1020_McKinsey.pdf

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1、Advancing Vascular care with T-Branch and TAMBE branched technology James F.Mckinsey M.D.,DFSVS,FACSMount Sinai Professor in Vascular Surgery and Interventional RadiologySystems Chief of Aortic Intervention for Mount Sinai Health Care SystemSurgical Director of the Jacobsons Aortic CenterDepartment

2、of SurgeryIcahn School of Medicine at Mount SinaiDisclosure:WL Gore ConsultantTerumo Medical SAB for Fenestrated Aortic Grafting and Educational ConsultantCook Medical-Educational Grant Branched Grafts Graft with Side Arm branches Maybe used for aneurysm with inadequate proximal landing zoneor aneur

3、ysms involving the visceral arteries Obtain a more secure seal than with fenestrated Modular system Multiple straight or helical grafts arms Proximal to target vessel Caudally or cranially oriented Cannulated via arm access Self expanded covered stent Disadvantages Large device Target vessel diamete

4、r and anatomyBranched GraftsTAAA(Chuter)Review 287 cases Mortality 6.9%early;13.6%Late Paraplegia 8.2%Endoleak 16.2%Early and Late reintervention rate 20%Branch Occlusion 3.5%Off the Shelf?Sweet et al 66 Patients referred for TAAA 88%could be treated with standard stent graftExperience with the GORE

5、 EXCLUDER Thoracoabdominal Branch Endoprosthesis(TAMBE)Device designTAMBE is a modular device consisting of:Aortic Component(AC)Branch ComponentsDistalBifurcated Component(DBC)Contralateral LegComponentDBCExtender ComponentGOREVIABAHNVBXBalloon Expandable EndoprosthesisGOREEXCLUDERIliac Branch Endop

6、rosthesis(IBE)Iliac Branch ComponentGOREEXCLUDER AAAEndoprosthesis Contralateral LegGOREEXCLUDERAAAEndoprosthesis Aortic Extender(VBX Stent Graft)Endoprosthesis and/or Iliac EndoprosthesisAortic ComponentTwo proximal diameters 31 mm:Aortic diameters 2229 mm 37 mm:Aortic diameters 2734 mmDistal diame