21 results on '"Sukgu M. Han"'
Search Results
2. In situ laser fenestration of aortic septum to bridge false and true lumen during endovascular repair of aortic dissection
- Author
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Alexander D. DiBartolomeo, MD, Elizabeth Miranda, MD, Sukgu M. Han, MD, MS, and Gregory A. Magee, MD, MSc
- Subjects
Aortic dissection ,Endovascular aortic repair ,Laser in situ fenestration ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Fenestration of the septum between the true and false lumen might be necessary after aortic dissection. We report the technical aspects of in situ laser fenestration of the aortic dissection septum. Two illustrative cases are provided: a 56-year-old man with false lumen deployment of a frozen elephant trunk graft, and a 67-year-old man who underwent fenestrated endovascular aortic repair with a target branch vessel off the false lumen. In both cases, the septum was crossed using in situ laser fenestration. This technique is a precise option to enable passage between true and false lumens during endovascular repair of an aortic dissection.
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- 2024
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3. Aortic rupture during STABILISE (stent-assisted balloon-induced intimal disruption and relamination in aortic dissection repair) technique
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Ashley C. Hsu, MD, Alexander D. DiBartolomeo, MD, Sukgu M. Han, MD, MS, Fernando Fleischman, MD, and Gregory A. Magee, MD, MSc
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Aortic ballooning ,Aortic dissection ,Aortic rupture ,Endovascular repair ,STABILISE technique ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
The STABILISE (stent-assisted balloon-induced intimal disruption and relamination in aortic dissection repair) technique has shown promising results for treating type B aortic dissections, but the potential exists for fatal adverse effects. We present a case of infrarenal aortic rupture while using a compliant balloon to balloon mold the true lumen inside previously placed bare metal stents during the STABILISE technique. Caution is advised for providers who wish to perform the STABILISE technique, and we recommend using a semi-compliant balloon sized to the smallest total aortic diameter to mitigate the risk of rupture.
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- 2023
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4. Incorporation of internal iliac arteries as target vessels during physician-modified fenestrated branched endovascular repair of pararenal abdominal aortic aneurysm with concomitant bilateral short common iliac artery aneurysms
- Author
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Michelle Manesh, MD, Herbert I. James, III, MD, Alyssa Pyun, MD, Young Hong, BS, Jacquelyn Paige, DNP, and Sukgu M. Han, MD, MS
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Abdominal aortic aneurysm ,Fenestrated branched endovascular repair ,Iliac artery aneurysm ,Iliac branch device ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
This report describes an alternative endovascular approach to iliac branch devices for treatment of an abdominal aortic aneurysm with concomitant bilateral short common iliac aneurysms. The short distance between the renal arteries and internal iliac artery origins made the addition of distal iliac branch devices to the proximal fenestrated stent graft challenging. We elected to perform physician-modified fenestrated branched endovascular repair, using four fenestrations for the visceral and renal arteries and an additional two directional branches for the bilateral internal iliac arteries. The patient recovered uneventfully, and the 24-month follow-up imaging shows successful aneurysm exclusion with patent internal iliac artery branches.
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- 2023
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5. Sandwich thoracic branch endoprosthesis technique for endovascular repair of thoracic aortic aneurysm with aberrant right subclavian artery
- Author
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Yasmeen Dhindsa, MD, Alexander DiBartolomeo, MD, Gregory A. Magee, MD, MSc, Fernando Fleischman, MD, and Sukgu M. Han, MD, MS
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Ruptured thoracic aortic aneurysm ,Thoracic branch endograft ,Thoracic endovascular aortic repair ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Subclavian artery coverage is frequently required to achieve an adequate proximal seal during thoracic endovascular aortic repair. The thoracic branch endoprosthesis (TBE; W.L. Gore & Associates) is the first U.S. Food and Drug Administration–approved branched device for thoracic endovascular aortic repair, designed for left subclavian artery incorporation. However, anatomic suitability of the TBE has been shown to be limited. In the present report, we describe a novel technique using the TBE in a sandwich periscope configuration to allow for emergent repair of a ruptured thoracic aortic aneurysm with a highly angulated proximal seal zone and aberrant right subclavian artery.
