Innovations in treating AAA: Innovative Endovascular Approaches

 

Aortic aneurysms involving aortic branches pose significant challenges for open and endovascular repair. Tuesday morning’s session, “New Developments with Juxta and Pararenal Aortic Aneurysms and Thoracoabdominal Aneurysms,” will be a discussion of surgical experiences with the first fenestrated graft approved in the United States and a review several other approaches to treatment.

“In the endovascular era, the increasing number of patients treated with aortic endografting [means more] patients with a failure of endovascular aneurysm repair (EVAR),” said Dr. Piergiorgio Cao, of the Università degli Studi di Perugia in Italy. “Until a few years ago, open conversion was the first and only choice. Now, especially in high-risk, fragile patients, the use of fenestrated endograft (F/EVAR) or chimney endograft (ChEVAR) might represent valid alternatives.”

The session will provide “an important update about the most recent advances in this field,” Dr. Cao added. “It will be focused on the most recent adjuncts to be used not only in patients with a failed EVAR but also in preventing the failure as well as the indications for using endovascular versus an open approach.”

The advantages and possible complications of ZFEN, the only fenestrated graft approved in the United States, will be discussed, as will a hybrid repair requiring laparotomy and multiple anastomoses, said co-moderator Dr. Giovanni Torsello, of the University of Münster in Germany.

The session kicks off with presentations on the current status of ZFEN by Dr. Andres Schanzer of UMass Memorial Medical Center and on circumstances in when superior mesenteric artery (SMA) scallops can cause problems during F/EVAR with ZFEN by Dr. Carlos Timaran of the University of Texas Southwestern Medical School.

From there the session will have several presentations on hostile neck abdominal aortic aneurysms (AAAs) and treatment options. Hostile neck anatomy, most notably short and/or angulated necks, is the primary factor limiting the applicability and compromising the outcomes of standard EVAR, said co-moderator Dr. Kim Hodgson, of the Southern Illinois University School of Medicine. A variety of off-label workarounds have been employed to facilitate EVAR in such patients, with varying degrees of success, he said. Patients with these aneurysms are not infrequent in clinical practice, Dr. Hodgson noted, with upwards of 20% of AAA patients having such anatomy.

“The topics covered in this session will aid vascular surgeons in deciding the best approach to treat such patients, by emphasizing the strengths, weaknesses, and limitations of the various options,” he said. “Tips and tricks to address specific circumstances can be invaluable in optimizing patient outcomes.”

The last portion of the session will cover F/EVAR for failed EVAR, including when F/EVAR is indicated, adjuncts to improve outcomes of treatment for challenging AAAs, and branched EVAR (B/EVAR). The session will wrap with a presentation by Dr. Piotr Szopinski of the Medical University of Warsaw on early clinical results from the COLT endograft system for treatment of thoracoabdominal aortic aneurysms (TAAAs).

“Attendees will have the opportunity to compare the different treatment options,” Dr. Torsello said. “We look forward to an open discussion that will lead to practical guidelines for decision making. The audience can develop their own treatment algorithms for patients with hostile or absent aortic aneurysm neck.”

“We currently have multiple modalities to prevent and treat complications,” Dr. Cao said. “Vascular surgeons should be familiar with different techniques and should tailor their approach to each patient according to the morphology of the native aorta and access vessels, as well as the clinical conditions and risk factors for open surgery.”
 

Session 12:
New Developments with Juxta and Pararenal Aortic Aneurysms and Thoracoabdominal Aneurysms
Tuesday, 10:20 a.m. – 12:00 p.m.
Grand Ballroom West, 3 ^rd Floor

 

Aortic aneurysms involving aortic branches pose significant challenges for open and endovascular repair. Tuesday morning’s session, “New Developments with Juxta and Pararenal Aortic Aneurysms and Thoracoabdominal Aneurysms,” will be a discussion of surgical experiences with the first fenestrated graft approved in the United States and a review several other approaches to treatment.

“In the endovascular era, the increasing number of patients treated with aortic endografting [means more] patients with a failure of endovascular aneurysm repair (EVAR),” said Dr. Piergiorgio Cao, of the Università degli Studi di Perugia in Italy. “Until a few years ago, open conversion was the first and only choice. Now, especially in high-risk, fragile patients, the use of fenestrated endograft (F/EVAR) or chimney endograft (ChEVAR) might represent valid alternatives.”

The session will provide “an important update about the most recent advances in this field,” Dr. Cao added. “It will be focused on the most recent adjuncts to be used not only in patients with a failed EVAR but also in preventing the failure as well as the indications for using endovascular versus an open approach.”

The advantages and possible complications of ZFEN, the only fenestrated graft approved in the United States, will be discussed, as will a hybrid repair requiring laparotomy and multiple anastomoses, said co-moderator Dr. Giovanni Torsello, of the University of Münster in Germany.

The session kicks off with presentations on the current status of ZFEN by Dr. Andres Schanzer of UMass Memorial Medical Center and on circumstances in when superior mesenteric artery (SMA) scallops can cause problems during F/EVAR with ZFEN by Dr. Carlos Timaran of the University of Texas Southwestern Medical School.

