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Boston Scientific — Technical Presentation (November 2006)
17 slides from Boston Scientific's technical presentation, November 2006
Slide 1: AAA and CIA occlusion
AAA and CIA occlusion Vascular Panos Kougias, MD Michael E. DeBakey Department of Surgery Division of Vascular Surgery Baylor College of Medicine Houston, TX
Slide 2: Overview
VASCULAR Overview ♦ 67 y/o man with 5.2 cm AAA ♦ PMHx: CHF (EF:20%), HTN ♦ Physical exam Weak right femoral, strong left femoral pulse, otherwise unremarkable Panos Kougias, MD
Slide 3: Management Plan
VASCULAR Management Plan ♦ Endovascular AAA repair ♦ If unsuccessful Æleave untreated since the patient is a high risk for open reconstruction Panos Kougias, MD
Slide 4: Aortogram via left groin approach
VASCULAR An aortogram is performed via left groin approach after a cutdown attempt to advance a Bentson wire through the right groin is unsuccessful. The right external iliac is occluded. A very prominent right hypogastric resembling the right external iliac is evident. Panos Kougias, MD
Slide 5: Another attempt to access the right common femoral
VASCULAR Another attempt to access the right common femoral indicates that the external iliac is occluded. Some dissection is also evident in this angiogram. Panos Kougias, MD
Slide 6: Pelvic arteriogram demonstrating reconstitution
VASCULAR A pelvic arteriogram is performed demonstrating reconstitution of the right common femoral artery and the dominant right hypogastric. Panos Kougias, MD
Slide 7: Stiff GlideWire brought up and over from left groin
VASCULAR A stiff GlideWire® Guidewire is brought up and over from the left groin to the right hypogastric. The wire is left in place indicating the take off of the right hypogastric as well as the outer wall of the right common iliac artery. Using this wire as an adjunct, the occlusion of the right
Slide 8: Dilation with sequentially increasing diameter dilators
VASCULAR Dilation is performed using sequentially increasing diameter dilators up to 14 Fr. Panos Kougias, MD
Slide 9: Contrast confirms progressive gain in external iliac diameter
VASCULAR After dilation, repeated contrast injection confirms the progressive gain in right external iliac diameter. Panos Kougias, MD
Slide 10: Main device brought through the left groin
VASCULAR The main device is brought through the left groin. Arteriogram is performed to localize the renals. Panos Kougias, MD
Slide 11: Hand injection of contrast via right groin
VASCULAR Hand injection of contrast via the right groin demonstrates adequate size for insertion of the contralateral limb. Panos Kougias, MD
Slide 12: Deployment of contralateral limb
VASCULAR After deployment of the contralateral limb the proximal attachment site is ballooned… Panos Kougias, MD
Slide 13: Ballooning of distal attachment sites
VASCULAR … followed by ballooning of the distal attachment sites. Panos Kougias, MD
Slide 14: Small waist during balloon angioplasty
VASCULAR A small waist is noted during balloon angioplasty of the right limb of the graft. Panos Kougias, MD
Slide 15: Completion angiogram shows filling defect
VASCULAR Completion angiogram demonstrates a filling defect at the takeoff of the right external iliac. Note the substantial luminal external iliac artery gain. A small endoleak – likely type 2 - is present. Panos Kougias, MD
Slide 16: Wallstent Endoprosthesis placed in right iliac artery
VASCULAR After further ballooning of the proximal attachment site a Wallstent® Endoprosthesis was placed in the right iliac artery. Both the endoleak and the filling defect have disappeared in the final completion arteriogram. Panos Kougias, MD
Slide 17: Conclusions
VASCULAR ♦ Occlusion of the one of the iliac vessels was thought to be a contraindication for endovascular aneurysm repair. ♦ This patient would not tolerate open repair of his aneurysm very well. Crossing the occluded vessel with standard endovascular techniques rendered the repair of the aneurysm
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