Ruolo dell’IVUS nelle - sicve.it · Ruolo dell’IVUS nelle procedure EVAR ... Curva di...
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Ruolo dell’IVUS nelle procedure EVAR Dpt of Vascular Surgery Civic and Benfratelli Hospital Palermo F. Talarico - G. La Barbera – G. Ferro
Transcript of Ruolo dell’IVUS nelle - sicve.it · Ruolo dell’IVUS nelle procedure EVAR ... Curva di...
Ruolo dell’IVUS nelle procedure EVAR
Dpt of Vascular Surgery
Civic and Benfratelli Hospital
Palermo
F. Talarico - G. La Barbera – G. Ferro
Pros
Visualizzazione “real-time” arterie target
Riduzione m.d.c.
Riduzione tempo di scopia
Elmina parallasse
Misurazione diametri aorto-iliaci
Cons
Curva di apprendimento
Costo aggiuntivo
Operatore dipendente
ARD
ARS
VRS
‘’Anaconda’’ Aortic Endograft
Repositionability NO Free - flow
Technical features
Angio Tc pre
Il Est dx
Ipog dx
Il Est dx
Ipog dx
Angio Tc post
January 2015 - October 2017 - 183 EVAR
47 EVAR by IVUS navigation
47 ANACONDA (repositionable EG)
Matherials and methods
Type A o B (EUROSTAR) Neck length ≥ 15 mm
NO Iliac Stenosis Iliac axis diam ≥ 7.5 mm
Population Data
44 Men - 3 Women
Mean age: 63.9 yrs (range: 87 – 58)
IVUS - Steps in EVAR Anatomic landmark
Body delivery Lowest Renal Artery (LoRA)
- diameters - Aortic Neck
Limbs delivery Hypogastric origin
- diameters - Common Iliac
- length - Hypog. EG Flow – Divid.
Matherials and methods
LoRANeck Ø
Hypog
CI Ø
Flow
Divd
er
-H
ypo
gastricle
ngth
Imaging findings - IVUS vs CT
Coeliac Trunk Hypogastric origin
Sup Mesenteric
Rigth Renal Art Aortic neck Ø
Left Renal Art Common iliac Ø
LoRA Limbs length
Matherials and methods
Contrast medium employement
IVUS not clear target artery vision
Final controll arteriography
IVUS findings n° pts %
CT Visualization 47 100
SM ‘’ 47 100
RRA ‘’ 47 100
LRA ‘’ 431 91
LoRA ‘’ 442 94
1 2 cases: Ao neck angle > 40° - 2 cases: RA covered by ctrl GW -2 Ao neck angle > 40°3 Hypogastric ostium calcifications
Results - 47 pts
IVUS findings n° pts %
Hypogastric ‘’ 903 96
Ao neck diam 47 100
Com. Il. ‘’ 94 100
Right limb length 47 100
Left ‘’ ‘’ 47 100
TC + TC -
IVUS + 277 0
IVUS - 4 1
Examined arteries = 282
Predictive value
Positive 100%
Negative 20%
Sensitivity
98.5%
Specificity
100%
Visceral aa + RRAA visualization - Preop IVUS vs CT
Results - 47 pts 30 d n° pts %
Lk tipo 1 0 0
Lk tipo 2 2 4
Morbidity 0 0
Mortality 12 2
FU 6 mo n° pts %
Lk type 2 2 4
Morbidity 0 0
Mortality 0 0
Intraop findings n° pts %
EG repositioning 321 68
Type 1 Lk 0 0
AAA sac embolization 1 4
Technical success 47 100
c. m. mean amount 40 ml
1 EG body vs ostio LoRA competition2 bowel ischemia
CO2 vs CM angiography - Advantages
Advantages
Meno denso del mdc
NO reazioni allergiche
NO tossicità renale
NO tossicità epatica
NO limitazioni quantità iniettate
Drawbacks
Rischio embolismo cerebrale, spinale, coronarico, polmonare NO iniezione sopra diaframma
Rischio contaminazione con aria
Si posiziona in alto minore definizione TC e MS
Maggiori acquisizioni maggiori radiazioni
Dolore alla iniezione aorta, arti inferiori, splancnico
Conclusions
In favorable anatomy, IVUS accurately detect boththe LoRA and hypogastrics origin.
In these cases repositionable EG, only assisted by IVUS, allow EVAR procedure without c.m., but the final control arteriography.
In the next future , technological evolution couldallow us to perform the entire EVAR procedure with only IVUS assistance.
