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IP011. Our Experience of Endovascular Treatment for Stanford Type B Aortic Dissection
56S
Journal of Vascular Surgery
Abstracts
June Supplement 2017 not significantly different (P ¼ .7). Multifactorial logistic regression showed that mortality was significantly affected by having a postoperative bowel complication (P ¼ .0247). Those without postoperative bowel complications had a 0.132 odds of mortality as compared to those who did have a bowel complication (P ¼ .0342). Conclusions: Infected aortic grafts with concomitant bowel injury remain a devastating pathology. Traditionally trained vascular surgeons have higher bowel complication rates as compared to bowel surgeons. Postoperative bowel complications significantly affect the overall mortality of this patient population. Author Disclosures: P. Armstrong: Nothing to disclose; K. A. Illig: Nothing to disclose; C. Jokisch: Nothing to disclose; H. McMullin: Nothing to disclose; M. L. Shames: Medtronic, W. L. Gore: speaker’s bureau; A. Tanious: Nothing to disclose; M. Wooster: Nothing to disclose.
IP007. Simplified Translumbar Treatment of a Type II Endoleak Using CT Fusion in Hybrid Room Sara Honari. Maimonides Medical Center, Brooklyn, NY Objectives: A 74-year-old man underwent endovascular aneurysm repair (EVAR) of a 5.0-cm infrarenal abdominal aortic aneurysm (AAA) with a stent graft. Endoleaks were not detected at the time of the completion angiogram. Follow-up aortic duplex study obtained 1 month later showed the presence of a small type II endoleak arising from the inferior mesenteric artery (IMA). The endoleak persisted and increased in size, with a subsequent sac diameter increase 3 years
after EVAR. A follow-up computed tomography angiogram (CTA) showed the presence of type II endoleak, with retrograde filling by the IMA and connection to a complex network of lumbar vessels. The AAA sac increased in size to 5.8 cm. Decision was made to proceed with treatment to obliterate this endoleak. We describe a novel approach in treating a persistent type II endoleak related to the IMA and the lumbar outflow vessels using a simplified translumbar approach. Using TrackVision software, we were able to delineate the track to the level of the endoleak. The software program allowed us to access the endoleak through a translumbar approach. A threedimensional cone-beam CT scan without contrast injection was used to identify the location of the endograft to match the exact position of the endoleak noted on the previous CTA in the superimposed prone position. After the entry and target trajectories were identified using both of the fused data sets, the model and planned trajectories were then exported into the TrackVision software, creating a virtual needle track. Methods: A 20-cm long, 18-gauge Chiba needle was used to access the endoleak cavity. Using progress and bull’s eye views, we were able to track the needle into the endoleak. The endoleak was then visualized using contrast showing feeding of the endoleak through the IMA. This entire region was then coil embolized with a total of four 4-mm 3mm Tornado Embolization Coils followed by one 5-mm 10-cm and two 10-mm 15-cm Nester Embolization Coils. Results: After coil embolization the IMA was not visualized. The patient was seen in follow-up 1 month following the procedure with complete obliteration of the endoleak and decrease in sac size to 5.3 cm. Conclusions: This simplified approach at treating complex endoleaks has allowed the procedure to be performed with minimal fluoroscopy and digital subtraction angiography imaging. In addition, the length of the procedure has become significantly shortened with the use of the virtual needle track. Author Disclosures: S. Honari: Nothing to disclose.
IP011. Our Experience of Endovascular Treatment for Stanford Type B Aortic Dissection Pouria Parsa,1 Jack Squiers,2 J. Michael DiMaio,2 James West,1 Dennis Gable2. 1Baylor University Medical Center Dallas, Tex; 2Baylor Heart and Vascular Hospital, Dallas, Tex Objectives: Aortic remodeling after thoracic endovascular aortic repair (TEVAR) of type B dissection is of significant interest because postoperaFig 1.
Fig 2.
Fig 1. Graph measuring an increase in mean true lumen index from preintervention to short follow-up (w1 month) and long follow-up (w1 year) using 95% confidence intervals (range bars).
Journal of Vascular Surgery
Abstracts
57S
Volume 65, Number 6S all-cause mortality was three (8.8%). Four patients were lost to follow-up. Conclusions: Volumetric analysis of type B dissection treated with TEVAR demonstrates the ability of endograft to cause favorable remodeling of aorta by expansion of true lumen volume.
