EVAR/TEVAR

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EVAR/TEVARÇALISTAY

• Prof.Dr. Fürüzan Numan
• Girisimsel Radyoloji Bilim Dali Bsk.
• Istanbul Üniversitesi
• Cerrahpasa Tip Fakültesi

2014 9.GIRISIMSEL RADYOLOJI YILLIK TOPLANTISI
ANTALYA
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AORTIK FISTÜLLER

• AORTO-ÖZEFAGIYAL
• AORTO-BRONSIYAL
• AORTO-ENTERIK

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UNUSUAL WAY TO TREATAORTO-EOSPHAGEAL FISTULA

• Prof. Furuzan Numan, M.D
• Chief of Interventional Radiology Department
• Istanbul University
• Cerrahpasa Medical Faculty,TURKIYE

VEITH 2009 NY
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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.

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Follow-up 2005 non-cotrast CT and MR
ABF by-pass graft
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Follow-up February 12th, 2006non-contrast MR
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March 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

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r-TEVAR
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May 11th, 2006
2nd month follow-up after TEVAR

• 
  

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Infected Aneurysm Sac

• he admitted to hospital with recent
• Symptoms of
• high fever, sweating,
• nausea, vomiting,
• weight-loss and
• backpain

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Endoscopic view of the fistula
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AEF a catastrophic complication
Outcomes of thoracic endovascular aortic repair
for aortobronchial and aortoesophageal
fistulas. Jonker et all. J Endovasc Ther. 2009
Aug16(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.
.
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Aortoesophageal fistula after thoracic aortic
stent-graft placement a rare but catastrophic
complication of a novel emerging technique
AEF a catastrophic complication
Eggebrecht H et all, JACC Cardiovasc Interv. 2009
Jun2(6)570-6

• 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.

.

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New option to treat AEF

• Medical !!
• TEVAR !!
• Surgery!!
• Percutaneous drainage of infected aneurysm sac

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CT guidance percutaneous 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.

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Procedure Two step 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

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Aspiration TLA needle
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Trocar TechniquePig-tail external drainage
catheter
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Trocar TechniquePig-tail external drainage
catheter
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• Drainage catheter was removed after 2 weeks
  while CT-scan showed total regression of
  collection in aneurysm sac with improvement in
  patients clinical condition

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Follow-up June 18 th ,2006 Control CT with oral
contrast eosphagraphy
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Follow-up July 03 rd,2006 eosphagraphy non
contrast CT

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Follow-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

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Conclusion

• 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.

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AORTO-BRONSIYAL FISTÜL

• 1996 da torkal aort cerrahi girisimi
• 2004 te hemoptizi
• CT
• DSA?
• TEVAR
• 10 senelik takip altinda, progresiv
  aterosklerotik anevrizma nedeni ile TEVAR disalde
  ÇT seviyesine kadar uzatildi,AAA çap nedeni ile
  takipte.

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AORTO-BRONSIYAL FISTÜL
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AORTO-BRONSIYAL FISTÜL
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28/06/2013Mezenter iskemi? MSCTOpere AAA, SKIA
Oklüde,fem-fem bypass
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09/07/2013Mezenter iskemi?DSA(-),proksimal
anastomoz hhattida psödöanevrizma
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24/07/2013Masiv GIS kanamasi,MSCT,
AORTO-ENTERIK FISTÜL
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24/07/2013 ACIL EVAR,AUI
AORTO-ENTERIK FISTÜL
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29/07/2013 Kontrol MSCT
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AORTIK FISTÜLLER

• Hasta öyküsü,klinik ve radyolojik dikkat ile
• gereginde nonvasküler yaklasimlarla tedavi
  edilebilecek ender ancak mortal olgulardir.

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