“Mise en place d' une endoproth é se branch è e hypogastrique” Alexandros Mallios
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Transcript of “Mise en place d' une endoproth é se branch è e hypogastrique” Alexandros Mallios
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“Mise en place d' une endoprothése branchèe hypogastrique”
Alexandros Mallios
2010 – 2011 COLLEGE CHIRURGIE VASCULAIRE IDF
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C' est quoi une
“endoprothèse branché hypogastrique”
???
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Pourquoi Faire
???
(Indications)
Préservation de l'artère iliaque interne et de la perfusion pelvienne
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20 – 30 %
des malades avec un AAA
ont aussi aneurysmes
des artères iliaques
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endoprothèses - importance des zones d'étanchéité
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Branches / Coils
Claudication de la fesse 45%
Ischémie du périnée, du côlon ou de la moelle
L'impuissance sexuelle
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Les tentatives précédentes
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Endoprothéses Branchèes - depuis 2002
Side branch Helical Branch
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“Par l' intérieur”
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“ Preloaded Catheter”
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Comment Faire
???
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10 mm
“Le lasso”
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10 mm10 mm
“through and through wire &
introducteur en cross over”
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Deuxième wire en parallèle&
et passage du “bridging stent graft”
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“largage du stent graft”
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Mise en place de l' endoprothèse
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“Mise en place du bridging stent graft”
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VIDEO
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L'évolution récente “Bifurcated – bifurcated graft”
Courtesy of Dr Roy Greenberg – Cleveland Clinic, Cleveland OH
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L'évolution récente“Bifurcated – bifurcated graft”
Courtesy of Dr Roy Greenberg – Cleveland Clinic, Cleveland OH
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L'évolution récente“Bifurcated – bifurcated graft”
Courtesy of Dr Roy Greenberg – Cleveland Clinic, Cleveland OH
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L'évolution récente“Bifurcated – bifurcated graft”
Courtesy of Dr Roy Greenberg – Cleveland Clinic, Cleveland OH
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Résultats dans la littérature
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Résultats dans la littérature
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Contraindications absolues:
1. Aneurysme de l' artere Hypogastrique
2. Stenose de l' artere Hypogastrique
3. Diamètre résiduelle de l artere iliaque primitive < 1,8 cm (lumiere sans thrombus)
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Conclusions
No doubt in the importance of IIA maintenance
Placement of a branched endograft for the IIA seems to be feasible and with good results
Technology and experience is improving and this normally will be reflected in the results
More evidence required for evaluation
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Literature – Articles a étudier
1. Tielliu et al. The role of branched endografts in preserving internal iliac arteries. J Cardiovasc Surg 2009;50:213-8
2. Malina et al. Feasibility of a Branched Stent Graft in Common Iliac Artery Aneurysms. J Endovasc Ther 2006;13:496-500
3.Greenberg et al. Beyond the aortic bifurcation: Branched endovascular grafts for thoracoabdominal and aortoiliac aneurysms J Vasc Surg 2006;43:879-86
4.Verzini et al. Endovascular treatment of iliac aneurysm: concurrent comparison of side branch endograft versus hypogastric exclusion J Vasc Surg 2009;49:1154-61
5.Dias et al. EVAR of Aortoiliac Aneurysms with Branched Stent grafts.EurJ Vasc Endovasc Surg 2008;35:677-84
6.Bergamini et al. External iliac artery to internal iliac artery endograft: A novel approach to preserve pelvic inflow in aortoiliac stant grafting J Vasc Surg 2002;35:120-4
7.Kritpracha et al. Bell bottom aortoiliac endografts: An alternative that preserves pelvic flow. J Vasc Surg 2002;35:874-81
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Merci pour votre attention :-)