- Published
- 2023
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6. Techniques of antegrade in situ laser fenestration for endovascular aortic repair of complex abdominal and thoracoabdominal aortic aneurysms
- Author
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Alexander D. DiBartolomeo, MD and Sukgu M. Han, MD, MS
- Subjects
Endovascular aneurysm repair ,In situ laser fenestration ,Ruptured aortic aneurysm ,Technique ,Thoracoabdominal aortic aneurysm ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Antegrade in situ laser fenestration allows for incorporation of visceral and renal arteries during endovascular repair of complex abdominal and thoracoabdominal aortic aneurysms. This technique can be particularly useful for urgent and emergent cases and for centers without access to manufactured fenestrated-branched endovascular aneurysm repair devices. In the present report, we have described two techniques of antegrade in situ fenestration, the common pitfalls, and the anatomic considerations for each technique.
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- 2022
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7. Physician-modified fenestrated endograft for postdissection thoracoabdominal aortic aneurysm following provisional extension to induce complete attachment and renal artery stenting
- Author
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Anand V. Ganapathy, MD, MEng, Jonathan C. Cash, MD, Gregory A. Magee, MD, MSc, Kenneth R. Ziegler, MD, and Sukgu M. Han, MD, MS
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Aneurysmal degeneration ,Aortic dissection ,Aortic remodeling ,Fenestrated endovascular aortic repair ,Malperfusion ,PETTICOAT ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
We have described a patient with a history of type A-11 dissection repair, who subsequently underwent thoracic endovascular aortic repair with distal bare metal dissection stents (provisional extension to induce complete attachment) and renal artery stenting for malperfusion. During the next 3 years, the thoracoabdominal aorta had continued to enlarge to 6.9 cm, despite false lumen embolization and thoracic endovascular aortic repair extension. Given the continued aortic enlargement, physician-modified fenestrated endovascular aortic repair was performed within the prior aortic and renal stents with successful aneurysm sealing. The results from the present case have illustrated that continued aneurysmal degeneration can occur after provisional extension to induce complete attachment and that subsequent physician-modified fenestrated endovascular aortic repair is feasible.
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- 2022
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8. Use of retrograde left subclavian branch portal of Gore TAG thoracic branch endoprosthesis for physician-modified fenestrated branched endovascular repair of thoracoabdominal aortic aneurysm
- Author
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Alexander D. DiBartolomeo, MD, Elizabeth Miranda, MD, MPH, Alyssa J. Pyun, MD, Fernando Fleischman, MD, Gregory A. Magee, MD, MSc, and Sukgu M. Han, MD, MS
- Subjects
Case report ,Fenestrated-branched endovascular repair ,Gore thoracic branch endoprosthesis ,Thoracoabdominal aortic aneurysm ,Thoracic endovascular aortic repair ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
A 75-year-old man who had undergone zone 2 thoracic endovascular repair of a symptomatic penetrating aortic ulcer using a Gore TAG thoracic branch endoprosthesis (TBE) device (W.L. Gore & Associates) 5 years before had presented with an enlarging extent I thoracoabdominal aortic aneurysm. A physician-modified five-vessel fenestrated-branched endograft repair was performed using preloaded wires. The visceral renal vessels were sequentially catheterized from the left brachial access via the TBE portal, and the endograft was deployed in staggered fashion. At 1 year of follow-up, imaging studies demonstrated a stable aneurysm sac, patent visceral renal branches, and no endoleak. The retrograde portal of Gore TAG TBE can facilitate fenestrated-branched endovascular repair of thoracoabdominal aortic aneurysms.
