1、Endovascular Surgery: The Evolving Role of the Cardiac Surgeon,Lee E. Errett MD, FRCSC, FRCSChief, 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
2、assembly,Surgical Tools,The Tools,Intravascular Ultrasound,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,Principles: Adequate vascular access Adeq
3、uate proximal and distal landing zones non-aneurysmal aortic segment diameter 24-38 mm length 20 mm,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 fra
4、ctures,Traumatic Aortic Transection,Preoperative CT,Postoperative CT: 1 month,Aneurysm Asymptomatic Contained rupture Acute Type B dissection Chronic dissection withaneurysm Penetrating ulcer Intramural hematoma Aortic coarctation Pseudoaneurysm associated with previous repair Aortic transection Aor
5、tobronchial 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,Endovas
6、cular 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 E
7、ndovascular Repair of the Ascending Aorta,Right coronary artery bypass occluded,Coils failed to close entry point,Aneurysm expanded from 6-10cm in 4 months,Preoperative CT,Ascending Aortic Stent Graft,Postoperative CT: 1 year,THE FUTURE IS NOW!,The Future is Bright!,Gore TAG,Medtronic Talent,Cook TX2,Thoracic Endografts,