Author Disclosures: J. DiMaio: Nothing to disclose; D. Gable: Nothing to disclose; P. Parsa: Nothing to disclose; J. Squiers: Nothing to disclose; J. West: Nothing to disclose.
IP013. Octogenarians Undergoing Open Repair Have Higher Mortality Compared to Fenestrated Endovascular Repair of Intact Abdominal Aortic Aneurysms Involving Visceral Vessels Satinderjit S. Locham, Hanaa N. Dakour Aridi, Besma J. Nejim, Muhammad Faateh, Rami Srouji, Mahmoud B. Malas. Johns Hopkins School of Medicine, Baltimore, Md Objectives: Prior studies have shown that octogenarians have higher risk of mortality compared to nonoctogenarians undergoing open
Fig 2. Regions of interest were outlined within the true and false lumens of the aortic dissection on the axial computed tomography angiography source images using the built-in segmentation tools of image analyzing software Amira 6.2.0 by FEI. The volumes of true and false lumens were then calculated using the same software.
Table. Multivariate logistic regression analysis of mortality after abdominal aortic aneurysm (AAA) repair Variable
95% CI
P value
Open repair
3.68
1.40-9.64
Smoking history
2.74
1.07-7.29
.04
Bleeding disorders
5.94
2.21-15.97
<.001
6.71
1.85-24.36
.004
1.75-728.03
.02
Sepsis Acute renal failure/dialysis tive false lumen patency is associated with increased requirements for reintervention. Previous volumetric analyses of true and false lumen volumes after TEVAR have extrapolated three-dimensional (3D) volumes from 2D computed tomography angiography (CTA) measurements. This is the first direct 3D volumetric analysis of true and false lumens using CTA data. We hypothesized that the true/false lumen ratio increases after TEVAR for type B dissection, representing favorable aortic remodeling. Methods: A retrospective analysis of patient data from two centers was performed. Patients with radiology-confirmed type B aortic dissection treated with TEVAR were included in the study. Preoperative and postoperative (1 month and 1 year) CTA data were analyzed with Amira 3D software for Life Sciences to perform total volume measurements of the true lumen and patent false lumen. True-to-false lumen ratios were then calculated to evaluate trends in the ratio postoperatively. Results: Between 2007 and 2014, 34 patients (mean age, 57 years) underwent TEVAR for type B aortic dissection for acute, complicated, and chronic type B dissections. Preoperative and postoperative CTA images were available for analysis in 21 patients. Any two consecutive CTAs were available for 24 patients. Stent grafts were used for TEVAR Cook TX2 (5 patients), Gore TAG (8 patients), and Medtronic Talent and Valiant total (21 patients). Baseline demographics, comorbidities, and mean stent diameter were not significantly different between grafts. None of the Gore group patients had coverage of subclavian artery; Cook (40%) and Medtronic (42.9%) patients had subclavian overlap. There was 0% mortality at 30 days. Mean true-to-false lumen ratio was 1.1 (range, 0.4-3.4) on preprocedural CTA, 2.5 (range, 1.1-4.2) at 30-day follow-up, and 3.7 (range, 2.4-8.1) at 1-year follow-up. During the follow-up period, which continued from the intervention date until January 2016, reintervention for retrograde type A dissection occurred in three patients (8.8%), and total reintervention for any reason occurred in 10 patients (29.4%). During the follow-up period,
Adjusted ORa
35.69
.008
CI, Confidence interval; OR, odds ratio. a Adjusted for open repair, age, gender, race, body mass index >30, smoking history, American Society of Anesthesiologists >III, functionally dependent status, diabetes, history of chronic obstructive pulmonary disease, hypertension, bleeding disorders, sepsis, steroid use, acute renal failure/dialysis, and progressive renal failure.
Fig. Thirty-day postoperative complications in octogenarians undergoing fenestrated endovascular repair (F-EVAR) and open repair (OAR) for abdominal aortic aneurysm (AAA) involving visceral vessels.
