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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Seite 13 Mortality EVAR vs. Open Repair
Seite 14 Mortality EVAR vs. Open Repair
Seite 15 raaa (clinical suspicion) Stable Yes Angio-CT, Reco (Stentgraft possible) Yes EVAR
Seite 16 raaa (clinical suspicion) Yes Stable No Assessment Vascular surgeon Anesthesiologist Angio-CT, Reco (Stentgraft possible) unfavorable Yes No EVAR Open repair Conservative
Seite 17 112 Patients; preoperative Status EVAR Open repair Cases 35 (m=31; f=4) 77 (m=64; f=13)
Seite 18 112 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 [%] 60 68 Nicotine [%] 46 44 CAD [%] 17 21 PAD [%] 20 14 Diabetes mellitus [%] 11 9
Seite 19 112 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 [%] 60 68 Nicotine [%] 46 44 CAD [%] 17 21 PAD [%] 20 14 Diabetes mellitus [%] 11 9 Renal Insufficiency [%] 34 17
Seite 20 112 Patients; postsurgical course Early Complications EVAR Open Repair Patients [%]
Seite 21 112 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% -
Seite 22 112 Patient; Discharged Home EVAR Open Repair Discharged Home 74% 68%
Seite 23 112 Patients; Conclusion I) Stentgraft good alternative in raaa
Seite 24 112 Patients; Conclusion I) Stentgraft good alternative in raaa II) should be prefered when anatomical feasable
Seite 25 112 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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Seite 27 Ruptured Aneurysm - Open repair Ruptured and elective
Seite 28 Ruptured Aneurysm - Open repair Ruptured and elective
Seite 29 Ruptured Aneurysm - EVAR-Volume Ruptured and elective
Seite 30 Ruptured Aneurysm - Open repair Ruptured and elective
Seite 31 Ruptured Aneurysm - EVAR Ruptured and elective
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Seite 37 Operative Mortality for raaa-repair
Seite 38 Operative Mortality for raaa-repair
Seite 39 Operative Mortality for raaa-repair
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Seite 44 112 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
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
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
Seite 47 Thank you for your attention hubert.schelzig@med.uni-duesseldorf.de