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VH06. The Knickerbocker Technique for Endovascular Exclusion of False Lumen in Chronic Type B Aortic Dissection
JOURNAL OF VASCULAR SURGERY Volume 63, Number 6S
Abstracts 231S
VH: “How I Do It” Video Session
VH04 VH04.
VH01.
Carotid-Subclavian Transposition and CarotidCarotid Bypass to Facilitate TEVAR Emily Spangler, MD, Mark F. Fillinger, MD. DartmouthHitchcock Medical Center, Lebanon, NH
Eversion Femoral Artery Endarterectomy and Endovascular Revascularization for Critical Limb Ischemia Gianluca Faggioli, MD, Liborio Ferrante, MD, Giuseppe Indelicato, MD, Rodolfo Pini, MD, Matteo Longhi, MD, Andrea Vacirca, MD, Mauro Gargiulo, MD, PhD, Andrea Stella, MD. University of Bologna, Bologna, Italy Background: This video shows the eversion endarterectomy technique for revascularization of the femoral bifurcation in conjunction with endovascular procedures and minor foot amputation. Author Disclosures: G. Faggioli: Nothing to disclose; L. Ferrante: Nothing to disclose; M. Gargiulo: Nothing to disclose; G. Indelicato: Nothing to disclose; M. Longhi: Nothing to disclose; R. Pini: Nothing to disclose; A. Stella: Nothing to disclose; A. Vacirca: Nothing to disclose.
VH02. VH02 Celiac Artery Decompression With Supraceliac Aorta-to-Celiac Bypass Charles A. West Jr, MD, FACS1, Joseph L. Mills, MD2. 1 Baylor St. Luke’s Medical Center, Houston, Tex; 2 Baylor College of Medicine, Houston, Tex Background: This video illustrates the technique of supraceliac aortic exposure via an upper midline incision. The steps at division of the median arcuate ligament are described followed by the sequence of step for supraceliac aortoceliac bypass. Author Disclosures: J. L. Mills: Nothing to disclose; C. A. West: Nothing to disclose.
Background: A 78-year-old man with oxygen-dependent COPD with a 6.8-cm saccular thoracic aneurysm involving the left subclavian artery is presented. Video of his two-stage repair demonstrates portions of the left carotid-subclavian transposition and retropharyngeal rightto-left carotid-carotid bypass used to facilitate debranching for TEVAR. Author Disclosures: M. F. Fillinger: Endologix and W. L. Gore: consulting fees (eg, advisory boards); E. Spangler: Nothing to disclose.
VH05 VH05. Novel Technique for Ablation of Persistent Retrograde Perfusion of False Lumen in Chronic Aortic Dissection April L. Rodriguez, MD, Benjamin W. Starnes, MD, Niten Singh, MD, MS. University of Washington, Seattle, Wash Background: The following video demonstrates a novel technique to address persistent retrograde false lumen perfusion after TEVAR in chronic aortic dissections with aneurysmal degeneration. This technique uses a reversed Cook Renu device and ZIP plug as well as Aptus Endoanchors to obliterate the false lumen. Of note, there is a higher-quality video available for presentation; however, this version was not submitted due to size constraints. Author Disclosures: A. L. Rodriguez: Nothing to disclose; N. Singh: Nothing to disclose; B. W. Starnes: Aortica: intellectual property/patents, ownership interest.
VH06 VH06. VH03. VH03 Fenestrated-Branched Endovascular Thoracoabdominal Aortic Aneurysm Repair for Chronic Dissections Aaron C. Baker, MD, MS, Gustavo S. Oderich, MD, Jan Hofer, RN, Mauricio Ribeiro, MD, PhD. Mayo Clinic, Rochester, Minn Background: This case video highlights the treatment of an extent II thoracoabdominal aortic aneurysm secondary to a chronic type B dissection using a patient-specific, manufactured four-vessel fenestrated-branched endograft under a physician-sponsored investigational device exemption study. The case video entails preoperative planning, the endovascular execution, and outcome. A specific challenge demonstrated in this case is the technique used to cross the chronic dissection flap to access the isolated right renal artery, which was perfused by the false lumen. Author Disclosures: A. C. Baker: Nothing to disclose; J. Hofer: Nothing to disclose; G. S. Oderich: Nothing to disclose; M. Ribeiro: Nothing to disclose.
