TEVARJune 2016

TEVAR

• Thoracic Endovascular Aortic Repair

• Reasons• Aneurysm• Dissection (Acute Aortic Syndrome)• Trauma

Aneurysm• Definition

• >50% diameter• Size important• Multifactorial causality

• More familiar AAA

• Thoracic• 35% descending aorta

Acute Aortic Syndrome

• PAU

• IMH

• Dissection

Acute Aortic Syndrome

Trauma

• Transection• MVA• Blunt Trauma• Flaps

Pre-op Care

• Dependent on indication• Trauma life-threatening surgical emergency

• Aneurysm• Preoperative work-up

» Cardiac/respiratory status» Size criteria» Adjunct procedures

Pre-op Care

• Acute Aortic Syndrome– Emergency signs of malperfusion Theatre

– Medical management cornerstone» BP control (Systolic 110, HR 60)» Analgesia» Monitored environment» Serial imaging

Procedure

• Principles– Proximal seal– Distal seal– Length of

Coverage– Covering of vessels– Need for

revascularisation

Early Complications

• Access Site• Bleeding, Haematoma, retroperitoneal

• Treated segment• Further injury – dissection

• Peripheral• Emboli, ALI, Stroke

Post-op Care• Access sites

• Closure Device vs Cutdown

• Neurovascular Obs• Limb ischaemia/emboli• Stroke• Neurology

• Pain

• Fever

Closure Devices

Spinal Drain

• Theory• CPP = MAP – ICP

• Able to manipulate • MAP

pharmacologically• ICP decreasing CSF

volume

Spinal Drain• 2 ways to drain

• Pressure (10cm H2O)» Need steady readings hence lying flat

• Volume (10ml/hr)

• Placed by anaesthetic team• Issues – notify

• Complications• Traumatic tap• Epidural haematoma

New Neurology• Notify team• O2• Lie flat• Assess drain to ensure able to drain

• Kinks in line

• Adjust MAP• Drain off more CSF• Reverse opioids• Vascular Status• Assess for epidural haematoma