Klinik für Gefäß- und Endovaskularchirurgie. Optimized treatment of raaa patients. Hubert Schelzig

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1 Klinik für Gefäß- und Endovaskularchirurgie Optimized treatment of raaa patients Hubert Schelzig Clinic for Vascular and Endovascular Surgery, Heinrich-Heine-University, Düsseldorf, Germany

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13 Seite 13 Mortality EVAR vs. Open Repair

14 Seite 14 Mortality EVAR vs. Open Repair

15 Seite 15 raaa (clinical suspicion) Stable Yes Angio-CT, Reco (Stentgraft possible) Yes EVAR

16 Seite 16 raaa (clinical suspicion) Yes Stable No Assessment Vascular surgeon Anesthesiologist Angio-CT, Reco (Stentgraft possible) unfavorable Yes No EVAR Open repair Conservative

17 Seite Patients; preoperative Status EVAR Open repair Cases 35 (m=31; f=4) 77 (m=64; f=13)

18 Seite Patients; preoperative Status EVAR Open repair Cases 35 (m=31; f=4) 77 (m=64; f=13) Age [years] 75 (53-88) 75 (44-93) Hypertension [%] Nicotine [%] CAD [%] PAD [%] Diabetes mellitus [%] 11 9

19 Seite Patients; preoperative Status EVAR Open repair Cases 35 (m=31; f=4) 77 (m=64; f=13) Age [years] 75 (53-88) 75 (44-93) Hypertension [%] Nicotine [%] CAD [%] PAD [%] Diabetes mellitus [%] 11 9 Renal Insufficiency [%] 34 17

20 Seite Patients; postsurgical course Early Complications EVAR Open Repair Patients [%]

21 Seite Patients; Mortality Causes MORTALITY CAUSES (clinical estimation) EVAR Open Repair Bloodloss 9% - Multi Organ Failure 3% 9% Ischemic Colitis - 18% Sepsis 3% 3% Myocardial Infarction - 3% Asystole 3% - Embolism Pulmonary Artery 3% -

22 Seite Patient; Discharged Home EVAR Open Repair Discharged Home 74% 68%

23 Seite Patients; Conclusion I) Stentgraft good alternative in raaa

24 Seite Patients; Conclusion I) Stentgraft good alternative in raaa II) should be prefered when anatomical feasable

25 Seite Patients; Conclusion I) Stentgraft good alternative in raaa II) should be prefered when anatomical feasable III) Open repair is integral part of optimal raaa program

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27 Seite 27 Ruptured Aneurysm - Open repair Ruptured and elective

28 Seite 28 Ruptured Aneurysm - Open repair Ruptured and elective

29 Seite 29 Ruptured Aneurysm - EVAR-Volume Ruptured and elective

30 Seite 30 Ruptured Aneurysm - Open repair Ruptured and elective

31 Seite 31 Ruptured Aneurysm - EVAR Ruptured and elective

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37 Seite 37 Operative Mortality for raaa-repair

38 Seite 38 Operative Mortality for raaa-repair

39 Seite 39 Operative Mortality for raaa-repair

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44 Seite Patients; Conclusion I) Stentgraft good alternative in raaa II) should be prefered when anatomical feasable III) Open repair is integral part of optimal raaa program

45 Seite 45 Conclusion 2012 I) Stentgraft good alternative in raaa II) should be prefered when anatomical feasable III) Open repair is integral part of optimal raaa program IV) Centralised/specialised therapy of raaa

46 Seite 46 Conclusion 2012 I) Stentgraft good alternative in raaa II) should be prefered when anatomical feasable III) Open repair is integral part of optimal raaa program IV) Centralised/specialised therapy of raaa V) Coincidential with EVAR outcome improved

47 Seite 47 Thank you for your attention