Endovascular approaches (TBL) Flashcards
Aortic aneurysm incidence in the US
60/1000
Deaths per year from ruptured aneurysms
15,000
Aortic aneurysm are the __ leading cause of death
12th
Aortic aneurysms occur mostly in what demographic
Elderly men
Aortic aneurysms occur mostly in what location
Infrarenal
Aortic aneurysm treatments for small size
(<5.0 cm)
Serial CT scans
Aortic aneurysm treatments for large size
(>5.0 cm)
Surgical repair
Aortic aneurysm treatment for ruptured aneurysms
Emergent repair
Surgical options
Trans peritoneal
Retroperitoneal
Laparoscopic
Endoluminal stent grafting (EVAR)
Open repair
Physically cut open patient to reach vessel area
Laparoscopic
Using a tool outside the body to be fed to vessel area without majorly cutting open patient
Endovascular stent grafting (EVAR) limitations
Prox neck angulation.
Delivery limited by tortuous, calcified, small iliacs.
concurring aneurysms limit use.
EVAR complications
Movement of prosthesis.
Continued/recurrent circulation of blood in aneurysm but outside stent.
Pseudoaneurysm formation.
Thrombus within stent leading to stenosis/occlusion.
Arterial dissection.
EVAR follow-up
Life-long surveillance. Physical exam. CT scan. Duplex scan. Interventions.
EVAR main goal
Aneurysm sac shrinkage
Endografts on Duplex (B mode)
Begin trans.
Document patency of renal arteries.
Measure aneurysm sac in trans, AP, lateral
Measure area.
Endografts on duplex (color/dopp)
Low color scale. Examine prox attachment site. Patency of graft. Evaluate each limb of graft (Bifur not in normal place). Scroll though graft with Doppler.
Doppler of endografts
Document signals in both common iliac, and both external iliac arteries.
Asses both iliac attachment sites.
Endoleak types
Type 1
Type 2
Type 3
Type 4
Type 1 endoleak
Occurs at attachment site. Inadequate seal.
1A=Proximal
1B=Distal
Type 2 endoleak
Occurs from back bleeding from branch vessels.
Lumbars
IMA
Type 3 endoleaks
Occurs from leak in fabric or modular disconnection
Type 4 endoleaks
Occurs from fabric porosity.
Leak through fabric
Result after endograft placement
Aneurysm should shrink over time.
Failure to shrink or begins to enlarge indicates leak.
Unrepaired leaks causing expansion leads to aneurysm rupture.
Assessing Endografts on Duplex
Assess the configuration of stent for bulges, kinking or fractures.
Evaluate lumen of stent for thrombus/stenosis.
Aneurysm size changes
AAA size reduction predicts successful exclusion.
Continuing endoleak and AAA enlargement are linked.
Aneurysms enlarge with no leak=poor imaging.
EVAR pros
AAA size not a limitation.
Delivered by bilateral trans-femoral route
