T-TEVAR for Type B

Question 1

Alternatives to TEVAR
CT Assessment of dissection(2)
Stanford types
Debakey types
Complicated dissection(3)

Answer 1

Open repair, fenestration…no tevar avail,anatomy
Shape and extent

A and B
I-both aorta, II-ascending,III-descending …B_A_D

==malperfusion
Hypertension,rupture or impending rupture aka leak,malperfusion aka branch vessel occlusion.

Question 2

Malperfusion categories(2)

Describe dissection on CT

Answer 2

Hepatomesenteric or lower limber visceral or peripheral

D-I-S-S-E-C-T: duration,intimal tear location,size of dissected aorta,segmental extent
Complication(clinical ),thrombus within false lumen

Question 3

TEVAR indications for uncomplicated

TEVAR Contraindications-absolute ,relative

Answer 3

Allergy to material

ANATOMY….femoral entry:small,calcified,tortuous
LANDING…2 cm neck to L subclav a
Aorta..kink or angular ion

Question 4

Types of branch vessel occlusion-2

Treatment

Answer 4

Static-direct extension of flat into ostium
Dynamic-widening of false lumen and occlusion of true lumen near ostiun

Tx= static…stent the branch

Dynamic—

Question 5

Brands of stent grafts

…sizes,markers,differences

Answer 5

Gore: 26-45mm,10-20cm. Marker 1cm from end,deploy from middle

Medtronic,22-46,10-21.2cm

Question 6

Anticoagulant?
Problem of tortuous femoral
Target position of Endograft..anatomical variants

Answer 6

80-100 units per kilogram of heparin IV
……..
Between left common carotid and left subclavian artery.
See origins of verts, AND IF BOTH OPEN .If LIMA used for CABG,L ARM aV graft ETC

Question 7

Graft diameter sizing?oversizing %
Complications of oversizing
Recommended graft length
Length in rupture

Answer 7

Measure between left common carotid and left subclavian ,or prox to that in non dilated segm
Tear,migration…max 10%
15 cm..some go 20cm
In rupture go to above celiac axis….prevent retrograde flow to false leak.

Question 8

Spinal cord artery supply t8-conus,prophylaxis
Landing zones of different diameters..which first?
Same diameters..which first?
Minimum overlap?
PTA

Answer 8

T8-conus,=lumbar enlargement of cord
Smaller first
Proximal first
5 mm
No** avoid secondary tears within septum  at ends of stent and theretrograde dissection

Question 9

Type 1 endoleak definition.
Treatment
Treatment due to improper positioning
F/u if L subclav covered

Answer 9

Incomplete seal
Gentle PTA
Add stent or judicious pta
F/u CT or Angiology to look for retrograde false lumen filling via retrograde subclav flow..subclavian steal…

Question 10

Treatment of subclav steal

Outcome with TaeVAR/surgery. Mortality

Answer 10

Transpose or bypass l cca/sca.occlude stump of subclav

Ir plug or coil l sca.==#1

9%9less than 10 % with TEVER, 33% (1/3) surgery

Question 11

F/u scan

Answer 11

Prior to d/c
1month,false lumen thrombosis
3,6,12 months