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Gefäßchirurgische Ausbildung in endovaskulärer Technik in Lausanne

Vascular surgical training in endovascular techniques in Lausanne

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Zusammenfassung

Zwischen 1995 und 2005 wuchs die Anzahl der jährlich von uns mit endovaskulären Techniken versorgten Aortenaneurysmen (EVAR) von 0 auf 50, und dies auf allen Stufen der Aorta. Zu unserer Organisation gehören ein breites Team von Chirurgen, ein Lager mit 3 kompletten Familien von Endoprothesen (gerade Endoprothesen, konische Endoprothesen, und Bifurkationen), ein mobiler Wagen mit Zubehör (Einführungsbestecke, Führungsdrähte, Katheter, Ballone etc.) und ein Apparat auf Rädern für die intravaskuläre Ultraschalluntersuchung (IVUS). Letzterer erlaubt es zusammen mit einer mobilen Durchleuchtungsanlage (C-Bogen), in jedem Operationssaal unserer Institution endovaskulär Aneurysmen zu analysieren, und dies in der Regel ohne Angiographie bzw. Kontrastmittel. Deshalb sind wir nicht mehr auf eine ausgiebige bildgebende präoperative Abklärung potenzieller Kandidaten für eine endovaskuläre Sanierung von Aneurysmen angewiesen und können rupturierte Aneurysmen der Bauchaorta oder der thorakalen Aorta ohne Verzug behandeln. Bei der endovaskulären Sanierung von Aortenaneurysmen unterscheiden wir zwischen Prozessschritten (Indikationsstellung, Darstellung der Zugangsgefäße, Ausmessen mittels IVUS und Roadmapping mittels Durchleuchtung, Implantatwahl, Implantatinsertion, Positionierung, Implantatabwurf, Erfolgsbeurteilung, Rekonstruktion der Zugangsgefäße und Nachkontrolle) und Kompetenzstufen (Assistent, Oberarzt, Leitender Arzt). Unsere ultraschallgestützte Technik zur endovaskulären Sanierung von Aneurysmen wurde mittels IVUS-Transporter und Telementoring erfolgreich auch anderen Institutionen zur Verfügung gestellt.

Abstract

Between 1995 and 2005, the number of aortic aneurysms treated annually using endovascular techniques (EVAR) increased from 0 to 50, including all aortic stages. Our organization includes a large team of surgeons, a stock of three complete families of endoprostheses (straight, conical and bifurcated), a mobile trolley with accessories (arterial introducer/introducer sheath, guide wire, catheters, balloons, etc.) and an appliance on wheels for intravascular ultrasound examination (IVUS). This appliance, together with a mobile fluoroscopy device (c-arm), allows endovascular aneurysms analysis of every operating room in our institution, usually without angiography or the use of contrast medium. In general, we are therefore not depending on substantial preoperative imaging in order to identify candidates for endovascular aneurysms repair and can treat abdominal and thoracic aortic ruptures without delay. For endovascular aortic aneurysms repair we distinguish between process steps on the one hand (determining indications, imaging of the access vessels, measurement using IVUS and road mapping via fluoroscopy, selection of implant, implant insertion, positioning, setting the implant, determining success, reconstruction of the access vessel and follow-up) and the level of competence on the other (assistant, senior and directing physicians). Our ultrasound supported technique for endovascular aneurysms repair has been successfully brought to other hospitals using an IVUS transporter and telementoring.

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Interessenkonflikt

L.K. von Segesser ist Gründer und Teilhaber der Smartcanula GmbH (Lausanne, Schweiz)

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Authors and Affiliations

  1. Department of cardiovascular surgery, Centre Hospitalier Universitaire Vaudois, CHUV, BH-10/275, 1011, Lausanne, Schweiz

    L.K. von Segesser, P. Tozzi, P. Ruchat, E. Ferrari, D. Delay, V. Argitis & G. Siniscalchi

  2. Kantonsspital Freiburg, Freiburg, Deutschland

    B. Marty

  3. Hôpital Pourtalès, Neuchatel, Schweiz

    I. Bruschweiler

  4. Ospedale San Giovanni, Bellinzona, Schweiz

    M. Bogen & A. Gallino

Authors
  1. L.K. von Segesser
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  2. B. Marty
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  3. P. Tozzi
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  4. P. Ruchat
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  5. E. Ferrari
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  6. D. Delay
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  7. V. Argitis
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  8. G. Siniscalchi
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  9. I. Bruschweiler
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  10. M. Bogen
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  11. A. Gallino
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Corresponding author

Correspondence to L.K. von Segesser.

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von Segesser, L., Marty, B., Tozzi, P. et al. Gefäßchirurgische Ausbildung in endovaskulärer Technik in Lausanne. Gefässchirurgie 12, 225–230 (2007). https://doi.org/10.1007/s00772-007-0526-z

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  • DOI: https://doi.org/10.1007/s00772-007-0526-z

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