TEVAR Case Studies (Marvin Atkins Jr, MD)

RE-EVOLUTION SUMMIT 2019 (10th Annual) This case-based discussion reviews technical challenges and decision-making in thoracic endovascular aortic repair through two illustrative scenarios. The first case involves a young trauma patient with blunt thoracic aortic injury, profound hypotension, hemothorax, and multisystem trauma. The discussion highlights the pitfalls of sizing thoracic endografts in severely under-resuscitated patients, especially when hypotension can underestimate true aortic diameter, leading to bird-beaking or proximal endoleak. The second case focuses on a patient with a descending thoracic aneurysm and extreme aortic tortuosity, emphasizing the importance of device trackability, wire strategy, and procedural sequencing when standard device advancement is not possible. Practical lessons include the value of intravascular ultrasound for accurate sizing, selective left subclavian revascularization when proximal seal is inadequate, and alternative deployment strategies in hostile anatomy. Overall, the session centers on complication avoidance, troubleshooting, and adapting TEVAR technique to unstable physiology and difficult anatomy. KEY LEARNING CONCEPTS • Aortic sizing in trauma can be misleading in hypotensive or under-resuscitated patients • Intravascular ultrasound can improve graft sizing and reduce risk of undersizing in TEVAR • Inadequate proximal seal may require left subclavian coverage with carotid-subclavian bypass and graft extension • Severe aortic tortuosity may require alternative wire strategies, buddy wire support, or altered deployment sequence • Device selection, trackability, and procedural flexibility are critical in complex thoracic aortic anatomy FOR MORE INFORMATION HM Academic Institute: https://www.houstonmethodist.org/acad... For the latest education and training opportunities from DeBakey CV Education: http://bit.ly/HMdebakeyemail Follow Us: DeBakey CV Education Homepage https://www.houstonmethodist.org/acad... DeBakey CV Education Facebook   / about   DeBakey CV Education X https://x.com/DeBakeyCVedu/ DeBakey CV Education LinkedIn   / debakey-cv-education   DeBakey CV Edu Instagram   / debakeycvedu   Want concise, relevant reviews of the hottest topics in CV medicine? Subscribe for FREE to the Methodist DeBakey Cardiovascular Journal for quarterly, peer-reviewed issues delivered to your door. https://journal.houstonmethodist.org/ April 4-5, 2019