- Email: [email protected]
Beneath the Skin: Inner Workings of a Hemodialysis Access Center
U.Gladziwa, H.G.Sieberth: Follow-up results after stent placement in failing arteriovenous shunts: a three-year experience. Cardiovasc lntervent Radiol 14 (1991) 285-289
14. Turmel-Rodrigues L, Sapoval M, Pengloan J, Billaux L, Testou D, Abaza M: Stents in angioaccess for hemodialysis: results for se1ctive indications. Abstract Paper " 169 Angioaccess for Hemodialysis Tours, 3.-5.6.96 p. 95
15. Schlirmann K, Vorwerk D, Kulisch A, Rosenbaum C, Biesterfeld S, Gunther RW: Puncture of stents implanted into veins and arteriovenous fistulas: an experimental study. Cardiovasc Intervent Radiol 18 (1995) 383-390 16. D.Volwerk, Gunther RW Removal of intimal hyperplasia in vascular endoprostheses by atherectomy and balloon dilatation. AJR 154 (1990) 617-619 17. Zollikofer C, Antonucci F, Stud,mann G, Mattias P, Brlihlmann W, Salomonowitz E: Stenotic veins, grafts and dialysis shunts: treatment with self-expanding prosthesis. Cardiovasc Inte rvent Radiol 1992; 15: 334-341 18. Sapoval M, Turmel-Rodrigues L, Raynaud A, Bourquelot P, Rodrigue H, Gaux J: Cragg-covered stents in hemodialysis access. Initial and mid-term results. Abstract Paper # 148 Angioaccess for Hemodialysis Tours, 3.-5.6.96 p. 84
11:45 a.m. Beneath the Skin: Inner Workings of a Hemodialysis Access Center jeffrey B. Siegel, MD Dallas Nephrology Associates Dallas, TX
2:30 p.m.-4:00 p.m. 2:30 p.m. Pearl: Constantin Cope, MD Presented by: Michael C. Soulen, MD Hospital of the University of Pennsylvania Philadelphia, PA
2:35 p.m. The Next Generation of AAA Grafts Roy Greenberg, MD Cleveland Clinic Foundation Cleveland, OH Endovascular grafting techniques have revolutionized the management of patients with infrarenal and thoracic aneUlysmal disease. It has also been described for the treatment of nearly all aortic diseases including aortobronchial fistulaes, traumatic disruption, occlusive stenoses, aortic coarctation, dissections, aneurysms involving branch vessels, aortitis conditions and others. There are several characteristics that allow an endograft to accomplish its goals, which included: fixation , sealing, durability, and patency. Although we can discuss each of the mechanical and design constraints around these goals, it must be understood that these designs are created for specific anatomic indications and disease states, and when used outside of the engineering gUideline may have a less predictable result. However, recent advances in device design and deployment mechanisms have allowed the placement of devices that incorporate the visceral aortic segments, branch into arch vessels and internal iliac arteries, and aid in the treatment of complex dissections of the a0l1a. These accomplishments represent the beginning of a new approach to the management of aortic disease with minimally invasive techniques. Fixation is an interesting and complex concept. The ultimate assessment of fixation lies with the ability of the endograft to maintain its position over time, without migration in the proximal or distal direction. Several investigators have described failure of this mechanism in both the thoracic and abdominal aorta. Additionally, migration has been reported with all endovascular prostheses to date. It can be divided into three fundamental components: radial force within the proximal or distal neck, columnar support, and penetrating (or tissue ingrowth) components-such as hooks or barbs. The actual fixation of an endograft is the sum of all of these factors. Lflxntion force =
L(radlat force witlun fhedef.ned)
L(coluOUl ar support)
+
Coordinator/Moderator: Michael D. Dake, NiD
Objectives: 1. Distinguish advantages of second generation AAA endografts. 2. Recognize current management strategies for endoleak. 3. Assess the current and potential role of endografts beyond the abdominal aorta.
