1. Dr Imran Javed MBBS, FCPS Surgery.
Ex-International Fellow
Arizona Heart Institute / Hospital, Phoenix, AZ, USA.
Ex-Senior Registrar Cardiovascular Surgery
Allama Iqbal Medical College/ Jinnah Hospital
Lahore, Pakistan.
Basic Endovascular Surgery
4. Endoluminal Therapy Offers Less Invasive
Approaches, Thereby Justifying Intervention at
Earlier Stages in the Symptom/Disease Complex
5. Classical Surgical Indications to
Treat Intermittent Claudication Are
Obsolete in Many Cases
Endoluminal Treatment
Has Liberalized
Indications For
Intervention
9. We Are A People On The Move...
Modern Treatment Methods Must
Accommodate Our Life Style
10. Intermittent Claudication
• Absence of pain at rest
• Commencement of pain, tension
weakness after walking has begun;
intensification of condition until
walking becomes impossible
• Disappearance of symptoms after
a period of rest
25. The Achilles heel
of angioplasty,
including stenting:
Restenosis and
In-stent
Restenosis
26. New stent designs have
decreased profile for
delivery, increased
flexibility, and
provided numerous
alternatives in sizing
-- but all of these
failed to solve the
restenosis problem
31. Balanced Effect -
Healing of
Stented Vessel
Inhibition of
Restenosis
The ideal drug has higher potency for smooth muscle cells
(SMCs) and lower potency for endothelial cells (ECs).
Benefit/Risk Relation
39. • The current standard procedure,
endoaneurysmorraphy with intraluminal graft
placement was popularized by Creech,
DeBakey and associates
Abdominal Aortic Aneurysms
40.
41. • Parodi JC, Palmaz JC, Barone, MD
– Transfemoral intraluminal graft implantation for
abdominal aortic aneurysms
Ann. Vasc. Surgery, 1991, Nov.
Endovascular Stent Grafting of
Abdominal Aortic Aneurysms
42. Commercially Available AAA Endografts
2002
Excluder
Gore
2005
PowerLink
Endologix
2003
Zenith
Cook
1999
AneuRx
Medtronic
April 15,
2008
43. If you had this 6cm infrarenal AAA,
would you prefer a 30cm xyphoid to pubis slice,
accompanied by perforations into veins, arteries and
other vital structures with needles, tubes, sheaths,
conduits, urinary catheter, etc?
50. The Aptus System
• Venture backed start-up
• Graft with fixation applied via
staples
• Smaller delivery system
• Locking modular limbs
• Unsupported body
51. ELGs have multiple advantages and when
applied properly, results are equal or superior
to classical procedure
Current Conclusions:
56. Great Vessel Transposition for Antegrade Delivery of
the TAG Endoprosthesis in the Proximal Aortic Arch
Edward B. Diethrich, MD; Marwan Ghazoul, MD;
Grayson H. Wheatley III, MD; Jeffrey B. Alpern, DO;
Julio A. Rodriguez-Lopez, MD; and Venkatesh Ramaiah, MD
Department of Cardiovascular and Endovascular Surgery
Arizona Heart Institute and Hospital, Phoenix, Arizona, USA
J. Endovas Therapy 2005
Surgical graft for
debranching
Endoluminal
graft
exclusion
81. • Core
• Stainless Steel
– Used for support
– Stiffness varies based on taper / diameter of core
• Nitinol
– Used for it’s flexibility, memory and kink resistance
• Tip
• Platinum / Gold
– Provides radiopacity
– Atraumatic
– Ribbon formed for shaping tip
Core Material
82. • Core
• Stainless Steel
– Used for support
– Stiffness varies based on taper / diameter of core
• Nitinol
– Used for it’s flexibility, memory and kink resistance
• Tip
• Platinum / Gold
– Provides radiopacity
– Atraumatic
– Ribbon formed for shaping tip
Core Material
83. • Core
• Stainless Steel
– Used for support
– Stiffness varies based on taper / diameter of core
• Nitinol
– Used for it’s flexibility, memory and kink resistance
• Tip
• Platinum / Gold
– Provides radiopacity
– Atraumatic
– Ribbon formed for shaping tip
Core Material
89. Sheaths
• Sheaths are hemostatic conduits inserted into the
vessel. They allow passage of guidewires, catheters
and interventional devices. The allows these to be
passed in and out of the body without damaging the
vessel and reducing the blood loss.
