Download Presentation - The PPT/PDF document "59 y.o . man: acute back pain" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Presentation on theme: "59 y.o . man: acute back pain"— Presentation transcript:
Slide1
59 y.o. man: acute back pain
11/7/15 CTA: AAA 6cm, with leak and retroperitoneal hematoma11/9/15 CTA: 2D s/p Endologix stent-graft repair: short bifurcated body, two proximal sleeves
1
EVAR Endoleaks – RAML 1.31.17
Leaking AAA
s/p
EVAR
Slide2
Surveillance missed. 13 mos. later: acute back pain
12/8/16 CTA: Type 3 endoleak and acute sac rupturemain body angulated in relation to and separated from proximal components
proximal components slipped distally into sac2
EVAR Endoleaks – RAML 1.31.17
Slide3
EVAR Endoleaks
EVAR stent-graftspurpose: exclude pressure from aneurysm sac, maintain distal flow.design: self-expanding stents outwardly press microporous fabric against atherosclerotic aortic and iliac walls, and sac thrombus. materials: push limits of stent and fabric thickness/strength vs. delivery size.procedure: unlike open graft, no opportunity to ligate or reimplant side branches (lumbar arteries, IMA).after aneurysm exclusion: sac thrombus matures, reconfigures, hemolyzes.
these principles provide the opportunities for failure (endoleaks) and the requirement for lifelong imaging surveillance.Endoleaks: classify them with imaging to understand their mechanism, and thus,
the urgency and type of repair.3
EVAR Endoleaks – RAML 1.31.17
Slide4
Endoleak Classification
Type 1: proximal or distal seals fail: high-pressure leak: URGENT REPAIR1-month post-op: limb attachment leak: Rx covered stent4
EVAR Endoleaks – RAML 1.31.17
Slide5
Endoleak Classification
Type 2: aortic side branches reconstitute flow in sac: lumbars, IMAlow-pressure leak: FOLLOW SAC SIZEembolize electively if leak persistent AND sac enlarging5
Type 4: porous fabric: usually seen while still anticoagulated postop.low-pressure leak: await reversal of anticoagulation.Type 5: “endotension”: sac growth in the absence of a visible leak.low-pressure leak: re-line stent-graft electively if sac enlarging
7
EVAR Endoleaks – RAML 1.31.17
Slide8
Summary
Endoleaks: classify them with imaging to understand their mechanism, and thus, the urgency and type of repair.High-pressure leaks: URGENT repair with covered stentsType 1: proximal or distal seals fail Type 3: graft disruption: fabric tear, component separation
Low-pressure leaks: treat electively if sac enlargingType 2: aortic side branches reconstitute flow in sac: lumbars, IMA
Type 4: porous fabric: usually seen while still anticoagulated postopType 5: “endotension”: sac growth in the absence of a visible leak8