(OAR) and endovascular (EVAR) abdominal aortic aneurysm (AAA) repair. Fenestrated EVAR (F-EVAR) has been populated as a less invasive approach to treat patients with suboptimal neck anatomy with favorable outcomes compared to traditional OAR. The aim of
Journal of Vascular Surgery
Abstracts
June Supplement 2017 not significantly different (P ¼ .7). Multifactorial logistic regression showed that mortality was significantly affected by having a postoperative bowel complication (P ¼ .0247). Those without postoperative bowel complications had a 0.132 odds of mortality as compared to those who did have a bowel complication (P ¼ .0342). Conclusions: Infected aortic grafts with concomitant bowel injury remain a devastating pathology. Traditionally trained vascular surgeons have higher bowel complication rates as compared to bowel surgeons. Postoperative bowel complications significantly affect the overall mortality of this patient population. Author Disclosures: P. Armstrong: Nothing to disclose; K. A. Illig: Nothing to disclose; C. Jokisch: Nothing to disclose; H. McMullin: Nothing to disclose; M. L. Shames: Medtronic, W. L. Gore: speaker’s bureau; A. Tanious: Nothing to disclose; M. Wooster: Nothing to disclose.
IP007. Simplified Translumbar Treatment of a Type II Endoleak Using CT Fusion in Hybrid Room Sara Honari. Maimonides Medical Center, Brooklyn, NY Objectives: A 74-year-old man underwent endovascular aneurysm repair (EVAR) of a 5.0-cm infrarenal abdominal aortic aneurysm (AAA) with a stent graft. Endoleaks were not detected at the time of the completion angiogram. Follow-up aortic duplex study obtained 1 month later showed the presence of a small type II endoleak arising from the inferior mesenteric artery (IMA). The endoleak persisted and increased in size, with a subsequent sac diameter increase 3 years
after EVAR. A follow-up computed tomography angiogram (CTA) showed the presence of type II endoleak, with retrograde filling by the IMA and connection to a complex network of lumbar vessels. The AAA sac increased in size to 5.8 cm. Decision was made to proceed with treatment to obliterate this endoleak. We describe a novel approach in treating a persistent type II endoleak related to the IMA and the lumbar outflow vessels using a simplified translumbar approach. Using TrackVision software, we were able to delineate the track to the level of the endoleak. The software program allowed us to access the endoleak through a translumbar approach. A threedimensional cone-beam CT scan without contrast injection was used to identify the location of the endograft to match the exact position of the endoleak noted on the previous CTA in the superimposed prone position. After the entry and target trajectories were identified using both of the fused data sets, the model and planned trajectories were then exported into the TrackVision software, creating a virtual needle track. Methods: A 20-cm long, 18-gauge Chiba needle was used to access the endoleak cavity. Using progress and bull’s eye views, we were able to track the needle into the endoleak. The endoleak was then visualized using contrast showing feeding of the endoleak through the IMA. This entire region was then coil embolized with a total of four 4-mm 3mm Tornado Embolization Coils followed by one 5-mm 10-cm and two 10-mm 15-cm Nester Embolization Coils. Results: After coil embolization the IMA was not visualized. The patient was seen in follow-up 1 month following the procedure with complete obliteration of the endoleak and decrease in sac size to 5.3 cm. Conclusions: This simplified approach at treating complex endoleaks has allowed the procedure to be performed with minimal fluoroscopy and digital subtraction angiography imaging. In addition, the length of the procedure has become significantly shortened with the use of the virtual needle track. Author Disclosures: S. Honari: Nothing to disclose.
IP011. Our Experience of Endovascular Treatment for Stanford Type B Aortic Dissection Pouria Parsa,1 Jack Squiers,2 J. Michael DiMaio,2 James West,1 Dennis Gable2. 1Baylor University Medical Center Dallas, Tex; 2Baylor Heart and Vascular Hospital, Dallas, Tex Objectives: Aortic remodeling after thoracic endovascular aortic repair (TEVAR) of type B dissection is of significant interest because postoperaFig 1.
Fig 2.
Fig 1. Graph measuring an increase in mean true lumen index from preintervention to short follow-up (w1 month) and long follow-up (w1 year) using 95% confidence intervals (range bars).
Journal of Vascular Surgery
Abstracts
57S
Volume 65, Number 6S all-cause mortality was three (8.8%). Four patients were lost to follow-up. Conclusions: Volumetric analysis of type B dissection treated with TEVAR demonstrates the ability of endograft to cause favorable remodeling of aorta by expansion of true lumen volume.
