THE HOSTILE NECK: ANATOMICAL THE HOSTILE NECK: ANATOMICAL LIMITS AND FAR: ISTANBUL LIMITS AND FAR: ISTANBUL

MEDICAL FACULTY EXPERIENCEMEDICAL FACULTY EXPERIENCE

Dr. Onur GÖKSELDr. Onur GÖKSELIstanbulIstanbul University, Istanbul Medical FacultyUniversity, Istanbul Medical Faculty

Department of Cardiovascular SurgeryDepartment of Cardiovascular Surgery

DISCLOSURESDISCLOSURES

I do not have any potential conflictI do not have any potential conflictss of of interestinterest

The clinical effectiveness of EVAR is wellThe clinical effectiveness of EVAR is wellestablished (EVAR 1, DREAM, EVAR 2,established (EVAR 1, DREAM, EVAR 2,Eurostar, etc.)Eurostar, etc.) The primary concerns that remain includeThe primary concerns that remain include-Durability over the long-term-Durability over the long-term--Performance outside of controlled trials Performance outside of controlled trials

whenwhen anatomical limits extended anatomical limits extended

EVAR eligibil i ty by neck lengthEVAR eligibil i ty by neck length

2013 CONSENSUS2013 CONSENSUS

The Current IFU’sThe Current IFU’s

Anatomical ChallengesAnatomical Challenges

Access site/Main body deployment sideAccess site/Main body deployment side

Endurant designed for Endurant designed for challenging necks challenging necks

1st and 2nd year data1st and 2nd year data

2008-20132008-2013

48 patients with necks 10-15mm48 patients with necks 10-15mm 47 pts with Endurant47 pts with Endurant 1 Patient with Ovation1 Patient with Ovation 29±17 months of followup29±17 months of followup No early/late rupturesNo early/late ruptures

47 Pts w/ 10-15 mm Neck 47 Pts w/ 10-15 mm Neck 2008-20132008-2013

Immediate/Early

6th Mo 12 mo 24 mo

Type I Endoleak

2 (4%) 1 (2%) 0 0

Rupture 0 0 0 0

Conversion 0 0 0 0

Reintervention 0 0 0 1 (2%)

Procedure Related Complication

0 0 0 1(Limb seperation)(2%)

Mortality 0 0 0 0

Lennox et al. EJVES 2010

Expanded Indications of Chimney EVAR in rAAAExpanded Indications of Chimney EVAR in rAAA

Tips & Pitfalls in Chimney Tips & Pitfalls in Chimney EVAREVAR

Lobato et al. JVS 2012;56:285.Lobato et al. JVS 2012;56:285.

Fenestrated /Branched EVAR Fenestrated /Branched EVAR