腹主动脉瘤AAA课件.pptxVIP

Abdominal Aortic Aneurysms Beyond Grey Hair and Back Pain Marty Schoen;AAA Basics: What is it?;AAA Basics: What is it?;AAA Basics: How Often?;AAA Basics: Mortality;AAA Basics: Mortality;AAA Basics: Risks?;NEWS FLASH! ? Diabetics were actually protected from AAA! -Odds ratio of 0.52 (0.45-0.61) ? Patients with DVT were also protected -Odds ratio of 0.67 (0.53-0.84);AAA Diagnosis;AAA Imaging;AAA Imaging;Pestentgraft AAA Measurement Guidelines;AAA Surgery ? Performed because of natural history of AAA expansion and risk of death ? There is also morbidity due to arterial thromboembolism to legs ? Therefore surgery is recommended in AAA over 5.5 cm ? 2002 study showed no benefit to operate on small (4-5.5) aneurysms;AAA Repair;Open vs. Endovascular;Ilio-iliac Axis d 90°;Anatomic Criteria;cpen Repair and Graft;Potential Complications;Indications for Endovascular Repair;Tube Endograft Placement;Uniiliac Endograft Placement;Bifurcated Endograft Placement;AneuRx ? Medtronic ? Modular bifurcated with extension cuffs ? Graft一thin walled polyester ? Stent一outer self expanding Nitinol stents ? Delivery—25F introducer sheath 一 Mechanical deployment handle;Benefits;Results of Endovascular Repair;Costs of EAAA repair;Complications of EAAA repair ? Systemic 一 Ml, CHF, arrhythmias, respiratory failure, renal failure ? Procedure related 一 Dissection, malpositioning, renal infarction, thromboembolizaton, ischemic colitis 一 Groin hematoma, wound infection ? Device related 一 Migration, detachment, rupture, stenosis, kinking, endoleak;Endoleaks;Endoleak Classification;Changes in Aortic Morphology ? Aneurysm diameter 一 Growth in size associated with persistent endoleak ? Neck size -Annual expansion 0.7mm 1st year, 0.9mm 2nd year 一 May lead to migration and late endoleaks ? Aneurysm length 一 Shortens 5mm in 68% patients at 12mos -Associated with kinking and dislocation;EAAA in 2004;Summary ? Endograft AAA repair is still a developing field with promise 一 Certain patient populations may bene