2020 UAB Cardiovascular Institute Annual Report CVI Annual Report 2019-2020 6 | Page 14

The vascular and cardiothoracic surgeons at UAB Medicine developed a comprehensive, multidisciplinary aorta
program and perform complex aortic procedures for acute and chronic diseases of the entire aorta. Open and
endovascular techniques are utilized to treat patients with diseases involving all segments of the aorta, from the
aortic root to the thoracoabdominal aorta and extending to the aortic bifurcation. This includes interventions from
open surgical repair to minimally invasive endovascular procedures to treat thoracoabdominal and abdominal
aneurysms using personalized branched and fenestrated endografts.
Our cardiothoracic and vascular surgeons collectively have performed thousands of aortic procedures using an
interdisciplinary approach to treating complex conditions.
HIGHLIGHTS
• USNWR “High-Performing” condition recognition for abdominal aortic surgery procedures
• Minimally invasive treatments available for catastrophic aortic conditions such as aortic transection due to
trauma, complicated thoracoabdominal aortic dissection, and symptomatic and ruptured thoracoabdominal
aneurysms
• Specialized hybrid operating room allowing intraoperative 3-D imaging for precise device delivery and
decreased operative times, lower radiation doses, and minimal contrast usage
• Specialized evaluation and treatment of genetic aortic disease
• Close collaboration with adult congenital heart disease specialists for adult patients with aortic disease related
to congenital aortic disease
• Extensive experience with aortic valve repair in the setting of aneurysmal disease
• Aortic branched/fenestrated IDE clinical trial for endovascular repair of branched portions of the aorta, which
normally requires treatment with a large-pen surgical procedure
• Ongoing clinical trials available for endovascular treatment of aneurysms involving the aortic arch in patients
who are not surgical candidates
• Total endovascular aortic arch repair
64-year-old male with 7.2cm transverse arch aneurysm.
Prohibitive risk for open surgery secondary to severe
LV dysfunction and frailty. Underwent successful total
endovascular arch repair using needle fenestration
and extracorporeal membrane oxygenation (ECMO).
Techniques published in Annals of Thoracic Surgery,
July 2019.
• Eudailey KW, Von Mering G, Johanson P, English
J, Lewis CT, Ahmed MI. Total Endovascular Arch
Repair Using Needle Fenestration and Extracorporeal
Membrane Oxygenation. Ann Thoracic Surg. 2020;
109:e127-9 DOI.org/10.1016/j.athoracsur.2019.05.064
AORTIC DISEASE
TOTAL ENDOVASCULAR ARCH REPAIR
A. Initial aortogram
B. Aortogram following initial graft deployment,
demonstrating exclusion of the arch aneurysm and
the head vessels
C. Orthogonal view fluoroscopy confirming trans-septal
needle position
D. Final aortogram demonstrating fenestration of
brachiocephalic and left carotid, left carotid-
subclavian bypass, and left subclavian origin plug
COMPLEX AORTIC SURGERY, JUNE 2014-JUNE 2019
ENDOVASCULAR REPAIR THORACOABDOMINAL ANEURYSM
Patient presented with a dissection/contained rupture
(arrow) within a Crawford Extent II thoracoabdominal
aneurysm. After temporizing with thoracic endovascular
aortic repair, an endovascular repair was done using
a custom 5-vessel branched and fenestrated aortic
endograft.
Post-operative image after successful custom
endovascular repair. UAB remains one of the only
hospitals in the southeastern United States capable of
performing repairs of this nature and is a major referral
center for patients with complex thoracoabdominal
aortic disease.
UAB cardiothoracic and vascular surgeons have performed more than 1,500 thoracic aortic procedures over the
past five years.
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