0810_Ravin.pdf

1、Iliac Aneurysms:Management and case discussion Reid Ravin,MDIliac aneurysmsMuch more commonly occur concurrently with aortic aneurysms Isolated common iliac aneurysms have relatively low incidence,and almost always involve common or hypogasticaneurysmFor isolated IAAs 3-3.5 are the recommended repai

2、r diameterYou should be thinking about management of any iliac larger than 2 when fixing This talk is focusing on patients getting bifurcated EVARsIliac aneurysm Obtaining a distal seal zone is not optional When talking about EVAR repair three common options:flare,cover and coil,or branchOlder appro

3、aches(debranching,parallel grafting)A quick note on FlaresTraditionally distal common iliac arteries 16mm have been treated with bell bottom iliac limbsIn a retrospective review of EVAR patients with CIA limbs 20mm compared with those 20mm,the rate of type Ib endoleak over 3 years was 3.9%(17 of 178

4、)in the 20mm iliac limb group versus 18%(11 of 61)in the 20mm cohortCoiln Cover(embolize and cover)Straight forward approach,can be applied to most anatomy Cheap(relatively speaking)Time tested Can be a pain in the ass (pause for polite audience laughter)Coiln CoverFew technical notesEmbolize proxim

5、al as possibleUp and over and ipsilateral access both possibleThink about cost and coil performance,consider plugsDrawbacks of coil and coverEmbolizing one hypogastric artery puts you at risk of:Buttock claudication 10-30%Rectal ischemia 1-2%Pelvic ischemia/ED These rates are significantly higher wh

6、en covering 2ESVS(2019)and SVS(2018)recommend preserving one if possibleIliac branch Devices There are now commercially available devices that allow placement of a branch into the hypogastric arteryThese devices have been shown in many studies to have high tec