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- 2023
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9. Near-wall hemodynamic changes in subclavian artery perfusion induced by retrograde inner branched thoracic endograft implantation
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William J. Yoon, MD, Kevin Mani, MD, PhD, Sukgu M. Han, MD, MS, Cheong J. Lee, MD, Jae S. Cho, MD, and Anders Wanhainen, MD, PhD
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Branched endografts ,Computational fluid dynamics ,Left subclavian artery revascularization ,Wall shear stress ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Objective: Left subclavian artery (LSA)-branched endografts with retrograde inner branch configuration (thoracic branch endoprosthesis [TBE]) offer a complete endovascular solution when LSA preservation is required during zone 2 thoracic endovascular aortic repair. However, the hemodynamic consequences of the TBE have not been well-investigated. We compared near-wall hemodynamic parameters before and after the TBE implantation using computational fluid dynamic simulations. Methods: Eleven patients who had undergone TBE implantation were included. Three-dimensional aortic arch geometries were constructed from the pre- and post-TBE implantation computed tomography images. The resulting 22 three-dimensional aortic arch geometries were then discretized into finite element meshes for computational fluid dynamic simulations. Inflow boundary conditions were prescribed using normal physiological pulsatile circulation. Outlet boundary conditions consisted of Windkessel models with previously published values. Blood flow, modeled as Newtonian fluid, simulations were performed with rigid wall assumptions using SimVascular's incompressible Navier-Stokes solver. We compared well-established hemodynamic descriptors: pressure, flow rate, time-averaged wall shear stress (TAWSS), the oscillatory shear index (OSI), and percent area with an OSI of >0.2. Data were presented on the stented portion of the LSA. Results: TBE implantation was associated with a small decrease in peak LSA pressure (153 mm Hg; interquartile range [IQR], 151-154 mm Hg vs 159 mm Hg; IQR, 158-160 mm Hg; P = .005). No difference was observed in peak LSA flow rates before and after implantation: 40.4 cm3/ (IQR, 39.5-41.6 cm3/s) vs 41.3 cm3/s (IQR, 37.2-44.8 cm3/s; P = .59). There was a significant postimplantation increase in TAWSS (15.2 dynes/cm2 [IQR, 12.2-17.7 dynes/cm2] vs 6.2 dynes/cm2 [IQR, 5.7-10.3 dynes/cm2]; P = .003), leading to decreases in both the OSI (0.088 [IQR, 0.063 to –0.099] vs 0.1 [IQR, 0.096-0.16]; P = .03) and percentage of area with an OSI of >0.2 (10.4 [IQR, 5.8-15.8] vs 15.7 [IQR, 10.7-31.9]; P = .13). Neither LSA side branch angulation (median, 81°, IQR, 77°-109°) nor moderate compression (16%-58%) seemed to have an impact on the pressure, flow rate, TAWSS, or percentage of area with an OSI of >0.2 in the stented LSA. Conclusions: The implantation of TBE produces modest hemodynamic disturbances that are unlikely to result in clinically relevant changes. : Clinical Relevance: The Gore thoracic branch endoprosthesis represents the only commercially available stent graft in the United States for the treatment of aortic arch pathologies involving the left subclavian artery. The implantation of endografts cause alterations in flow patterns that, in turn, can have a significant impact on long-term device durability and the prognosis of the patient. The results of this computational modelling study provide important data regarding the hemodynamic performance of the thoracic branch endoprosthesis relevant to the associated clinical outcomes and subsequent implications on device durability.
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- 2023
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10. Caudally directed in situ fenestrated endografting for emergent thoracoabdominal aortic aneurysm repair
- Author
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Miguel Manzur, MD, Gregory A. Magee, MD, Kenneth R. Ziegler, MD, Fred A. Weaver, MD, Vincent L. Rowe, MD, and Sukgu M. Han, MD, MS
- Subjects
Ruptured thoracoabdominal aortic aneurysm ,In situ fenestrated ,Branched endovascular aortic repair ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
We previously described a transfemoral antegrade in situ laser fenestration technique (in situ fenestrated endovascular abdominal aortic aneurysm repair) for ruptured thoracoabdominal aortic aneurysms. In the present report, we have described an alternative technique of caudally directed in situ fenestrated endografts using upper extremity access for branch vessel incorporation. This technique involves partial deployment of the aortic stent graft in the thoracic aorta to achieve proximal control, followed by sequential branch incorporation using a laser probe through a steerable sheath, from the upper extremity access. The advantages of the technique include rapid proximal aortic control before branch incorporation without target vessel prestenting and separation of in situ fenestration from the target branch vessel origin, facilitating cannulation of angulated branch vessels.
