血管内手术心脏外科医生不断演变的角色英文

Endovascular Surgery: The Evolving Role of the Cardiac Surgeon Lee E. Lee E. ErrettErrett MD, FRCSC, FRCS MD, FRCSC, FRCS Chief, Division of Cardiovascular and Thoracic Surgery, St. Michaels Hospital Terrence Donnelly Cardiac Centre. Professor, University of Toronto The Workshop Image Intensifier Fixed surgical table X-ray tube assembly Surgical Tools The Tools Intravascular Ultrasound Aorta Subclavian Coronary SFA And Below Iliac Renal No vessel is sage The heart and most vessels are accessible via percutaneous approaches. Traditional Approach Or This? Left common carotid Left subclavian Aortic 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 Z0 Z1 Z2 Z3 Z4 Initial thoracic ELG Coverage of LSCA Extra-thoracic debranching Intra-thoracic debranching 17 yo male struck by minivan Traumatic aortic transection Close head trauma Spleen & liver injuries Open fractures Traumatic Aortic Transection Preoperative CT Postoperative CT: 1 month Aneurysm Asymptomatic Contained rupture Acute Type B dissection Chronic dissection with aneurysm Penetrating ulcer Intramural hematoma Aortic coarctation Pseudoaneurysm associated with previous repair Aortic transection Aortobronchial fistula Potential for Thoracic Stenting 41 yo male Incidentally discovered during hospitalization for pneumonia Remote history of MVA Case: Innominate artery aneurysm Standard vs. Innovative Postoperative CT 79 yo male PHx: Prior Cardiac Sx Prostate Cancer HTN Case: 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 occluded Pseudoaneurysm of Ascending Aorta Coils failed to close entry point Aneurysm expanded from 6 -10cm in 4 months Preoperative CT Ascending Aortic Stent Graft Postoperative CT: 1 year