The IX t h Makassed Medical Congress - American University of Beirut

“STATUS ON T-EVAR” (THORACIC ENDOVASCULAR ANEURYSM REPAIR)
Fady Haddad MD
Thoracic Aortic pathologies (Aneurysms, Dissections, Traumatic ruptures) remain challenging
despite substantial improvements in surgical and critical care techniques.
Over the past few years, endovascular approach (T-EVAR: Thoracic Endovascular Aneurysm
Repair) rapidly became the first option in most centers, when anatomically feasible, specially
with short and mid-term data showing reduced aneurysm related mortality and peri-procedural
morbidity and reduced incidence of spinal cord ischemia (SCI). With the encouraging results,
endovascular management is being extended to more difficult anatomy beyond the original IFU,
with the combination of “hybrid procedures” or endovascular branched devices. Today there
are already three devices in the US that are FDA approved for T-EVAR, and others are under
clinical trials.
Indications, procedure and outcome of T-EVAR will be discussed and a summarized algorithm for
approach to a patient with TAA will be presented.
THE RADIA APPROACH IN PCI
Mohammad Zgheib M.D
The trans-radial procedure is often associated with improved patient’s safety and comfort and
typically results in overall fewer bleeding complications. Over the past 30 years, trans-radial
vascular access for coronary angiography and intervention has flourished in many countries
while still accounting for less than 2% of all cases performed in the United States. The benefits of
trans-radial access include decreased bleeding risk, increased patient comfort, lessened postprocedure
nursing workload, and decreased hospital costs. The reasons why the trans-radial
approach has not caught on in the US and worldwide are unclear, but are probably related to
physician and ancillary staff’s comfort with femoral access, apprehension toward change, and
higher operator radiation exposure. However, once the procedure is mastered, the operator
and staff become extremely comfortable with the technique and radiation exposure can be
substantially reduced. Although the femoral approach is more common, cardiac catheterization
via femoral access demands greater post-procedural nursing care, is limited by prolonged
bed rest (usually about 4 hours), and delays discharge. Femoral access is also more frequently
associated with increased back pain, urinary retention, delayed ambulation, and neuropathy. To
overcome some of these limitations, many operators have adopted the use of vascular closure
devices, but published data have consistently shown that these devices are associated with
the same or increased hemorrhagic risks in comparison with manual compression. In addition,
rare complications such as infections, femoral artery stenosis, arterial laceration, uncontrolled
bleeding, pseudo-aneurysm, arterio-venous fistula, and device embolism and limb ischemia
have all been reported with the use of vascular closure devices. An increased awareness of the
advantages of trans-radial catheterization is therefore necessary in order for interventionalists to
adopt this safe and effective technique.
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