- Published
- 2021
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11. Physician-Modified Fenestrated Endovascular Repair for Iatrogenic Innominate Vein Injury
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Kyung Bae Lee, Alyssa J. Pyun, Jonathan Praeger, Kenneth R. Ziegler, and Sukgu M. Han
- Subjects
endovascular procedures ,iatrogenic disease ,brachiocephalic vein ,jugular veins ,Diseases of the blood and blood-forming organs ,RC633-647.5 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Iatrogenic innominate vein injuries are rare complications associated with internal jugular venous catheters. These complications are accompanied by high morbidity and mortality rates in patients with severe underlying medical conditions. Without proper treatment, emergency surgery may be needed due to acute cardiac tamponade or hemothorax. Endovascular repair can be advantageous for patients with significant medical comorbidities. Herein, we report the case of a 62-year-old female with an iatrogenic injury to the innominate vein at the subclavian vein and internal jugular confluence due to a malpositioned left internal jugular catheter. A customized fenestrated endograft was positioned with fenestration oriented to the internal jugular vein and a new tunneled catheter was inserted across the fenestration into the superior vena cava upon removal of the malpositioned catheter. In addition, a brachio-basilic arteriovenous fistula was created. At one month follow-up, the patient had a palpable thrill over the arteriovenous fistula and a functioning tunneled catheter.
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- 2022
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12. Antegrade in situ fenestrated endovascular repair of a ruptured thoracoabdominal aortic aneurysm
- Author
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Louis L. Zhang, MD, Fred A. Weaver, MD, Vincent L. Rowe, MD, Kenneth R. Ziegler, MD, Gregory A. Magee, MD, and Sukgu M. Han, MD
- Subjects
In situ laser fenestration ,Thoracoabdominal aortic aneurysm ,Fenestrated endovascular aortic repair ,Thoracic endovascular aortic repair ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
We describe a technique for antegrade in situ laser fenestration that has several advantages in the setting of ruptured thoracoabdominal aortic aneurysms. This technique involves rapid aneurysm sealing by deployment of aortic stent graft, followed by sequential incorporation of branch vessels using a laser probe through steerable sheath. The advantages of this technique include (1) rapid seal of the ruptured aneurysm, (2) preservation of the visceral and renal branch perfusion, (3) use of an off-the-shelf device, and (4) the ability to be performed without general anesthesia.
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- 2020
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13. Endovascular septal fenestration using a radiofrequency wire to salvage inadvertent false lumen deployment of a frozen elephant trunk stent graft
- Author
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Anastasia Plotkin, MD, Sue E. Hanks, MD, Sukgu M. Han, MD, MS, Fernando Fleischman, MD, Fred A. Weaver, MD, MMM, and Gregory A. Magee, MD, MSc
- Subjects
Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
ABSTRACT: We report a case of a frozen elephant trunk arch repair, where the stent graft was unintentionally placed into the false lumen. Postoperative imaging demonstrated an enlarged false lumen with no thoracic aorta fenestrations that could be traversed to place another thoracic endovascular aortic repair endograft into the true lumen. An atraumatic radiofrequency wire (PowerWire, Baylis Medical, Montreal, Quebec, Canada) was used to create a new septal fenestration, enabling thoracic endovascular aortic repair endograft extension into the thoracic true lumen. This novel use of a radiofrequency wire can enable safe and controlled endovascular septal fenestration even in chronic dissections to redirect flow into the true lumen. Keywords: Aortic dissection, Fenestration, TEVAR, Radiofrequency wire, Septum, False lumen, Elephant trunk
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- 2019
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14. Transbrachial branch cannulation during Zenith fenestrated endovascular aortic aneurysm repair using a robotically guided body-floss technique
- Author
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Sukgu M. Han, MD, Anuj Mahajan, MD, Sung W. Ham, MD, William Lee, MD, Vincent L. Rowe, MD, and Fred A. Weaver, MD
- Subjects
Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Caudal angulation and stenosis of the renal arteries pose significant challenges in branch cannulation during the standard fenestrated endovascular aortic aneurysm repair (FEVAR). We describe an alternative technique of branch cannulation during FEVAR in a patient with a 6.5-cm juxtarenal abdominal aortic aneurysm, renal artery stenosis, and bilateral caudally oriented renal arteries. A brachiofemoral or “body-floss” access was established by traversing the top scallop. The brachial sheath was deflected toward the target fenestration using a steerable robotic femoral sheath, enabling transbrachial cannulation of the downgoing target renal artery. Postoperatively, the patient was discharged without complications. Steerable sheath-guided body-floss technique may facilitate cannulation of severely downgoing branch vessels during FEVAR.
