COMPLEX AORTIC ANEURYSMS

OPTIONS OF TREATMENT
CS DZSINICH, P BEREK, T PATAKI, L SZENTPTERY
DEPARTMENT OF CARDIOVASCULAR AND THORACIC SURGERY
NATIONAL INSTITUTE OF HEALTH OF HUNGARY
CENTRAL MILITARY HOSPITAL

IUA WORLD CONGRESS

PRAGUE, JULY 1-5 , 2012

TERMINOLOGY

COMPLEX AORTIC ANEURYSMS :

EXTENDING TO MORE ANATOMICAL SEGMENTS
MULTIPLEX MANIFESTTION
COMPLICATED BY SIDEBRANCH DISEASE
PARAANASTOMOTIC ANEURYSMS

CHALLENGES

INDICATION
CAREFUL EVALUATION OF RISK FACTORS
OPERATION IN ONE STAGE OR SEPARATED
TECHNICAL PLANNING
APPROACH STERNOTOMY
THORACOTOMY
THORACOLAPAROTOMY
LAPAROTOMY
COMBINATIONS

CHALLENGES
TECHNICAL OPPORTUNITIES

OPEN SURGERY
HYBRID SOLUTION
ENDOVASCULAR

CHALLENGES

TECHNICAL ANDJUNCTIVES
ARTEFICIAL CIRCULTION :
CARDIOPULMONARY BYPASS
DEEP HYPOTHERMIA
FEMORO-FEMORAL BYPASS
GOTT SHUNT
CSF DRAINAGE
SPINAL CORDCOOLING
MONITORING SEP / MEP OR BIOCHEMICAL

TAKAYASU TYPE IV

TAKAYASU TYPE IV

LUSORY ARTERY AND B TYPE AORTIC

DISSECTION

LUSORY ARTERY AND B TYPE AORTIC

DISSECTION-TREATED BY HYBRID
PROCEDURE

HYBRID PROCEDURES AT THE AORTIC ARCH

HYBRID PROCEDURES AT THE AORTIC ARCH

EXTENDED COMPLEX ANEURYSM OF

THE THORACIC AORTA

EXTENDED COMPLEX ANEURYSM OF THE

THORACIC AORTA

EXTENDED COMPLEX ANEURYSM OF THE

THORACIC AORTA

EXTENDED COMPLEX ANEURYSM OF THE

THORACIC AORTA

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EXTENDED COMPLEX ANEURYSM OF THE

THORACIC AORTA

EXTENDED COMPLEX ANEURYSM OF THORACIC

AORTA-ENDOGRAFT FIXATION OFT THE
ELEPHANT TRUNK

RECONSTRUCTIVE TECHNIQUES FOR TYPE II.THAATHE CRAWFORDS TECHNIQUE

PROXIMAL ANEURYSM FORMATION 2

YRS AFTER THORACOABDOMINAL
OPEN SURGERY

PROXIMAL ENDOGRAFTING 2 YRS AFTER

THORACOABDOMINAL OPEN SURGERY

PROXIMAL ENDOGRAFTING 2 YRS AFTER

THORACOABDOMINAL OPEN SURGERY

TYPE IV THAAA ENDOGRAFTING AFTGER

DEBRANCHING OF THE CELIAC TRUNK

GIANT CHRONIC DISSECTING ANEURYSM OF THE

THORACOABDOMINAL AORTA - EXTENSION INTO
BOTH ILIAC ARTERIES

CHRONIC III B TYPE AORTIC DISSECTION OF A

MARFAN PATIENT

LATE ANASTOMOSIS DISRUPTION AFTER

SUBCLAVIAN-AORTIC BYPASS GRAFT.
NEW BYPASS GRAFT

RECONSTRUCTIVE TECHNIQUES FOR TYPE II.THAATHE CRAWFORDS TECHNIQUE

GIANT CHRONIC DISSECTING

ANEURYSM OF THE
THORACOABDOMINAL AORTAEXTENSION ONTO BOTH ILIAC
ARTERIES

GIANT CHRONIC DISSECTING

ANEURYSM OF THE
THORACOABDOMINAL AORTAEXTENSION ONTO BOTH ILIAC
ARTERIES

ADVANTAGES OF OPEN SURGERY

LESS MORPHOLOGICAL EXCLUSIONS

TRANSMURAL FIXATION OF THE GRAFT
ACCURATE BLEEDING CONTROL
NO ENDOLEAK
VISUAL CONTROL OF THE SIDE BRANCHES

ADVANTAGES OF OPEN SURGERY

SAFE REATTACHMENT OF SIDE BRANCHES

DECOMPRESSION OF VICINITY
REMOVAL OF HEMATOME
WELL KNOWN EARLY AND LONG TERM RESULTS
OPTION FOR CONVERSION

DISADVANTAGES OF OPEN SURGERY

HIGHER SURGICAL TRAUMA

HIGHER RISK OF INTERVENTION
POOR RISK PATIENTS ARE NOT AMANABLE
NEED FOR EC PERFUSION AND HYPOTHERMIA
LONGER CLAMPING TIME

CONCLUSIONS:

ENDOGRAFTING OF COMPLEX AORTIC ANEURYSMS

MAY REDUCE SURGICAL TRAUMA SIGNIFICANTLY
HYBRID PROCEDURES AT THE AORTIC ARCH AND
THORACOABDOMINAL AORTA HAVE OPENED A NEW
APPROACH TO AORTIC ANEURYSMS/DISSECTIONS
OPEN SURGERY HAS STILL INEVITABLE ROLE IN
RECONSTRUCTIONS OF THE THORACIC AORTA

CONCLUSION

EXTENDED AORTIC ENDOGRAFTING MUST

BE PERFORMED AT CARDIO VASCULAR
DEPARTMENTS WITH ROUTINE EXPERIENCE OF
OPEN SURGERY OF COMPLEX AORTIC
ANEURYSMS