The Knickerbocker Technique for Endovascular Exclusion of False Lumen in Chronic Type B Aortic Dissection Fabio Verzini, MD, PhD1, Diletta Loschi, MD1, Gioele Simonte, MD1, Luca Farchioni, MD1, Gianbattista Parlani, MD2, yPaola De Rango, MD, PhD2. 1University of Perugia, Perugia, Italy; 2Azienda Ospedaliera di Perugia, Perugia, Italy Background: Simple endovascular coverage of primary entry tear in chronic type B aortic dissection (CTBAD) is often unsuccessful in promoting false lumen (FL) thrombosis and aortic remodeling as it occurs with acute dissections. Aim of this video is to illustrate technical solutions used for effective endovascular treatment in a case of a residual CTBAD after acute type A aortic dissection. Critical issues addressed are (1) creation of a suitable landing zone for endografting at the time of the original open surgery for the acute Type A dissection, with the use of a branched open graft for revascularization and proximal rerouting of the innominate and the left common carotid arteries, (2) left subclavian (that presented chronic dissection involving
JOURNAL OF VASCULAR SURGERY June Supplement 2016
232S Abstracts
the dominant vertebral artery) revascularization with carotid-subclavian by pass plus vertebral artery reimplantation, at the time of thoracic endografting, as the first step of residual CTBAD treatment, (3) secondary sealing of FL distal backflow by deploying in the distal thoracic true lumen an oversized, tapered stent graft, followed by controlled balloon rupture of the dissection membrane, the so-called knickerbocker technique. The ballooning maneuver dilated the endograft to full diameter at its midsection, permitting the graft to adhere to the outer aortic layer with a rapid expansion suggesting the dissection membrane had effectively ruptured. Author Disclosures: yP. De Rango: Nothing to disclose; L. Farchioni: Nothing to disclose; D. Loschi: Nothing to disclose; G. Parlani: Nothing to disclose; G. Simonte: Nothing to disclose; F. Verzini: Cook Medical and Medtronic: consulting fees (eg, advisory boards), W. L. Gore: fee. VH07. VH07 Endovascular Retrieval of a Trapease IVC Filter Zack Nash, MD, Jean Bismuth, MD, Alan Lumsden, MD, FRCS, Carlos F. Bechara, MD, MS. Houston Methodist Hospital, Houston, Tex Background: This is a retrieval of a permanent Trapease filter that was placed a year before our intervention. The patient’s hematologist was planning to stop her anticoagulation after a year of treatment and requested removal. We used a layered support technique using multiple sheaths. Author Disclosures: C. F. Bechara: Nothing to disclose; J. Bismuth: Nothing to disclose; A. Lumsden: Boston Scientific, Medtronic, and W. K. Gore: consulting fees (eg, advisory boards), speaker’s bureau, Maquet and Siemens: consulting fees (eg, advisory boards); Z. Nash: Nothing to disclose. VH08. VH08 Supraceliac Aorta to Common Hepatic Artery and Superior Mesenteric Artery Bypass for Chronic Mesenteric Ischemia Danielle M. Pineda, MD, Samuel Tyagi, MD, Douglas A. Troutman, MD, Matthew Dougherty, MD, Keith D. Calligaro, MD. Pennsylvania Hospital, Philadelphia, Pa Background: This video illustrates the technique for a bypass from supraceliac aorta to common hepatic artery and superior mesenteric artery in a patient with chronic mesenteric ischemia and failed celiac artery stent. Despite
the increased use of advanced mesenteric techniques, it remains important for trainees to understand how to treat patients using open bypass when stents have failed. Author Disclosures: K. D. Calligaro: Nothing to disclose; M. Dougherty: Nothing to disclose; D. M. Pineda: Nothing to disclose; D. A. Troutman: Nothing to disclose; S. Tyagi: Nothing to disclose. VH09 VH09. Femoral Vein Transposition Arteriovenous Fistula for Dialysis Access Jeffrey Siracuse, MD, Alik Farber, MD. Boston University School of Medicine, Boston, Mass Background: In this video, we describe a 48-year-old woman undergoing a femoral vein transposition arteriovenous fistula for dialysis access. This patient had end-stage renal disease and a history of multiple upper extremity vascular accesses as well as peritoneal dialysis catheters. Preoperative central venography confirmed subclavian and superior vena cava occlusion. Author Disclosures: A. Farber: Bard: consulting fees (eg, advisory boards); J. Siracuse: Nothing to disclose.