- Published
- 2016
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15. Caudally directed in situ fenestrated endografting for emergent thoracoabdominal aortic aneurysm repair
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Sukgu M. Han, Fred A. Weaver, Vincent L. Rowe, Kenneth R. Ziegler, Miguel F. Manzur, and Gregory A. Magee
- Subjects
medicine.medical_specialty ,Innovative technique ,RD1-811 ,Target vessel ,Branch vessel ,030204 cardiovascular system & hematology ,Aortic stent ,Thoracoabdominal Aortic Aneurysms ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,medicine ,Thoracic aorta ,Diseases of the circulatory (Cardiovascular) system ,Ruptured thoracoabdominal aortic aneurysm ,Aortic aneurysm repair ,business.industry ,medicine.disease ,Abdominal aortic aneurysm ,Surgery ,In situ fenestrated ,RC666-701 ,cardiovascular system ,Cardiology and Cardiovascular Medicine ,Fenestration ,business ,Branched endovascular aortic repair - Abstract
We previously described a transfemoral antegrade in situ laser fenestration technique (in situ fenestrated endovascular abdominal aortic aneurysm repair) for ruptured thoracoabdominal aortic aneurysms. In the present report, we have described an alternative technique of caudally directed in situ fenestrated endografts using upper extremity access for branch vessel incorporation. This technique involves partial deployment of the aortic stent graft in the thoracic aorta to achieve proximal control, followed by sequential branch incorporation using a laser probe through a steerable sheath, from the upper extremity access. The advantages of the technique include rapid proximal aortic control before branch incorporation without target vessel prestenting and separation of in situ fenestration from the target branch vessel origin, facilitating cannulation of angulated branch vessels.
- Published
- 2021
16. Intercostal artery incorporation to prevent spinal cord ischemia during total endovascular thoracoabdominal aortic repair
- Author
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Miguel F. Manzur, Gregory A. Magee, Mark J. Cunningham, Fernando Fleischman, Sukgu M. Han, and Anastasia Plotkin
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,medicine.disease ,Aortic repair ,Left Common Iliac Artery ,Thrombosis ,Surgery ,Pseudoaneurysm ,Aortic aneurysm ,Lumbar ,Aneurysm ,Adult: Aorta: Evolving Technology: Surgical Technique ,medicine.artery ,cardiovascular system ,medicine ,cardiovascular diseases ,business ,Intercostal arteries - Abstract
A 71-year-old man with prior total arch repair and open repair of Crawford extent II thoracoabdominal aortic aneurysm (TAAA) presented with hemoptysis in the setting of two large pseudoaneurysms of his intercostal and visceral artery Carrel patches and left common iliac artery aneurysm. Despite a presumed aortobronchial fistula, endovascular repair was planned due to his advanced age, and prior extensive open aortic repairs. A thoracic endograft modified with a single caudally directed side branch was used to repair the intercostal patch pseudoaneurysm, while preserving flow to the intercostal artery. Subsequently, he underwent a 4-vessel fenestrated endovascular aortic repair with left iliac branched endograft. Completion CTA demonstrated thrombosis of both pseudoaneurysms, preservation of flow into all branches, and no endoleak. Due to preservation of the intercostal artery, the endovascular repairs were completed without lumbar drain placement.
