofhepato-duodenal artery from both sides
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Zipfel B
The course
• Extubation on the table
• Hemodynamically stable
• Insignificant blood loss• Hb dropped 12.1 to 9.2 (g/l)
• No transfusion
• Discharge POD 4
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Zipfel B
The CT 3 months later
LINC 2018Retrograde acces to CA in BrTEVAR 15
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No endoleak
CA branch perfused despite 90° angulation
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Zipfel B
Conclusion
• A running through wire of collateral
mesenteric arteries may solve access
problems to target arteries in branched
TEVAR.
• However injury to these fragile collaterals
is likely and it’s management has to be
prepared in advance.
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Zipfel B
Thank youfor your attention.—
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Gefäßzentrum Berlin-Brandenburg
Connection of Celiac Artery to Branched Stent-Graft by Retrograde Access through SMA:
A Case Report
Burkhart Zipfel MD, PhD; Andreas Gussmann MD, Jens Kühn MD
Helios Kliniken Berlin Buch, Bad Saarow
LINC 2018
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