endoleak type ii: my management€¦ · high risk for type ii endoleak • patent ima >2.5 mm...
TRANSCRIPT
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Endoleak type II: my management
Pawanrat Kranokpiraksa
IR Unit, Radiology Department
Chulalongkorn University
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Disclosure
Speaker name:
.................................................................................
I have the following potential conflicts of interest to report:
Consulting
Employment in industry
Stockholder of a healthcare company
Owner of a healthcare company
Other(s)
I do not have any potential conflict of interest
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Type II Endoleak
• 40% (II alone + II plus other types)
• 75% spontaneous resolved
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Treatment Strategies
• Transarterial
• Translumbar
• Perigraft
• Open surgery
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NBCA GLUE
• Viscosity of glue VS Radiopaque
• Coil enhancing slow flow
• Loss microcatheter access after embolization
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Onyx
• Fill both nidus and inflow/outflow VV
• Radiopaque
• Decreased risk of nontargeted embolization
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Transarterial approach
• IMA
• Lumbar arteries
• Stable access and proper equipment
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Percutaneous approach
Access the aneurysm sac at the level the endoleak
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• Fluoroscopy with
anatomical landmarks
• Needle guide software
• Xperguide (Philips)
• DynaCT (Siemens)
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Perigraft approach
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High risk for type II endoleak
• Patent IMA >2.5 mm
• LA >1.9mm
• 2 or more LA extending from the aneurysm sac
• >30mm aortic flow lumen
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• Preventing development of type II endoleak
• Decreased sac size
• Decreased reintervention rates
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Perigraft sac coil embolization
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Surgical approach
Transarterial
Translumbar
Perigraft
Transcaval
Surgical approach
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Conclusion
• Various approach techniques
• Proper equipment
• CT-angio suite: ideal room to perform percutaneous approach
• Onyx : more expensive but more reliable and reduce re-intervention rate
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Endoleak type II: my management
Pawanrat Kranokpiraksa
IR Unit, Radiology Department
Chulalongkorn University