- Published
- 2021
17. Antegrade in situ fenestrated endovascular repair of a ruptured thoracoabdominal aortic aneurysm
- Author
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Kenneth R. Ziegler, Fred A. Weaver, Gregory A. Magee, Vincent L. Rowe, Sukgu M. Han, and Louis L. Zhang
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Innovative technique ,medicine.medical_specialty ,In situ laser fenestration ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Fenestrated endovascular aortic repair ,lcsh:Surgery ,Thoracic endovascular aortic repair ,030204 cardiovascular system & hematology ,Aortic stent ,Thoracoabdominal Aortic Aneurysms ,Seal (mechanical) ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Aortic aneurysm ,0302 clinical medicine ,Aneurysm ,medicine ,cardiovascular diseases ,business.industry ,Laser probe ,lcsh:RD1-811 ,medicine.disease ,Surgery ,lcsh:RC666-701 ,cardiovascular system ,Cardiology and Cardiovascular Medicine ,business ,Fenestration ,Perfusion ,Thoracoabdominal aortic aneurysm - Abstract
We describe a technique for antegrade in situ laser fenestration that has several advantages in the setting of ruptured thoracoabdominal aortic aneurysms. This technique involves rapid aneurysm sealing by deployment of aortic stent graft, followed by sequential incorporation of branch vessels using a laser probe through steerable sheath. The advantages of this technique include (1) rapid seal of the ruptured aneurysm, (2) preservation of the visceral and renal branch perfusion, (3) use of an off-the-shelf device, and (4) the ability to be performed without general anesthesia.
- Published
- 2020
18. Ultrasound-determined diameter measurements are more accurate than axial computed tomography after endovascular aortic aneurysm repair
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Aaron E. Bond, Sukgu M. Han, Susana Perese, Fred A. Weaver, Vincent L. Rowe, and Kaushel Patel
- Subjects
medicine.medical_specialty ,Time Factors ,High variability ,Computed tomography ,Aortography ,Aortic aneurysm ,symbols.namesake ,Blood Vessel Prosthesis Implantation ,Aneurysm ,Imaging, Three-Dimensional ,Predictive Value of Tests ,medicine ,Humans ,Ultrasonography, Doppler, Color ,Aortic aneurysm repair ,medicine.diagnostic_test ,business.industry ,Ultrasound ,medicine.disease ,Aortic Aneurysm ,Cross-Sectional Studies ,Treatment Outcome ,symbols ,Linear Models ,Radiographic Image Interpretation, Computer-Assisted ,Surgery ,Tomography ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Doppler effect ,Tomography, Spiral Computed - Abstract
Objective This study evaluated the correlation of ultrasound (US)-derived aortic aneurysm diameter measurements with centerline, three-dimensional (3-D) reconstruction computed tomography (CT) measurements after endovascular aortic aneurysm repair (EVAR). Methods Concurrent CT and US examinations from 82 patients undergoing post-EVAR surveillance were reviewed. The aortic aneurysm diameter was defined as the major axis on the centerline images of 3-D CT reconstruction. This was compared with US-derived minor and major axis measurements, as well as with the minor axis measurement on the conventional axial CT images. Correlation was evaluated with linear regression analyses. Agreement between different imaging modalities and measurements was assessed with Bland-Altman plots. Results The correlation coefficients from linear regression analyses were 0.92 between CT centerline major and US minor measurements, 0.94 between CT centerline major and US major measurements, and 0.93 between CT minor and centerline major measurements. Bland-Altman plots showed a mean difference of 0.11 mm between US major and CT centerline measurements compared with 5.38 mm between US minor and CT centerline measurements, and 4.25 mm between axial CT minor and centerline measurements. This suggested that, compared with axial CT and US minor axis measurements, US major axis measurements were in better agreement with CT centerline measurements. Variability between major and minor US and CT centerline diameter measurements was high (standard deviation of difference, 4.27-4.84 mm). However, high variability was also observed between axial CT measurements and centerline CT measurements (standard deviation of difference, 4.36 mm). Conclusions The major axis aneurysm diameter measurement obtained by US imaging for surveillance after EVAR correlates well and is in better agreement with centerline 3-D CT reconstruction diameters than axial CT.
