Authors (including presenting author) :
CHEUNG IHW(1), CHOI KH(1), LAU V(1), MAN KY(1), HO KL(2), CHEUNG CW(1).
Affiliation :
(1) Department of Radiology, Queen Mary Hospital, (2) Department of Cardiothoracic Surgery, Queen Mary Hospital.
Introduction :
Thoracic aortic aneurysm (TAA) is dilatation of the thoracic aorta to greater than 1.5 times of normal size. Commonest aetiology includes atherosclerosis, followed by connective tissue disease and inflammatory cause. In our institution, thoracic endovascular aortic repair (TEVAR) treatment is an option offered for patients with TAA >6cm involving the aortic arch or descending thoracic aorta. Endovascular approach is often preferred to open repair due to associated low morbidity, decisive factors include patient’s age, anatomy considerations and device availability. Careful multidisciplinary team planning and complex techniques are critical to ensure satisfactory exclusion of the aneurysm which must be achieved by having adequate landing zones; flow dynamics post stenting in patients with aortic dissection should also be anticipated to reduce the risks such as stent failure and organ malperfusion.
Objectives :
(1) Review clinical outcomes of all TEVAR cases performed at QMH since December 2017.
(2) Understand the challenges faced in complex cases and need for more advanced interventions.
(3) Demonstrate the importance of multidisciplinary team meetings to plan each case intervention.
Methodology :
Retrospective review of consecutive patients treated with TEVAR since December 2017. Patient data were extracted from ePR and RIS systems. Key outcomes reviewed and analysed include demographics, past medical history, intervention technique, procedural success and complications.
Result & Outcome :
This submission aims to present our experience of TEVAR, and demonstrates the management pathway in our institute. There is significant increase in complex thoracic aortic disease requiring endovascular therapy in QMH as well as increasing demand for treating aorta as an entire organ rather than separately as thoracic or abdominal aorta. Challenging cases including four vessel fenestrations for complete aorta reconstruction, utilisation of endoanchors to optimise landing zones and novel techniques in creating luminal fenestration will be discussed. The importance of pre-procedural planning in a multidisciplinary team manner will be explained as a critical step in procedural success.