From there the session will have several presentations on hostile neck abdominal aortic aneurysms (AAAs) and treatment options. Hostile neck anatomy, most notably short and/or angulated necks, is the primary factor limiting the applicability and compromising the outcomes of standard EVAR, said co-moderator Dr. Kim Hodgson, of the Southern Illinois University School of Medicine. A variety of off-label workarounds have been employed to facilitate EVAR in such patients, with varying degrees of success, he said. Patients with these aneurysms are not infrequent in clinical practice, Dr. Hodgson noted, with upwards of 20% of AAA patients having such anatomy.

“The topics covered in this session will aid vascular surgeons in deciding the best approach to treat such patients, by emphasizing the strengths, weaknesses, and limitations of the various options,” he said. “Tips and tricks to address specific circumstances can be invaluable in optimizing patient outcomes.”

The last portion of the session will cover F/EVAR for failed EVAR, including when F/EVAR is indicated, adjuncts to improve outcomes of treatment for challenging AAAs, and branched EVAR (B/EVAR). The session will wrap with a presentation by Dr. Piotr Szopinski of the Medical University of Warsaw on early clinical results from the COLT endograft system for treatment of thoracoabdominal aortic aneurysms (TAAAs).

“Attendees will have the opportunity to compare the different treatment options,” Dr. Torsello said. “We look forward to an open discussion that will lead to practical guidelines for decision making. The audience can develop their own treatment algorithms for patients with hostile or absent aortic aneurysm neck.”

“We currently have multiple modalities to prevent and treat complications,” Dr. Cao said. “Vascular surgeons should be familiar with different techniques and should tailor their approach to each patient according to the morphology of the native aorta and access vessels, as well as the clinical conditions and risk factors for open surgery.”
 

Session 12:
New Developments with Juxta and Pararenal Aortic Aneurysms and Thoracoabdominal Aneurysms
Tuesday, 10:20 a.m. – 12:00 p.m.
Grand Ballroom West, 3 ^rd Floor

 

Aortic aneurysms involving aortic branches pose significant challenges for open and endovascular repair. Tuesday morning’s session, “New Developments with Juxta and Pararenal Aortic Aneurysms and Thoracoabdominal Aneurysms,” will be a discussion of surgical experiences with the first fenestrated graft approved in the United States and a review several other approaches to treatment.

“In the endovascular era, the increasing number of patients treated with aortic endografting [means more] patients with a failure of endovascular aneurysm repair (EVAR),” said Dr. Piergiorgio Cao, of the Università degli Studi di Perugia in Italy. “Until a few years ago, open conversion was the first and only choice. Now, especially in high-risk, fragile patients, the use of fenestrated endograft (F/EVAR) or chimney endograft (ChEVAR) might represent valid alternatives.”

The session will provide “an important update about the most recent advances in this field,” Dr. Cao added. “It will be focused on the most recent adjuncts to be used not only in patients with a failed EVAR but also in preventing the failure as well as the indications for using endovascular versus an open approach.”

The advantages and possible complications of ZFEN, the only fenestrated graft approved in the United States, will be discussed, as will a hybrid repair requiring laparotomy and multiple anastomoses, said co-moderator Dr. Giovanni Torsello, of the University of Münster in Germany.

The session kicks off with presentations on the current status of ZFEN by Dr. Andres Schanzer of UMass Memorial Medical Center and on circumstances in when superior mesenteric artery (SMA) scallops can cause problems during F/EVAR with ZFEN by Dr. Carlos Timaran of the University of Texas Southwestern Medical School.

From there the session will have several presentations on hostile neck abdominal aortic aneurysms (AAAs) and treatment options. Hostile neck anatomy, most notably short and/or angulated necks, is the primary factor limiting the applicability and compromising the outcomes of standard EVAR, said co-moderator Dr. Kim Hodgson, of the Southern Illinois University School of Medicine. A variety of off-label workarounds have been employed to facilitate EVAR in such patients, with varying degrees of success, he said. Patients with these aneurysms are not infrequent in clinical practice, Dr. Hodgson noted, with upwards of 20% of AAA patients having such anatomy.

“The topics covered in this session will aid vascular surgeons in deciding the best approach to treat such patients, by emphasizing the strengths, weaknesses, and limitations of the various options,” he said. “Tips and tricks to address specific circumstances can be invaluable in optimizing patient outcomes.”

The last portion of the session will cover F/EVAR for failed EVAR, including when F/EVAR is indicated, adjuncts to improve outcomes of treatment for challenging AAAs, and branched EVAR (B/EVAR). The session will wrap with a presentation by Dr. Piotr Szopinski of the Medical University of Warsaw on early clinical results from the COLT endograft system for treatment of thoracoabdominal aortic aneurysms (TAAAs).

“Attendees will have the opportunity to compare the different treatment options,” Dr. Torsello said. “We look forward to an open discussion that will lead to practical guidelines for decision making. The audience can develop their own treatment algorithms for patients with hostile or absent aortic aneurysm neck.”

“We currently have multiple modalities to prevent and treat complications,” Dr. Cao said. “Vascular surgeons should be familiar with different techniques and should tailor their approach to each patient according to the morphology of the native aorta and access vessels, as well as the clinical conditions and risk factors for open surgery.”
 

Session 12:
New Developments with Juxta and Pararenal Aortic Aneurysms and Thoracoabdominal Aneurysms
Tuesday, 10:20 a.m. – 12:00 p.m.
Grand Ballroom West, 3 ^rd Floor