Endovascular Treatment of an Iliac Artery Aneurysm U lizing the

Endovascular Treatment of an Iliac Artery Aneurysm U lizing the

 Endovascular Treatment of an Iliac Artery Aneurysm U7lizing the Snorkel Technique: A modified approach
LUIS VIRGEN MD PhD
Cardiovascular Research Institute Director
Guadalajara, Jalisco. México
Valuntary Faculty, University of Miami. USA
www.cardiovascular.mx
luisvirgenmd@yahoo.com
Incidence of Iliac Artery Aneurysms • 
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75-­‐95% present with AAA 0.03% life9me incidence 0.3-­‐1.9% of arterial aneurysms 7th-­‐8th decade of life 8-­‐9:1 male:female ra9o Common Iliac Artery -­‐ 70% Internal Iliac Artery -­‐ 20% External Iliac Artery -­‐ 10% Bilateral Disease – 20-­‐60% •  Keep in mind that 25% of pa9ents with an AAA also have aneurysms of the Iliac Arteries. POSSIBLE ENDOVASCULAR TREATMENTS o  EMBOLIZACION AND STENT GRAFT o  ILIAC BRANCH DEVICE o  SANDWICH-­‐SNORKEL TECHNIQUE The emboliza9on op9on could lead to serious problem ILIAC BRANCHE DEVICE CONTRAINDICACIONES q NO STENOSIS q NO ANEURISMATIC IIA q NO KINKING q LANDING ZONE10 MM NO For these reasons this technique is not possible for every pa9ent . Only 38-­‐55% are candidates We think if we change braquial acces, using contraleteral acces, in the lobato tecnique will be easer and beaer. YOU HAVE A
NEW
APPROACH? YES, I HAVE
A SNORKELSANDWICH
ME TOO, BUT
WITH
ANATOMICAL
FIXATION…
BRAQUIAL
ACCES
CONTRALATERAL
ACCES
Bifurcated Stent Grab, followed by Cateteriza9on of the ipsilateral internel iliac artery throug a leb brachial acces Place a covered self expanding stent 2 cm inside iliac internal artery with 6 cm overlapping Posi9oning of and iliac limb extension 1 cm below covered stent. First deploy the iliac limb extension and then the covered stent Endovascular Aor9c Stent Grab-­‐EVAR with Anatomical Fixa9on Endologix Balkin Up & Over®
Contralateral Design Sheat
CONTRALATERAL ACCES
COURTESY DR. ALEJANDRO FABIANI
5 fr Cateter
Internal Iliac
Artery
Hydrophilic
Wire Guide &Amplatz
super stiff 1 cm
Engineering Analysis of a Hypogastric Artery stent Grabing Technique in EVAR Ideal-­‐ Double D Engineering Analysis of a Hypogastric Artery stent Grabing Technique in EVAR With Two Symmetrical Covered Stents Engineering Analysis of a Hypogastric Artery stent Grabing Technique in EVAR We prefer the Asymmetrical Double D Technique using a limb extension and covered Stent To Date follow up; 6 Cases-­‐Asymmetrical Double D POWERLINK&VIABAHN CONTRALATERAL SHEAT 8FR KISSING BALLON AMPLATZ STIFF 1CM KISSING STENT CONTROL ILIAC LIMB EXTENSION + 2 VIABAHN 8X50 Y 8X100 FINAL ANGIOGRAPHY
VIRGEN. PRESENT AT TCT 2013 CONTROL CT SCAN 8-30 MONTHS
Present TCT 2013. Virgen et al.
TAKE HOME MESSAGE v  IF THE PATIENTS PRESENT WITH STENOSIS, INTERNAL ILIAC ANEURYSMS OR HEAVY KINKING, THE ILIAC BRANCH DEVICE IS CONTRAINDICATED. v  THE SANDWICH-­‐SNORKEL TECHNIQUE IS A EXCELLENT ALTERNATIVE FOR THESE PATIENTS. v  THE EASIEST SANDWICH-­‐SNORKEL APPROACH IS USING AN ANATOMICAL FIXATION AORTIC STENT GRAFT.