April 6, 2017 Copyright UPM-Kymmene Group 1 The Standard of Care for Chronic Type B Dissection is Endovascular Repair Benjamin W. Starnes MD, FACS The Alexander Whitehill Clowes MD Endowed Chair of Vascular Surgery Professor of Surgery Chief, Division of Vascular Surgery University of Washington Seattle, WA Disclosures • Co-Founder: AORTICA Corporation Will the REAL Michael Conte please stand up! Scientist Open Surgeon Endovascular Surgeon What do we know about Conte? • Extremely Smart • Very Charismatic • Good Looking • Fit • Great Technical Surgeon • Good Common Sense
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The Standard of Care for Chronic Type B Disclosures …€¦ · Estrera AL, Sandhu H, Afifi RO, Azizzadeh A, Charlton-Ouw K, Miller CC, et al. Open repair of chronic complicated type
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April 6, 2017
Copyright UPM-Kymmene Group 1
The Standard of Care for Chronic Type B Dissection is Endovascular Repair
Benjamin W. Starnes MD, FACSThe Alexander Whitehill Clowes MD Endowed Chair of Vascular Surgery
Professor of SurgeryChief, Division of Vascular Surgery
University of WashingtonSeattle, WA
Disclosures
• Co-Founder: AORTICA Corporation
Will the REAL Michael Conte please stand up!
Scientist Open Surgeon
Endovascular Surgeon
What do we know about Conte?
• Extremely Smart
• Very Charismatic
• Good Looking
• Fit
• Great Technical Surgeon
• Good Common Sense
April 6, 2017
Copyright UPM-Kymmene Group 2
46 yo Marfan’s 10/11/2007
10/11/2007 2/27/2008 1/5/2011 3/7/2015
7.5 Year Follow Up ?
April 6, 2017
Copyright UPM-Kymmene Group 3
Open Surgery for CTBAD
• 10% 30 Day Mortality
• 10% Paraplegia
• 10% Renal Failure (Half go on to Dialysis)
• 10% Pulmonary Failure
Leshnower BG, Szeto WY, Pochettino A, Desai ND, Moeller PJ,Nathan DP, et al. Thoracic endografting reduces morbidity and remodelsthe thoracic aorta in DeBakey III aneurysms. Ann Thorac Surg2013;95:914-21.
Estrera AL, Sandhu H, Afifi RO, Azizzadeh A, Charlton-Ouw K,Miller CC, et al. Open repair of chronic complicated type B aorticdissection using the open distal technique. Ann Cardiothorac Surg2014;3:375-84.
Aortic Dissection- Classification
Stanford Type A Type B
DeBakey
Type B Aortic Dissection-University of Washington Strategy
Diagnosis with CTA
No Malperfusion
Medical TherapyB- Blockade / VasodilatorDecrease dP/dT