Lille

• Wednesday, January 25th: 11:36 - 12:04, Room 2 - Main Arena 2

  Case 43 – EVAR + left iliac branched device

  Center:

  Lille

  Case 43 – LIL 01: male, 63 years, (L-D)

  Operators:

  • Stephan Haulon

  CLINICAL DATA
  Incidental finding of AAA during work-up for intermittent claudication
  CTA: AAA 51 mm, aneurysm proximal right CIA, dilatation distal left CIA
  Plan: EVAR + left iliac branched device + embolisation right IIA
  
  RISK FACTORS
  Former smoker, hypertension
  
  HISTORY
  Aortic valve stenosis, CVA, bilateral inguinal hernia repair, lumbar herniated disc repair
  
  PRESENT STATE
  Duplex supra-aortic vessels: normal
  Cardiac ultrasound: EF 74%, AS (3.13 cm2), Ao asc 45 mm
  
  PROCEDURAL STEPS
  1. L: 10F sheath, Lunderquist, dilators (up to 20F) 50 U/kg Heparin
  
  2. R: 5F55 sheath, TERUMO, SIM, AMI embolized (Amplatzer 6 mm)
  
  3. R: 10F Right IIA embolized (Coils 10 mm)
  
  4. R: 10F sheath, wire exchange: starter, TERUMO, Rosen-GW stiff wire (COOK), 12F sheath, 45cm; tip positioned above aortic bifurcation
  
  5. L: ZBIS advanced into distal aorta, unsheath until preloaded catheter of ZBIS appears; exchange wire of preloaded catheter for 260 cm TERUMO
  
  6. R: Snare through-and-through (tat)-wire (TERUMO, 0.035") – advance dilator of 12F sheath
  
  7. R: 12F dilator connects to tip of preloaded catheter – secure both ends with clamps
  
  8. Position C-arm and open branch of ZBIS (COOK)
  
  9. Advance 12F dilator into ZBIS (pull & push, 'nobody holds the wire')
  
  10. Puncture valve of 12F TERUMO/catheter to catheterize IIA, angio
  
  11. Wire exchange/Rosen
  
  12. Over Rosen, advance 55 cm 7F sheath into 12F to IIA, tat-wire under tension
  
  13. Advance bridging stentgraft in 7F sheath
  
  14. Remove tat-wire
  
  15. Pull down ZBIS, depending on angle of IIA
  
  16. Pull back 7F sheath and inflate bridging stent
  
  17. Advance 7F sheath again into stentgraft – dilate distal seal if required – Angio
  
  18. Finish deployment of Zbis – release trigger wires
  
  19. Secure branch/stentgraft with balloon while removing nose cone
  
  20. Continue with EVAR
  
  21. R: release proximal stent
  
  22. L: iliac angiogram
  
  23. L: contralateral limb insertion holding the main body, deployment
  
  24. R: finish bifurcated endograft deployment + distal attachment release
  
  27. R: ipsilateral limb insertion & deployment + IIE stenting (Nitinol stent LUMINEX 10*60 mm)
  
  28. R+L: CODA balloon (COOK)
  
  29. L: Long angio catheter/Angiogram +/- non-contrast CBCT
  
  30. R+L: sheaths retrieval + close groins
  

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• Thursday, January 26th: 15:28 - 16:05, Room 2 - Main Arena 2

  Case 71 – FEVAR for dissecting TAAA

  Center:

  Lille

  Case 71 – LIL 02: male, 61, years (H-M)

  Operators:

  • Stephan Haulon

  CLINICAL DATA
  2013: type B aortic dissection, conservative treatment
  Acute tubular necrosis and occlusion right renal artery with atrophic right kidney
  2014 aneurysmatic evolution infrarenal aorta: Open AAA tubular repair
  Aneurysmatic evolution descending thoracic and thoraco-abdominal aorta,
  with a maximum diameter 61 mm
  November 2016: TEVAR
  January 2017: FEVAR
  
  RISK FACTORS
  Smoker, hypertension
  
  HISTORY
  Gastric ulcers, pancreatitis, OSA, GORD
  
  PRESENT STATE
  At present asymptomatic
  Renal function: creatinine 12 mg/l, GFR 64
  Cardiac ultrasound: normal EF, mild AI, otherwise normal
  Duplex carotid arteries: normal
  Spirometry: mild obstructive pattern
  
  PROCEDURAL STEPS
  1. L: 7F sheath/Lunderquist/dilators (up to 20F) + 100 U/kg Heparin (Target ACT≥250)
  2. L: 20F sheath above the aortic bifurcation
  3. L (through 20F): Two 7F sheaths, one 6F sheath
  4. L (through 20F): Advance marked angio catheter through 7F sheath
  5. R: 10F sheath/Lunderquist/dilators up to 20F
  6. Fluoroscopy to locate fenestrated endograft markers
  7. R: Advanced fenestrated endograft (COOK)
  8. Aortic angiogram/fenestrated endograft deployment
  9. L: Catheterization of the fenestrated endograft lumen through 6F sheath with C2/KMP catheter and TERUMO wire
  10. Advance 6F sheath to the endograft lumen
  11. C2/RIM/DAV + TERUMO/Roadrunner through 6F for renal artery catheterisation
  12. Renal angiogram +/- nitro injection
  13. Exchange TERUMO for a Rosen
  14. Advance 6F to the renal artery
  15. Advance stent into the parking position
  16. L: Through last 7F sheath advance C2+ TERUMO to catheterize fenestrated endograft lumen
  17. Advance 7F below the fenestration of SMA
  18. C2/VS1 + TERUMO/Roadrunner through 7F sheath to catheterize SMA
  19. Vessel angiogram to check position in main trunk
  20. Exchange TERUMO for Amplatz (BOSTON SCIENTIFIC) wire
  21. Advance 7F in the target vessel
  22. Advance stent into parking position
  23. 16-19 for the coeliac trunk
  24. R: Release reducing ties / proximal attachment and distal attachment
  25. R: Nose capture & retrieval under fluoroscopy/Molding with CODA balloon (COOK)
  26. L: Renal artery stent deployment (1/3 aortic lumen) after 6F retrieval
  27. L: Flare the stent inside the aortic portion with 10–20 mm balloon
  28. L: Advance 6F in the renal stent/selective angiogram
  29. L: SMA stent deployment (1/3 aortic lumen) after 7F retrieval
  30. L: CT stent deployment (1/3 aortic lumen) after 7F retrieval
  31. L: Flare the stent inside the aortic portion with 10-20 mm balloon
  33. R: Remove fenestrated device delivery system
  34. L: Pull back 20F sheath in common iliac
  35. Continue with EVAR procedure
  36. CODA balloon at the level of overlaps (COOK)
  37. L: Long angio catheter/Angiogram +/- non-contrast CBCT
  

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