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Endovascular Surgery: The Evolving Role of the Cardiac SurgeonChief, Division of Cardiovascular and Thoracic Surgery, St. Michaels HospitalTerrence Donnelly Cardiac Centre.Professor, University of Toronto The Workshop Image IntensifierFixed surgical table X-ray tube assembly Surgical Tools The Tools Intravascular Ultrasound AortaSubclavianCoronarySFAAndBelowIliacRenal No vessel is sageThe heart and most vessels are accessible via percutaneous approaches. Traditional Approach Or This? Left common carotid Left subclavianAortic neck diameters (range 23mm-37mm)20mm 20mm to celiac Principles: Adequate vascular access Adequate proximal and distal landing zones non-aneurysmal aortic segment diameter 24-38 mm length 20 mm Z0Z1Z2Z3Z4 Initial thoracic ELGCoverage of LSCAExtra-thoracic debranchingIntra-thoracic debranching 17 yo male struck by minivan Traumatic aortic transection Close head trauma Spleen & liver injuries Open fracturesTraumatic Aortic Transection Preoperative CT Postoperative CT: 1 month AneurysmAsymptomaticContained ruptureAcute Type B dissectionChronic dissection withaneurysmPenetrating ulcerIntramural hematomaAortic coarctationPseudoaneurysm associated with previous repairAortic transectionAortobronchial fistulaPotential for Thoracic Stenting 41 yo male Incidentally discovered during hospitalization for pneumonia Remote history of MVACase: Innominate artery aneurysm Standard vs. Innovative Postoperative CT 79 yo male PHx: Prior Cardiac Sx Prostate Cancer HTNCase: Arch Aneurysm Endovascular Solution? Future of Arch Endografting J. L. Andersen, Australia Innovative Endovascular Approaches to the Arch J. L. Andersen, Australia J. L. Andersen, Australia Future of Thoracoabdominal Aortic Surgery Ascending Aorta Safe from Endovascular Approaches?Not Anymore! Initial Experience with Endovascular Repair of the Ascending Aorta Right coronary artery bypass occludedPseudoaneurysm of Ascending Aorta Coils failed to close entry point Aneurysm expanded from 6-10cm in 4 monthsPreoperative CT Ascending Aortic Stent Graft Postoperative CT: 1 year The Future is Bright! Gore TAG Medtronic Talent Cook TX2Thoracic Endografts
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