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Home > Vascular Annual Meeting^® > VS5. Endograft Exclusion of Acute Descending Thoracic...

VS5. Endograft Exclusion of Acute Descending Thoracic Aortic Dissection – Critical Role of Intravascular Ultrasound

Rodney White, Carlos Donayre, Irwin Walot, George Kopchok, Joe Chauvapun, Arash Keyhani, Omid Jazaeri
Harbor-UCLA Medical Center, Torrence, CA

OBJECTIVES: This video demonstrates the use intravascular ultrasound (IVUS) during endograft exclusion of descending thoracic aortic dissections.

METHODS: The video demonstrates endograft exclusion of an acute descending aortic dissection in a 53-year-old male with abdominal pain, suspected visceral ischemia and left leg ischemia. Emergent intervention demonstrated descending aortic anatomy amenable for endograft exclusion with complete collapse of the true lumen in the mid-descending aorta as the cause of the visceral and limb ischemia. IVUS was used to guide endograft exclusion of the primary entry site just distal to the left subclavian artery and a second entry in the mid-descending aorta at the location of the true lumen collapse using Valiant Thoracic Endografts made available as part of a single-center FDA approved Investigator IDE.

RESULTS: There was immediate reperfusion of the true lumen, visceral arteries and lower extremities. Following the procedure the patient underwent exploratory laparotomy with ileocolectomy for ischemic gut. Leg ABIs returned to normal and no other operative procedures were required.

CONCLUSIONS: The video demonstrates the immediate effect of device insertion on the dynamic flow changes of the true and false lumen and clearly illustrates the utility of this technique in guiding all aspects of the intervention.

AUTHOR DISCLOSURES: R. White, Volcano, Medtronic; C. Donayre, Medtronic, Volcano; I. Walot, None; G. Kopchok, Medtronic, Volcano, Endologix; J. Chauvapun, None; A. Keyhani, None; O. Jazaeri, None.