Beruflich Dokumente
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Patrick Chong Department of Vascular Surgery, Frimley Park Hospital NHS Foundation Trust Surrey Vascular Group Network
South East Coast Vascular Network Inaugural Meeting Kent & Canterbury Hospital 26th September 2012
11%
Salmonella spp.
Rupture
Extrinsic compression
Urological Neuropathy Deep venous
There is no significant correlation between size of internal iliac aneurysm and risk of rupture
r=+0.161 Spearman p=0.279 De Donato 2005
Endovascular options
Balloon expandable
Jostent by JOMED,
Self-expanding
Fluency stent by BARD Haemobahn by GORE
Viabahn by GORE
Treatment options
Open repair
Bypass
Endovascular repair
Stent Embolisation Hybrid approaches
Ligation
10-23mm stent diameter 60-140mm stent length >25mm proximal >20mm distal 10-15% oversize
Data is not robust after 2 years Is your patient fit for open repair?
Left IIAA found on diagnostic trans-femoral angiography Beware of using TFA findings alone ! CT Aortogram showed no proximal neck coil embolization
Large Right CIAA with no distal landing zone proximal to the Right IIA origin. Proximal coiling of Right IIA origin Right iliac stent with distal landing zone in the external iliac artery
Large Right CIAA with no proximal landing zone Aorto-uni-iliac stent to Left CIA Fem-Fem crossover bypass
Embolisation tips
Contralateral approach / Ansel crossover sheath (COOK) / Terumo hydrophilic wire Amplatzer vascular plugs Coils Glue Thrombin Onyx
Summary
Rupture risk Surveillance Consider repair when < 3cm low >5cm significant <3cm 3.5-4.0 cm yearly 6 months
>4cm or symptomatic
Open repair may be better in patients with compressive symptoms Endovascular therapy may be safer in co-morbid patients
Further need for long term durability comparison of open vs. endovascular repair