1040_Schneider.pdf

1、Upper vs.Femoral Access for Complex Fenestrated/Branched EVARVascular Surgery and Endovascular TherapyDarren B.Schneider,MDProfessor and Chief,Division of Vascular Surgery and Endovascular TherapyPerelman School of Medicine,University of PennsylvaniaThe Hospital of the University of PennsylvaniaSept

2、ember 11,20252Disclosures I have the following potential conflicts of interest to report:Receipt of grants/research supportDetails:Cook;Philips;W.L.GoreReceipt of honoraria and travel supportDetails:Abbott;Boston Scientific;Cook;Philips;Penumbra;W.L.GoreParticipation in a company sponsored speakers

3、bureauDetails:N/AEmployment in industryDetails:N/AShareholder in a healthcare companyDetails:N/AOwner of a healthcare companyDetails:I do not have any potential conflicts of interest to reportI will be discussing unlabeled use of devices and unapproved devicesXXX3“Its all about the access!”4Access c

4、an make or break a good FB-EVAR case5Access site selection Extent of aortic diseaseLocation of sealing zonesDiameter of aortic lumenVessel orientationAtherosclerotic diseaseTortuositySize of access vessels Endovascular Aortic Repair,Oderich ed;Springer;1st ed.20176Utility of upper extremity(UE)acces

5、sDirectional downward branchesDownward visceral arteriesSequential deployment and preloaded devices that are accessed from aboveEarlier restoration of lower limb perfusionAllows for through wire access7Steerable Sheath Technology A Gamechanger for F/BEVARSteerable SheathSteerable Sheath8Upper extrem

6、ity vs.Transfemoral AccessPotential perioperative stroke associated with traversing the aortic arch and supra-aortic trunksTheoretical advantages of Transfemoral Access(vs Upper Extremity Access):Decreased risk of embolic strokeImproved ergonomicsDecreased radiation exposureShorter operative time12