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19. Low-profile Zenith Alpha™ Thoracic Stent Graft Modification Using Preloaded Wires for Urgent Repair of Thoracoabdominal and Pararenal Abdominal Aortic Aneurysms
- Author
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Salome Weiss, Emanuel R. Tenorio, Gustavo S. Oderich, Sukgu M. Han, Louis L. Zhang, and Aleem K. Mirza
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Male ,medicine.medical_specialty ,Time Factors ,Minnesota ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Prosthesis Design ,Ischemic colitis ,030218 nuclear medicine & medical imaging ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,medicine ,Humans ,Adverse effect ,610 Medicine & health ,Dialysis ,Aged ,Retrospective Studies ,Aged, 80 and over ,Aortic Aneurysm, Thoracic ,business.industry ,Endovascular Procedures ,Acute kidney injury ,Stent ,General Medicine ,Middle Aged ,medicine.disease ,Blood Vessel Prosthesis ,Surgery ,Treatment Outcome ,Respiratory failure ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,Paraplegia ,business ,Switzerland ,Aortic Aneurysm, Abdominal ,Kidney disease - Abstract
Background: The aim of this study is to describe a modification technique using the low-profile Cook Zenith Alpha™ thoracic stent graft, and addition of a preloaded wire system, for urgent repair of pararenal (PRA) and thoracoabdominal (TAAA) aortic aneurysms. Methods: We analyzed 20 consecutive patients who underwent urgent physician modified endograft repair (PMEG) of PRA and TAAA at 2 institutions. The low-profile Cook Zenith Alpha Thoracic stent graft was modified in accordance with each specific patient anatomic characteristics. End points were technical success, 30-day mortality, and major adverse events (MAEs). Results: Technical success was achieved in all patients (100%). A total of 76 renal-mesenteric arteries were incorporated by fenestrations (70%) or directional branches (30%) with an average of 3.7 ± 0.6 vessels per patient. There were 6 different types of stent configuration. The most common design consisted of 4 fenestrations (9 patients, 45%). The average of modification time was 110 ± 27 minutes. Total procedure time (including the time for open component) was 242 ± 75 minutes. There was no death within the first 30 days or hospital stay. MAEs occurred in 10 patients (50%). The most common MAEs were acute kidney injury (by Risk, Injury, and Failure; and Loss; and End-stage kidney disease criteria) in 6 patients (30%), estimated blood loss >1 L, respiratory failure requiring reintubation in 2 patients (10%) each, and paraplegia and ischemic colitis in 1 patient (5%) each. One patient (5%) required temporary, new-onset dialysis. Conclusions: PMEG using low-profile Zenith Alpha thoracic stent graft was safe with no early mortality and acceptable early morbidity. Copyright © 2020 Elsevier Inc. All rights reserved.
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20. Axillary-femoral hypogastric bypass for spinal cord protection during fenestrated, branched endovascular repair of post-dissection thoracoabdominal aortic aneurysm
- Author
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Dorothy Han, Alyssa J Pyun, Mark Mueller, Wesley Lew, and Sukgu M Han
- Subjects
Thoracoabdominal aortic aneurysm ,Aortic dissection ,Jump graft ,Spinal cord ischemia ,Endovascular repair ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Abstract
We present a case of a 65-year-old male who previously underwent left axillofemoral bypass, left carotid stenting, and right iliac stenting followed by ascending and hemiarch repair for type A aortic dissection, complicated by left external iliac artery occlusion. He presented to our center with a symptomatic 8.5 cm post-dissection extent II thoracoabdominal aortic aneurysm. A staged repair was performed to decrease spinal cord ischemia. The first stage employed the novel use of a jump graft from the left axillary-femoral bypass to the left internal iliac artery to restore pelvic circulation, combined with zone 2 thoracic branched endoprosthesis (TBE). The second stage included thoracic endovascular repair (TEVAR) extension and 3-vessel custom-modified fenestrated/branched endovascular repair (FBEVAR).
- Published
- 2024
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21. Oncovascular Surgery: There Would Be No Such Thing without Vascular Surgeons
- Author
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Sukgu M Han
- Subjects
Diseases of the blood and blood-forming organs ,RC633-647.5 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2019
- Full Text
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