VH10 VH10. Transcaval Small and Large Sheath Aortic Access Yazan Duwayri, MD1, Bradley G. Leshnower, MD2, Ravi K. Veeraswamy, MD2, Ateet B. Patel, MD1, Vinod H. Thourani, MD2, Vasilis Babaliaros, MD2. 1Emory University, Atlanta, Ga; 2Emory University School of Medicine, Atlanta, Ga Background: The video illustrates the technique of aortic device delivery through transcaval venous access, followed by closure of the aortocaval fistula. The technique provides an alternative to transfemoral arterial access in patients with small ileofemoral access vessels. The presentation will include percutaneous aortic valve delivery using this method, in addition to using the same principles for type II endoleak embolization after EVAR. Author Disclosures: V. Babaliaros: Nothing to disclose; Y. Duwayri: Nothing to disclose; B. G. Leshnower: CryoLife: consulting fees (eg, advisory boards); A. B. Patel: Nothing to disclose; V. H. Thourani: Nothing to disclose; R. K. Veeraswamy: Nothing to disclose.
Abstracts 231S
VH: “How I Do It” Video Session
VH04 VH04.
VH01.
Carotid-Subclavian Transposition and CarotidCarotid Bypass to Facilitate TEVAR Emily Spangler, MD, Mark F. Fillinger, MD. DartmouthHitchcock Medical Center, Lebanon, NH
Eversion Femoral Artery Endarterectomy and Endovascular Revascularization for Critical Limb Ischemia Gianluca Faggioli, MD, Liborio Ferrante, MD, Giuseppe Indelicato, MD, Rodolfo Pini, MD, Matteo Longhi, MD, Andrea Vacirca, MD, Mauro Gargiulo, MD, PhD, Andrea Stella, MD. University of Bologna, Bologna, Italy Background: This video shows the eversion endarterectomy technique for revascularization of the femoral bifurcation in conjunction with endovascular procedures and minor foot amputation. Author Disclosures: G. Faggioli: Nothing to disclose; L. Ferrante: Nothing to disclose; M. Gargiulo: Nothing to disclose; G. Indelicato: Nothing to disclose; M. Longhi: Nothing to disclose; R. Pini: Nothing to disclose; A. Stella: Nothing to disclose; A. Vacirca: Nothing to disclose.
VH02. VH02 Celiac Artery Decompression With Supraceliac Aorta-to-Celiac Bypass Charles A. West Jr, MD, FACS1, Joseph L. Mills, MD2. 1 Baylor St. Luke’s Medical Center, Houston, Tex; 2 Baylor College of Medicine, Houston, Tex Background: This video illustrates the technique of supraceliac aortic exposure via an upper midline incision. The steps at division of the median arcuate ligament are described followed by the sequence of step for supraceliac aortoceliac bypass. Author Disclosures: J. L. Mills: Nothing to disclose; C. A. West: Nothing to disclose.
