Chia-Hsun Lin
Nationality
Taiwan
Current Position
・Chief, Department of Cardiovascular Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei
・Associate Professor, School of Medicine, Fu Jen Catholic University
・Honorary President, Taiwan Society for Vascular Surgery
Organization
Thoracic Aorta (II) Session

Topic: Zone 0 TEVAR in High Risk Patients, A Retrospective Case Series

Abstract

Ascending aortic diseases, involving dissection or aneurysm, are usually treated with open surgical repair. However, among patients with ascending aortic disease, up to 10% are actually determined to be inoperable. For these high-risk patients, endovascular stent grafting is associated with significantly lower morbidity and mortality than open repair, and may provide a less invasive alternative for aortic repair. Patients with comorbid conditions such as concomitant stroke, chronic obstructive pulmonary disease, liver cirrhosis, or advanced age and frailty are not suitable for open procedures but may be considered suitable for ascending endovascular repair. Unlike thoracic endovascular aortic repair (TEVAR) of the descending thoracic aorta, endovascular therapy for the ascending aorta, referred to as zone 0, presents a unique challenge because of the complex pathology, anatomy and volatile hemodynamic characteristics of proximal ascending aorta. The zone 0 landing denotes an unfavorable seal zone signifying gravity of aortic pathology and a poorer prognosis. Despite the few published literature reporting the feasibility of applying endovascular stent graft repair for ascending aortic pathology under specific circumstances, such approach in treating ascending aortic disease in Asia has been rarely explored. To gain a preliminary overview of the effectiveness of ascending endovascular aortic repair for high-risk patients who were not suitable for open surgery in Taiwan, we conducted this study to report our experience applying zone 0 endovascular stent graft repair in ascending aortic disease in high surgical risk patients and to evaluate the safety and feasibility of the approach for this patient population.

Access Session

Topic: Outcome of Stent-graft Treatment for Central Vein Occlusive disease in Hemodialysis Patients

Abstract

Central venous occlusive disease is a critical complication in long-term hemodialysis patients with arteriovenous

(AV) dialysis circuits. A meta-analysis study comparing PTA and BMS stenting and a prospective cohort study using Gore Excluder AAA contralateral leg endoprosthesis with superior results had been published in SKH vascular center. Treatment of central vein obstructions in hemodialysis patients with stent-grafts is feasible and effective. Our experience of indication and case selection, technique, stent-graft selection and precautions will be presented.