Author Disclosures: J. DiMaio: Nothing to disclose; D. Gable: Nothing to disclose; P. Parsa: Nothing to disclose; J. Squiers: Nothing to disclose; J. West: Nothing to disclose.
IP013. Octogenarians Undergoing Open Repair Have Higher Mortality Compared to Fenestrated Endovascular Repair of Intact Abdominal Aortic Aneurysms Involving Visceral Vessels Satinderjit S. Locham, Hanaa N. Dakour Aridi, Besma J. Nejim, Muhammad Faateh, Rami Srouji, Mahmoud B. Malas. Johns Hopkins School of Medicine, Baltimore, Md Objectives: Prior studies have shown that octogenarians have higher risk of mortality compared to nonoctogenarians undergoing open
Fig 2. Regions of interest were outlined within the true and false lumens of the aortic dissection on the axial computed tomography angiography source images using the built-in segmentation tools of image analyzing software Amira 6.2.0 by FEI. The volumes of true and false lumens were then calculated using the same software.
Table. Multivariate logistic regression analysis of mortality after abdominal aortic aneurysm (AAA) repair Variable
95% CI
P value
Open repair
3.68
1.40-9.64
Smoking history
2.74
1.07-7.29
.04
Bleeding disorders
5.94
2.21-15.97
<.001
6.71
1.85-24.36
.004
1.75-728.03
.02
Sepsis Acute renal failure/dialysis tive false lumen patency is associated with increased requirements for reintervention. Previous volumetric analyses of true and false lumen volumes after TEVAR have extrapolated three-dimensional (3D) volumes from 2D computed tomography angiography (CTA) measurements. This is the first direct 3D volumetric analysis of true and false lumens using CTA data. We hypothesized that the true/false lumen ratio increases after TEVAR for type B dissection, representing favorable aortic remodeling. Methods: A retrospective analysis of patient data from two centers was performed. Patients with radiology-confirmed type B aortic dissection treated with TEVAR were included in the study. Preoperative and postoperative (1 month and 1 year) CTA data were analyzed with Amira 3D software for Life Sciences to perform total volume measurements of the true lumen and patent false lumen. True-to-false lumen ratios were then calculated to evaluate trends in the ratio postoperatively. Results: Between 2007 and 2014, 34 patients (mean age, 57 years) underwent TEVAR for type B aortic dissection for acute, complicated, and chronic type B dissections. Preoperative and postoperative CTA images were available for analysis in 21 patients. Any two consecutive CTAs were available for 24 patients. Stent grafts were used for TEVAR Cook TX2 (5 patients), Gore TAG (8 patients), and Medtronic Talent and Valiant total (21 patients). Baseline demographics, comorbidities, and mean stent diameter were not significantly different between grafts. None of the Gore group patients had coverage of subclavian artery; Cook (40%) and Medtronic (42.9%) patients had subclavian overlap. There was 0% mortality at 30 days. Mean true-to-false lumen ratio was 1.1 (range, 0.4-3.4) on preprocedural CTA, 2.5 (range, 1.1-4.2) at 30-day follow-up, and 3.7 (range, 2.4-8.1) at 1-year follow-up. During the follow-up period, which continued from the intervention date until January 2016, reintervention for retrograde type A dissection occurred in three patients (8.8%), and total reintervention for any reason occurred in 10 patients (29.4%). During the follow-up period,
Adjusted ORa
35.69
.008
CI, Confidence interval; OR, odds ratio. a Adjusted for open repair, age, gender, race, body mass index >30, smoking history, American Society of Anesthesiologists >III, functionally dependent status, diabetes, history of chronic obstructive pulmonary disease, hypertension, bleeding disorders, sepsis, steroid use, acute renal failure/dialysis, and progressive renal failure.
Fig. Thirty-day postoperative complications in octogenarians undergoing fenestrated endovascular repair (F-EVAR) and open repair (OAR) for abdominal aortic aneurysm (AAA) involving visceral vessels.
(OAR) and endovascular (EVAR) abdominal aortic aneurysm (AAA) repair. Fenestrated EVAR (F-EVAR) has been populated as a less invasive approach to treat patients with suboptimal neck anatomy with favorable outcomes compared to traditional OAR. The aim of