Endovascular Treatment of an Iliac Artery Aneurysm U lizing the Snorkel Technique

16 Pages·2014·12.65 MB·English

Endovascular
 Treatment
 of
 an
 Iliac
 Artery
 Aneurysm

U7lizing
 the
 Snorkel
 Technique:
 A
 modified
 approach

LUIS VIRGEN MD PhD
Cardiovascular Research Institute Director
Guadalajara, Jalisco. México
Valuntary Faculty, University of Miami. USA
www.cardiovascular.mx
[email protected]
Incidence
 of
 Iliac
 Artery
 Aneurysms

•  75-­‐95%
 present
 with
 AAA

•  0.03%
 life9me
 incidence

•  0.3-­‐1.9%
 of
 arterial
 aneurysms

•  7th-­‐8th
 decade
 of
 life

•  8-­‐9:1
 male:female
 ra9o

•  Common
 Iliac
 Artery
 -­‐
 70%

•  Internal
 Iliac
 Artery
 -­‐
 20%

•  External
 Iliac
 Artery
 -­‐
 10%

•  Bilateral
 Disease
 –
 20-­‐60%

•  Keep
 in
 mind
 that
 25%
 of
 pa9ents
 with
 an
 AAA
 also
 have

aneurysms
 of
 the
 Iliac

 Arteries.
POSSIBLE
 ENDOVASCULAR
 TREATMENTS

o  EMBOLIZACION
 AND
 STENT
 GRAFT

o  ILIAC
 BRANCH
 DEVICE

o  SANDWICH-­‐SNORKEL
 TECHNIQUE
The
 emboliza9on
 op9on
 could

lead
 to
 serious
 problem
ILIAC
 BRANCHE
 DEVICE

CONTRAINDICACIONES

q NO
 STENOSIS

q NO
 ANEURISMATIC
 IIA

q NO
 KINKING

q LANDING
 ZONE10
 MM

NO
For
 these
 reasons
 this
 technique
 is
 not

 possible
 for
 every
 pa9ent
 .

Only
 38-­‐55%
 are
 candidates

We
 think
 if

 we
 change
 braquial
 acces,
 using
 contraleteral
 acces,
 in
 the

lobato
 tecnique

 will
 be

 easer

 and
 beaer.

YOU HAVE A

NEW
APPROACH?

YES, I HAVE
A SNORKEL-
SANDWICH
ME TOO, BUT
WITH
ANATOMICAL
FIXATION…
BRAQUIAL CONTRALATERAL
ACCES ACCES
Bifurcated
 Stent
 Grab,
 followed
 by

Place
 a
 covered
 self
 expanding

Cateteriza9on
 of
 the
 ipsilateral

stent
 2
 cm
 inside
 iliac
 internal

internel
 iliac
 artery
 throug
 a
 leb

artery
 with
 6
 cm
 overlapping

brachial
 acces

Posi9oning
 of
 and
 iliac
 limb
 extension
 1
 cm
 below
 covered
 stent.

First
 deploy
 the
 iliac
 limb
 extension
 and
 then
 the
 covered
 stent
Endovascular
 Aor9c
 Stent
 Grab-­‐EVAR
 with
 Anatomical
 Fixa9on

Endologix

CONTRALATERAL ACCES
5 fr Cateter

t
a
Internal Iliac
e
h
S Artery

n
® g
i
rs
ee
vD
O

l
a
&
r
e
p
t
Ua
l
a
n
r
kint
alo Hydrophilic
BC
Wire Guide &Amplatz
super stiff 1 cm
COURTESY DR. ALEJANDRO FABIANI