EVAR/TEVARÇALIŞTAY

Prof.Dr. Fürüzan NumanGirişimsel Radyoloji Bilim Dalı Bşk.

İstanbul ÜniversitesiCerrahpasa Tıp Fakültesi

2014 9.GİRİŞİMSEL RADYOLOJİ YILLIK TOPLANTISI ANTALYA

AORTİK FİSTÜLLER

AORTO-ÖZEFAGİYAL

AORTO-BRONŞİYAL

AORTO-ENTERİK

UNUSUAL WAY TO TREATUNUSUAL WAY TO TREATAORTO-EOSPHAGEAL FISTULAAORTO-EOSPHAGEAL FISTULA

Prof. Furuzan Numan, M.DChief of Interventional Radiology Department

Istanbul UniversityCerrahpasa Medical Faculty,TURKIYE

VEITH 2009 NY

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.

Follow-up 2005 Follow-up 2005 non-cotrast CT and MRnon-cotrast CT and MR

ABF by-pass graft

Follow-up February 12th, 2006Follow-up February 12th, 2006non-contrast MRnon-contrast MR

March 07,2006March 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

r-TEVARr-TEVAR

May 11th, 2006May 11th, 2006

2nd month follow-up after TEVAR

Infected Aneurysm SacInfected Aneurysm Sac

he admitted to hospital with recent

Symptoms of ;

high fever, sweating,

nausea, vomiting,

weight-loss and

backpain

Endoscopic view of the fistulaEndoscopic view of the fistula

.

AEF: a catastrophic complication

Outcomes of thoracic endovascular aortic repair for aortobronchial and aortoesophageal fistulas.Jonker et all. J Endovasc Ther. 2009 Aug;16(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.

Aortoesophageal fistula after thoracic aortic stent-graft Aortoesophageal fistula after thoracic aortic stent-graft placement: a rare but catastrophic complication of a placement: a rare but catastrophic complication of a

novel emerging technique;novel emerging technique;

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.

.

Eggebrecht H et all, JACC Cardiovasc Interv. 2009 Jun;2(6):570-6

AEF: a catastrophic complication

New option to treat AEF New option to treat AEF

Medical !!

TEVAR !!

Surgery!!

Percutaneous drainage of infected aneurysm sac

CT guidance percutaneous CT guidance percutaneous drainage of infected aneurysm sac 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.

Procedure:Procedure: TwoTwo step techniquestep 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

Aspiration :TLA needle Aspiration :TLA needle

Trocar Technique:Pig-tail external Trocar Technique:Pig-tail external drainage catheterdrainage catheter

Trocar Technique:Pig-tail external Trocar Technique:Pig-tail external drainage catheterdrainage catheter

Drainage catheter was removed after 2 weeks while CT-scan showed total regression of collection in aneurysm sac with improvement in patient’s clinical condition

Follow-up June 18 th ,2006 Follow-up June 18 th ,2006 Control CT with oral contrast & eosphagraphy Control CT with oral contrast & eosphagraphy

Follow-up July 03 rd,2006Follow-up July 03 rd,2006 eosphagraphy & non contrast CT eosphagraphy & non contrast CT

Follow-upFollow-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

ConclusionConclusion

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.

AORTO-BRONŞİYAL FİSTÜL1996 da torkal aort cerrahi girişimi

2004 te hemoptizi

CT

DSA?

TEVAR

10 senelik takip altında, progresiv aterosklerotik anevrizma nedeni ile TEVAR disalde ÇT seviyesine kadar uzatıldı,AAA çap nedeni ile takipte.

AORTO-BRONŞİYAL FİSTÜL

AORTO-BRONSİYAL FİSTÜL

28/06/2013Mezenter iskemi? MSCT

Opere AAA, SKİA Oklüde,fem-fem bypass

09/07/2013Mezenter iskemi?

DSA(-),proksimal anastomoz hhattıda psödöanevrizma

24/07/2013Masiv GİS kanaması,MSCT,

AORTO-ENTERİK FİSTÜL

24/07/2013 ACİL EVAR,AUI

AORTO-ENTERİK FİSTÜL

29/07/2013 Kontrol MSCT

AORTİK FİSTÜLLER

Hasta öyküsü,klinik ve radyolojik dikkat ile

gereğinde nonvasküler yaklaşımlarla tedavi edilebilecek ender ancak mortal olgulardır.