evar/tevar ÇaliŞtay
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EVAR/TEVAR ÇALIŞTAY. Prof.Dr. Fürüzan Numan Girişimsel Radyoloji Bilim Dalı Bşk. İstanbul Üniversitesi Cerrahpasa Tıp Fakültesi. 2014 9.GİRİŞİMSEL RADYOLOJİ YILLIK TOPLANTISI ANTALYA. AORTİK FİSTÜLLER. AORTO-ÖZEFAGİYAL AORTO-BRONŞİYAL AORTO-ENTERİK. - PowerPoint PPT PresentationTRANSCRIPT
EVAR/TEVARÇALIŞTAY
Prof.Dr. Fürüzan NumanGirişimsel Radyoloji Bilim Dalı Bşk.
İstanbul ÜniversitesiCerrahpasa Tıp Fakültesi
2014 9.GİRİŞİMSEL RADYOLOJİ YILLIK TOPLANTISI ANTALYA
AORTİK FİSTÜLLER
AORTO-ÖZEFAGİYAL
AORTO-BRONŞİYAL
AORTO-ENTERİK
UNUSUAL WAY TO TREATUNUSUAL WAY TO TREATAORTO-EOSPHAGEAL FISTULAAORTO-EOSPHAGEAL FISTULA
Prof. Furuzan Numan, M.DChief of Interventional Radiology Department
Istanbul UniversityCerrahpasa Medical Faculty,TURKIYE
VEITH 2009 NY
Background:
History: A 68-year-old male
HT,CRF, TAA
ABF by-pass surgery (AAA) 2004,
Patient refused to have TEVAR,
While he was followed at another center.
Follow-up 2005 Follow-up 2005 non-cotrast CT and MRnon-cotrast CT and MR
ABF by-pass graft
Follow-up February 12th, 2006Follow-up February 12th, 2006non-contrast MRnon-contrast MR
March 07,2006March 07,2006
Recent symptoms; Intense backpain & discomfort,
no hematemesis, had been treated
for unknown source of infection
last 3-4months
Diagnosis;
contained rupture Choice of treatment;
TEVAR
r-TEVARr-TEVAR
May 11th, 2006May 11th, 2006
2nd month follow-up after TEVAR
Infected Aneurysm SacInfected Aneurysm Sac
he admitted to hospital with recent
Symptoms of ;
high fever, sweating,
nausea, vomiting,
weight-loss and
backpain
Endoscopic view of the fistulaEndoscopic view of the fistula
.
AEF: a catastrophic complication
Outcomes of thoracic endovascular aortic repair for aortobronchial and aortoesophageal fistulas.Jonker et all. J Endovasc Ther. 2009 Aug;16(4):428-40
CONCLUSION: TEVAR management of AEF is associated with poor results and should not be considered definitive treatment. TEVAR could serve as a bridge to surgery for emergency cases of AEF only, with definitive open surgical correction of the fistula undertaken as soon as possible.
Aortoesophageal fistula after thoracic aortic stent-graft Aortoesophageal fistula after thoracic aortic stent-graft placement: a rare but catastrophic complication of a placement: a rare but catastrophic complication of a
novel emerging technique;novel emerging technique;
Surgical repair was performed in only 1 patient and declined in the remaining because of comorbidities and multiorgan system failure. Despite this, all patients died due to fatal rebleeding (n = 4) or mediastinitis (n = 2).
CONCLUSION: AEF is a rare and unusual complication of TEVAR that occurs relatively early after the procedure and is almost invariably fatal.
.
Eggebrecht H et all, JACC Cardiovasc Interv. 2009 Jun;2(6):570-6
AEF: a catastrophic complication
New option to treat AEF New option to treat AEF
Medical !!
TEVAR !!
Surgery!!
Percutaneous drainage of infected aneurysm sac
CT guidance percutaneous CT guidance percutaneous drainage of infected aneurysm sac drainage of infected aneurysm sac
prone position
general anesthesia
left endobronchial intubation to stop ventilation and collapse of the right lung to insert drainage catheter without damaging right lung.
Procedure:Procedure: TwoTwo step techniquestep technique
• 19 G TLA Needle to confirm the infected material,(Staphylococcus auricularis,Streptoccus viridans, Candida albicans),soft outer sheat stayed at position till the end of procedure (not to contaminate mediastinum & pleura)
• Insertion of the 10F pig-tail external drainage catheter from another level
Aspiration :TLA needle Aspiration :TLA needle
Trocar Technique:Pig-tail external Trocar Technique:Pig-tail external drainage catheterdrainage catheter
Trocar Technique:Pig-tail external Trocar Technique:Pig-tail external drainage catheterdrainage catheter
Drainage catheter was removed after 2 weeks while CT-scan showed total regression of collection in aneurysm sac with improvement in patient’s clinical condition
Follow-up June 18 th ,2006 Follow-up June 18 th ,2006 Control CT with oral contrast & eosphagraphy Control CT with oral contrast & eosphagraphy
Follow-up July 03 rd,2006Follow-up July 03 rd,2006 eosphagraphy & non contrast CT eosphagraphy & non contrast CT
Follow-upFollow-up
The patient was under antibiotic therapy(Duocid,Tavanic,Triflucan) for a year
MI was the cause of death at 2008 ,
2 years after percutaneous drainage
ConclusionConclusion
Percutaneous drainage of infected anuersym sac can be a life saving option of patients having rare and unusual complication of AEF after TEVAR at suitable conditions.
AORTO-BRONŞİYAL FİSTÜL1996 da torkal aort cerrahi girişimi
2004 te hemoptizi
CT
DSA?
TEVAR
10 senelik takip altında, progresiv aterosklerotik anevrizma nedeni ile TEVAR disalde ÇT seviyesine kadar uzatıldı,AAA çap nedeni ile takipte.
AORTO-BRONŞİYAL FİSTÜL
AORTO-BRONSİYAL FİSTÜL
28/06/2013Mezenter iskemi? MSCT
Opere AAA, SKİA Oklüde,fem-fem bypass
09/07/2013Mezenter iskemi?
DSA(-),proksimal anastomoz hhattıda psödöanevrizma
24/07/2013Masiv GİS kanaması,MSCT,
AORTO-ENTERİK FİSTÜL
24/07/2013 ACİL EVAR,AUI
AORTO-ENTERİK FİSTÜL
29/07/2013 Kontrol MSCT
AORTİK FİSTÜLLER
Hasta öyküsü,klinik ve radyolojik dikkat ile
gereğinde nonvasküler yaklaşımlarla tedavi edilebilecek ender ancak mortal olgulardır.