Endovascular Techniques for Visceral Artery Aneurysm Treatment
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1 Wednesday, January 31, :21-17:27 Endovascular Techniques for Visceral Artery Aneurysm Treatment S.Müller-Hülsbeck, MD, EBIR, FCIRSE, FICA, FSIR ACADEMIC HOSPITALS Flensburg of Kiel University Faculty of Medicine Ev.-Luth. Diakonissenanstalt zu Flensburg Knuthstraße 1, FLENSBURG Dept. of Diagnostic and Interventional Radiology / Neuroradiology 1
2 Disclosure Speaker name:...stefan Müller-Hülsbeck... I have the following potential conflicts of interest to report: x Consulting: Terumo, Boston Scientific, GE, Cordis Johnson&Johnson, Eurocor Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s) I do not have any potential conflict of interest 2
3 Indication for treatment I - due to a higher risk of rupture elective repair is preferable in the appropriately chosen patient I. splenic artery aneurysms measuring 2 cm or larger and those found in women of childbearing age, > 4 cm cirrhotic patients II. persons undergoing liver transplantation III. Hepatic artery aneurysms 2 cm or larger IV. Superior Mesenteric Artery + non-symptomatic Renal Artery > 1 to 1.5 cm) V. those that are multiple or non-atherosclerotic in nature Belli AM, Markose G, Morgan R. The role of interventional radiology in the management of abdominal viscerala artery aneurysms. Cardiovasc Intervent Radiol Apr;35(2): doi: /s Epub 2011 Jun 15. 3
4 Indication for treatment II - due to a higher risk of rupture treatment indicated regardless location or measure I. visceral artery pseudoaneurysms (increasing incidence / iatrogenic / pancreatitis) Flood K, Nicholson AA. Inferior pancreaticoduodenal artery aneurysms associated with occlusive lesions of the celiac axis: diagnosis, treatment options, outcomes, and review of the literature. Cardiovasc Intervent Radiol Jun;36(3): reperfusion is an important complication of endovascular management Sachdev-Ost U. Mt Sinai J Med May-Jun;77(3):
5 Incidence 0.01% - 2% Nosher JL, Chung J, Brevetti LS et-al. Visceral and renal artery aneurysms: a pictorial essay on endovascular therapy. Radiographics. 2006;26 (6):
6 Access transbrachial, left proper stability of the vascular access platform triaxial system I. reinforced vascular sheath (65 90 cm) II. 6-F guiding or 5-F diagnostic angled catheter III. microcatheter 6
7 Aneuryms morphology treatment options 7
8 Endovascular treatment options Atrium V12 ( ), Viabahn ( ), Fluency, Wallgraft = main branches, easyily accessable, proximal Numerous detachable: Concerto, Retracta, Azur, Ruby, = narrow neck AVP, = ruptured aneurysm 8
9 Endovascular treatment options BMS (open-cell, SES) neck support Coiling through Solitaire, Expert, = wide neck Flow-diverter = preservation of side branches Glue N-Butyl-2-cyanoacrylate (Histoacryl) Ethylene Vinyl Alcohol Copolymer (Onyx) = peripheral locations 9
10 Narrow neck dens packing technique (>24%) Packing density >24% calculated coil lenght I. 800cm for 20-mm aneurysm II. 3,000cm for 30-mm aneurysm Sluzewski M, van Rooij WJ, Slob MJ, et al. Relation between aneurysm volume, packing, and compaction in 145 cerebral aneurysms treated with coils. Radiology. 2004;231:
11 Renal artery aneurysm Yasumoto T, Osuga K, Yamamoto H, et al. Long-term outcomes of coil packing for visceral aneurysms: correlation between packing density and incidence of coil compaction or recanalization. J Vasc Interv Radiol. 2013;24:
12 Gastroduodenal artery aneursym Yasumoto T, Osuga K, Yamamoto H, et al. Long-term outcomes of coil packing for visceral aneurysms: correlation between packing density and incidence of coil compaction or recanalization. J Vasc Interv Radiol. 2013;24:
13 Splenic artery aneurysm covered stent 49-year-old female, asymptomatic 13
14 Splenic artery aneurysm covered stent Material Sheath 90cm 6F efferent afferent Cobra 4F GW.018-inch SES covered 49-year-old female, asymptomatic 14
15 Splenic artery aneurysm covered stent 49-year-old female, asymptomatic 15
16 Splenic artery aneurysm covered stent 24hrs 49-year-old female, asymptomatic 16
17 17
18 Splenic artery aneurysm supporting stent 70-year-old female, asymptomatic 18
19 Splenic artery aneurysm supporting stent Material Guide 6F Cobra 4F GW.014-inch BES 3.5x16 Microcatheter 70-year-old female, asymptomatic 19
20 Splenic artery aneurysm supporting stent 70-year-old female, asymptomatic 20
21 Splenic artery aneurysm flow diverter 21
22 Flow diverter 22
23 Splenic artery aneurysm flow diverter Courtesy of 23
24 24
25 Conclusion Endovascular techniques for visceral artery treamtent Non-invasive imaging: CTA, MRA Indication evaluation - appropriate patient selection Safe access tri axial treatment options - aneuryms morphology Stent grafts (feasible in 30%) Coils Plugs SES + Coils Flow diverter Glue/Onyx in case of coiling - dens packing technique (>24%) required to avoid early reperfusion! 25
26 Wednesday, January 31, :21-17:27 Endovascular Techniques for Visceral Artery Aneurysm Treatment S.Müller-Hülsbeck, MD, EBIR, FCIRSE, FICA, FSIR ACADEMIC HOSPITALS Flensburg of Kiel University Faculty of Medicine Ev.-Luth. Diakonissenanstalt zu Flensburg Knuthstraße 1, FLENSBURG Dept. of Diagnostic and Interventional Radiology / Neuroradiology 26
S.Müller-Hülsbeck, MD, EBIR, FCIRSE, FICA, FSIR
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