EVAR/TEVAR ÇALIŞTAY Prof.Dr. Fürüzan Numan Girişimsel Radyoloji Bilim Dalı Bşk. İstanbul Üniversitesi Cerrahpasa Tıp Fakültesi 2014 9.GİRİŞİMSEL RADYOLOJİ YILLIK TOPLANTISI ANTALYA

AORTİK FİSTÜLLER AORTO-ÖZEFAGİYAL AORTO-BRONŞİYAL AORTO-ENTERİK

UNUSUAL WAY TO TREAT AORTO-EOSPHAGEAL FISTULA Prof. Furuzan Numan, M.D Chief of Interventional Radiology Department Istanbul University Cerrahpasa Medical Faculty,TURKIYE VEITH 2009 NY

Background: HT,CRF, TAA ABF by-pass surgery (AAA) 2004, History: A 68-year-old male HT,CRF, TAA ABF by-pass surgery (AAA) 2004, Patient refused to have TEVAR, While he was followed at another center.

Follow-up 2005 non-cotrast CT and MR ABF by-pass graft

Follow-up February 12th, 2006 non-contrast MR

March 07,2006 TEVAR contained rupture Recent symptoms; Intense backpain & discomfort, no hematemesis, had been treated for unknown source of infection last 3-4months Diagnosis; contained rupture Choice of treatment; TEVAR

r-TEVAR

May 11th, 2006 2nd month follow-up after TEVAR

Infected Aneurysm Sac he admitted to hospital with recent Symptoms of ; high fever, sweating, nausea, vomiting, weight-loss and backpain

Endoscopic view of the fistula

AEF: a catastrophic complication Outcomes of thoracic endovascular aortic repair for aortobronchial and aortoesophageal fistulas. Jonker et all. J Endovasc Ther. 2009 Aug;16(4):428-40 CONCLUSION: TEVAR management of AEF is associated with poor results and should not be considered definitive treatment. TEVAR could serve as a bridge to surgery for emergency cases of AEF only, with definitive open surgical correction of the fistula undertaken as soon as possible. .

AEF: a catastrophic complication Aortoesophageal fistula after thoracic aortic stent-graft placement: a rare but catastrophic complication of a novel emerging technique; Eggebrecht H et all, JACC Cardiovasc Interv. 2009 Jun;2(6):570-6 Surgical repair was performed in only 1 patient and declined in the remaining because of comorbidities and multiorgan system failure. Despite this, all patients died due to fatal rebleeding (n = 4) or mediastinitis (n = 2). CONCLUSION: AEF is a rare and unusual complication of TEVAR that occurs relatively early after the procedure and is almost invariably fatal. .

New option to treat AEF Medical !! TEVAR !! Surgery!! Percutaneous drainage of infected aneurysm sac

CT guidance percutaneous drainage of infected aneurysm sac prone position general anesthesia left endobronchial intubation to stop ventilation and collapse of the right lung to insert drainage catheter without damaging right lung.

Procedure: Two step technique 19 G TLA Needle to confirm the infected material,(Staphylococcus auricularis,Streptoccus viridans, Candida albicans),soft outer sheat stayed at position till the end of procedure (not to contaminate mediastinum & pleura) Insertion of the 10F pig-tail external drainage catheter from another level

Aspiration :TLA needle

Trocar Technique:Pig-tail external drainage catheter

Trocar Technique:Pig-tail external drainage catheter

Drainage catheter was removed after 2 weeks while CT-scan showed total regression of collection in aneurysm sac with improvement in patient’s clinical condition

Follow-up June 18 th ,2006 Control CT with oral contrast & eosphagraphy

Follow-up July 03 rd,2006 eosphagraphy & non contrast CT

Follow-up The patient was under antibiotic therapy(Duocid,Tavanic,Triflucan) for a year MI was the cause of death at 2008 , 2 years after percutaneous drainage

Conclusion Percutaneous drainage of infected anuersym sac can be a life saving option of patients having rare and unusual complication of AEF after TEVAR at suitable conditions.

AORTO-BRONŞİYAL FİSTÜL 1996 da torkal aort cerrahi girişimi 2004 te hemoptizi CT DSA? TEVAR 10 senelik takip altında, progresiv aterosklerotik anevrizma nedeni ile TEVAR disalde ÇT seviyesine kadar uzatıldı,AAA çap nedeni ile takipte.

AORTO-BRONŞİYAL FİSTÜL

AORTO-BRONSİYAL FİSTÜL

28/06/2013 Mezenter iskemi? MSCT Opere AAA, SKİA Oklüde,fem-fem bypass

09/07/2013 Mezenter iskemi?DSA(-),proksimal anastomoz hhattıda psödöanevrizma

24/07/2013 Masiv GİS kanaması,MSCT, AORTO-ENTERİK FİSTÜL

24/07/2013 ACİL EVAR,AUI AORTO-ENTERİK FİSTÜL

29/07/2013 Kontrol MSCT

AORTİK FİSTÜLLER Hasta öyküsü,klinik ve radyolojik dikkat ile gereğinde nonvasküler yaklaşımlarla tedavi edilebilecek ender ancak mortal olgulardır.