Background: A 78-year-old man with oxygen-dependent COPD with a 6.8-cm saccular thoracic aneurysm involving the left subclavian artery is presented. Video of his two-stage repair demonstrates portions of the left carotid-subclavian transposition and retropharyngeal rightto-left carotid-carotid bypass used to facilitate debranching for TEVAR. Author Disclosures: M. F. Fillinger: Endologix and W. L. Gore: consulting fees (eg, advisory boards); E. Spangler: Nothing to disclose.
VH05 VH05. Novel Technique for Ablation of Persistent Retrograde Perfusion of False Lumen in Chronic Aortic Dissection April L. Rodriguez, MD, Benjamin W. Starnes, MD, Niten Singh, MD, MS. University of Washington, Seattle, Wash Background: The following video demonstrates a novel technique to address persistent retrograde false lumen perfusion after TEVAR in chronic aortic dissections with aneurysmal degeneration. This technique uses a reversed Cook Renu device and ZIP plug as well as Aptus Endoanchors to obliterate the false lumen. Of note, there is a higher-quality video available for presentation; however, this version was not submitted due to size constraints. Author Disclosures: A. L. Rodriguez: Nothing to disclose; N. Singh: Nothing to disclose; B. W. Starnes: Aortica: intellectual property/patents, ownership interest.
VH06 VH06. VH03. VH03 Fenestrated-Branched Endovascular Thoracoabdominal Aortic Aneurysm Repair for Chronic Dissections Aaron C. Baker, MD, MS, Gustavo S. Oderich, MD, Jan Hofer, RN, Mauricio Ribeiro, MD, PhD. Mayo Clinic, Rochester, Minn Background: This case video highlights the treatment of an extent II thoracoabdominal aortic aneurysm secondary to a chronic type B dissection using a patient-specific, manufactured four-vessel fenestrated-branched endograft under a physician-sponsored investigational device exemption study. The case video entails preoperative planning, the endovascular execution, and outcome. A specific challenge demonstrated in this case is the technique used to cross the chronic dissection flap to access the isolated right renal artery, which was perfused by the false lumen. Author Disclosures: A. C. Baker: Nothing to disclose; J. Hofer: Nothing to disclose; G. S. Oderich: Nothing to disclose; M. Ribeiro: Nothing to disclose.
The Knickerbocker Technique for Endovascular Exclusion of False Lumen in Chronic Type B Aortic Dissection Fabio Verzini, MD, PhD1, Diletta Loschi, MD1, Gioele Simonte, MD1, Luca Farchioni, MD1, Gianbattista Parlani, MD2, yPaola De Rango, MD, PhD2. 1University of Perugia, Perugia, Italy; 2Azienda Ospedaliera di Perugia, Perugia, Italy Background: Simple endovascular coverage of primary entry tear in chronic type B aortic dissection (CTBAD) is often unsuccessful in promoting false lumen (FL) thrombosis and aortic remodeling as it occurs with acute dissections. Aim of this video is to illustrate technical solutions used for effective endovascular treatment in a case of a residual CTBAD after acute type A aortic dissection. Critical issues addressed are (1) creation of a suitable landing zone for endografting at the time of the original open surgery for the acute Type A dissection, with the use of a branched open graft for revascularization and proximal rerouting of the innominate and the left common carotid arteries, (2) left subclavian (that presented chronic dissection involving
JOURNAL OF VASCULAR SURGERY June Supplement 2016
232S Abstracts