P216
+
+
L(force created by penetrating components)
L(mgrowth force)
Despite the ability to define the material properties of the prosthesis, the actual fixation force is largely dependent upon the anatomy into which the device will be placed. For example, the quantity and quality of the proximal neck will define length over which the radial force may be applied. Alternatively, tortuosity within the aorta or iliac arteries will change the vectors of columnar support, altering the amount of force that is applied proximally or distally to fixation. The degree of tissue ingrowth has been described as minimal with most endografts, but is variable. Penetrating components have
14. Turmel-Rodrigues L, Sapoval M, Pengloan J, Billaux L, Testou D, Abaza M: Stents in angioaccess for hemodialysis: results for se1ctive indications. Abstract Paper " 169 Angioaccess for Hemodialysis Tours, 3.-5.6.96 p. 95
15. Schlirmann K, Vorwerk D, Kulisch A, Rosenbaum C, Biesterfeld S, Gunther RW: Puncture of stents implanted into veins and arteriovenous fistulas: an experimental study. Cardiovasc Intervent Radiol 18 (1995) 383-390 16. D.Volwerk, Gunther RW Removal of intimal hyperplasia in vascular endoprostheses by atherectomy and balloon dilatation. AJR 154 (1990) 617-619 17. Zollikofer C, Antonucci F, Stud,mann G, Mattias P, Brlihlmann W, Salomonowitz E: Stenotic veins, grafts and dialysis shunts: treatment with self-expanding prosthesis. Cardiovasc Inte rvent Radiol 1992; 15: 334-341 18. Sapoval M, Turmel-Rodrigues L, Raynaud A, Bourquelot P, Rodrigue H, Gaux J: Cragg-covered stents in hemodialysis access. Initial and mid-term results. Abstract Paper # 148 Angioaccess for Hemodialysis Tours, 3.-5.6.96 p. 84
11:45 a.m. Beneath the Skin: Inner Workings of a Hemodialysis Access Center jeffrey B. Siegel, MD Dallas Nephrology Associates Dallas, TX
2:30 p.m.-4:00 p.m. 2:30 p.m. Pearl: Constantin Cope, MD Presented by: Michael C. Soulen, MD Hospital of the University of Pennsylvania Philadelphia, PA
2:35 p.m. The Next Generation of AAA Grafts Roy Greenberg, MD Cleveland Clinic Foundation Cleveland, OH Endovascular grafting techniques have revolutionized the management of patients with infrarenal and thoracic aneUlysmal disease. It has also been described for the treatment of nearly all aortic diseases including aortobronchial fistulaes, traumatic disruption, occlusive stenoses, aortic coarctation, dissections, aneurysms involving branch vessels, aortitis conditions and others. There are several characteristics that allow an endograft to accomplish its goals, which included: fixation , sealing, durability, and patency. Although we can discuss each of the mechanical and design constraints around these goals, it must be understood that these designs are created for specific anatomic indications and disease states, and when used outside of the engineering gUideline may have a less predictable result. However, recent advances in device design and deployment mechanisms have allowed the placement of devices that incorporate the visceral aortic segments, branch into arch vessels and internal iliac arteries, and aid in the treatment of complex dissections of the a0l1a. These accomplishments represent the beginning of a new approach to the management of aortic disease with minimally invasive techniques. Fixation is an interesting and complex concept. The ultimate assessment of fixation lies with the ability of the endograft to maintain its position over time, without migration in the proximal or distal direction. Several investigators have described failure of this mechanism in both the thoracic and abdominal aorta. Additionally, migration has been reported with all endovascular prostheses to date. It can be divided into three fundamental components: radial force within the proximal or distal neck, columnar support, and penetrating (or tissue ingrowth) components-such as hooks or barbs. The actual fixation of an endograft is the sum of all of these factors. Lflxntion force =
L(radlat force witlun fhedef.ned)
L(coluOUl ar support)
+
Coordinator/Moderator: Michael D. Dake, NiD
Objectives: 1. Distinguish advantages of second generation AAA endografts. 2. Recognize current management strategies for endoleak. 3. Assess the current and potential role of endografts beyond the abdominal aorta.
P216
+
+
L(force created by penetrating components)
L(mgrowth force)
Despite the ability to define the material properties of the prosthesis, the actual fixation force is largely dependent upon the anatomy into which the device will be placed. For example, the quantity and quality of the proximal neck will define length over which the radial force may be applied. Alternatively, tortuosity within the aorta or iliac arteries will change the vectors of columnar support, altering the amount of force that is applied proximally or distally to fixation. The degree of tissue ingrowth has been described as minimal with most endografts, but is variable. Penetrating components have