Imaging Surveillance, Leaks, and Late Complications

1
Imaging Surveillance, Leaks, and Late
Complications

• Ross Milner, MD
• Assistant Professor of Surgery
• SAVS 2007 Postgraduate Course
• January 17, 2007

2
Disclosures

• Consultant WL Gore and Assoc
• Scientific Advisory Board and Ownership Interest
  CardioMEMS, Inc.

3
Surveillance
4
(No Transcript)
5
CTA
6
MRA
7
Imaging Limitations

• Ultrasound is not useful
• CTA requires repeated administration of
  nephrotoxic contrast
• MRA experience for surveillance in the thoracic
  aorta is limited

8
The EndoSure AAA Wireless Pressure
Sensor(current system)
14 Fr Delivery System
Implantable Sensor
Measurement System
9
(No Transcript)
10
Remote Pressure Sensing for TAA?
11
Remote Pressure Sensing for TAA?
12
Remote Pressure Sensing for TAA?
13
First in Man Performed July,2005

• Performed at Florianopolis, Brazil

14
(No Transcript)
15
First in Man Performed July,2005

• Performed at Florianopolis, Brazil
• Performed by
• Dr. Pierre Silveira, Universidade Federal de
  Santa Catarina
• Dr. Ross Milner, Emory University Hospital

16
Thoracic Aneurysm Application
Sensor
17
Pre-exclusion
18
Post-exclusion
19
August 30, 2005
20
November 22, 2005
21
February 7, 2006
22
Pre-exclusion
6 months
23
1st Thoracic Patient BT-01
24
February 7, 2006
25
February 7, 2006
26
February 7, 2006
27
Patient Follow-up at 6 Months
28
Remote Pressure Sensing

• Off-label use
• Over 50 implanted worldwide
• Feasible for thoracic aneurysm exclusion and
  surveillance
• May have more utility due to type I and III
  endoleak risk

29
Endoleaks
30
(No Transcript)
31
Systemic Pressurization
32
Type I Endoleak
33
Type III Endoleak
34
Type III Endoleak
1 year follow-up
Sac size 5.3 cm
35
Type III Endoleak
2 year follow-up
Sac size 6.3 cm
36
(No Transcript)
37
Non-systemic Pressurization
38
Type II Endoleak
39
Non-systemic Pressurization

• What to do?

40
Late Complications
41
(No Transcript)
42
Aortic Perforation
43
Device Fracture
44
History

• 31 yo with prior aortic coarctation repair and
  redo repair
• Presents with hemoptysis

45
History

• 31 yo with prior aortic coarctation repair and
  redo repair
• Presents with hemoptysis
• 13 weeks pregnant

46
(No Transcript)
47
(No Transcript)
48
(No Transcript)
49
And.

• Returns with enlarging proximal pseudoaneurysm
• Placement of 26 x 10 TAG device (x 2)

50
Iliac artery injury
51
Iliac artery injury
52
And.

• Delivers the baby
• Difference in blood pressure between arms and
  legs
• Angiogram and CTA done

53
(No Transcript)
54
(No Transcript)
55
(No Transcript)
56
(No Transcript)
57
(No Transcript)
58
(No Transcript)
59
Perfect Therapy?
60
History

• 64 yo man with prior open descending thoracic
  aorta repair in Houston
• Presents with back pain after recent coronary
  stents placed

61
(No Transcript)
62
(No Transcript)
63
History

• 64 yo man with prior open descending thoracic
  aorta repair in Houston
• Presents with back pain after recent coronary
  stents placed
• TAG placed and does great

64
(No Transcript)
65
(No Transcript)
66
(No Transcript)
67
(No Transcript)
68
(No Transcript)
69
Conclusions

• Lifelong surveillance is mandatory

70
Conclusions

• Lifelong surveillance is mandatory
• Type I and III Endoleaks need to be aggressively
  treated

71
Conclusions

• Lifelong surveillance is mandatory
• Type I and III Endoleaks need to be aggressively
  treated
• Device design continues to improve

72
Conclusions

• Lifelong surveillance is mandatory
• Type I and III Endoleaks need to be aggressively
  treated
• Device design continues to improve
• Late complications can be fatal