the dominant vertebral artery) revascularization with carotid-subclavian by pass plus vertebral artery reimplantation, at the time of thoracic endografting, as the first step of residual CTBAD treatment, (3) secondary sealing of FL distal backflow by deploying in the distal thoracic true lumen an oversized, tapered stent graft, followed by controlled balloon rupture of the dissection membrane, the so-called knickerbocker technique. The ballooning maneuver dilated the endograft to full diameter at its midsection, permitting the graft to adhere to the outer aortic layer with a rapid expansion suggesting the dissection membrane had effectively ruptured. Author Disclosures: yP. De Rango: Nothing to disclose; L. Farchioni: Nothing to disclose; D. Loschi: Nothing to disclose; G. Parlani: Nothing to disclose; G. Simonte: Nothing to disclose; F. Verzini: Cook Medical and Medtronic: consulting fees (eg, advisory boards), W. L. Gore: fee. VH07. VH07 Endovascular Retrieval of a Trapease IVC Filter Zack Nash, MD, Jean Bismuth, MD, Alan Lumsden, MD, FRCS, Carlos F. Bechara, MD, MS. Houston Methodist Hospital, Houston, Tex Background: This is a retrieval of a permanent Trapease filter that was placed a year before our intervention. The patient’s hematologist was planning to stop her anticoagulation after a year of treatment and requested removal. We used a layered support technique using multiple sheaths. Author Disclosures: C. F. Bechara: Nothing to disclose; J. Bismuth: Nothing to disclose; A. Lumsden: Boston Scientific, Medtronic, and W. K. Gore: consulting fees (eg, advisory boards), speaker’s bureau, Maquet and Siemens: consulting fees (eg, advisory boards); Z. Nash: Nothing to disclose. VH08. VH08 Supraceliac Aorta to Common Hepatic Artery and Superior Mesenteric Artery Bypass for Chronic Mesenteric Ischemia Danielle M. Pineda, MD, Samuel Tyagi, MD, Douglas A. Troutman, MD, Matthew Dougherty, MD, Keith D. Calligaro, MD. Pennsylvania Hospital, Philadelphia, Pa Background: This video illustrates the technique for a bypass from supraceliac aorta to common hepatic artery and superior mesenteric artery in a patient with chronic mesenteric ischemia and failed celiac artery stent. Despite
the increased use of advanced mesenteric techniques, it remains important for trainees to understand how to treat patients using open bypass when stents have failed. Author Disclosures: K. D. Calligaro: Nothing to disclose; M. Dougherty: Nothing to disclose; D. M. Pineda: Nothing to disclose; D. A. Troutman: Nothing to disclose; S. Tyagi: Nothing to disclose. VH09 VH09. Femoral Vein Transposition Arteriovenous Fistula for Dialysis Access Jeffrey Siracuse, MD, Alik Farber, MD. Boston University School of Medicine, Boston, Mass Background: In this video, we describe a 48-year-old woman undergoing a femoral vein transposition arteriovenous fistula for dialysis access. This patient had end-stage renal disease and a history of multiple upper extremity vascular accesses as well as peritoneal dialysis catheters. Preoperative central venography confirmed subclavian and superior vena cava occlusion. Author Disclosures: A. Farber: Bard: consulting fees (eg, advisory boards); J. Siracuse: Nothing to disclose.
VH10 VH10. Transcaval Small and Large Sheath Aortic Access Yazan Duwayri, MD1, Bradley G. Leshnower, MD2, Ravi K. Veeraswamy, MD2, Ateet B. Patel, MD1, Vinod H. Thourani, MD2, Vasilis Babaliaros, MD2. 1Emory University, Atlanta, Ga; 2Emory University School of Medicine, Atlanta, Ga Background: The video illustrates the technique of aortic device delivery through transcaval venous access, followed by closure of the aortocaval fistula. The technique provides an alternative to transfemoral arterial access in patients with small ileofemoral access vessels. The presentation will include percutaneous aortic valve delivery using this method, in addition to using the same principles for type II endoleak embolization after EVAR. Author Disclosures: V. Babaliaros: Nothing to disclose; Y. Duwayri: Nothing to disclose; B. G. Leshnower: CryoLife: consulting fees (eg, advisory boards); A. B. Patel: Nothing to disclose; V. H. Thourani: Nothing to disclose; R. K. Veeraswamy: Nothing to disclose.