management of a aaa with obstructive uropathy by evar using … · management of a aaa with...
TRANSCRIPT
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Management of a AAA with Obstructive Uropathy by EVAR
Using 20ml of Contrast
Ahmed Sayed MD
A.Sayed, H. Mostafa, K. Elhindawy
Division of Vascular Surgery
Kasr Alainy Hospital Cairo University, Egypt
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Disclosure
Speaker name:
Ahmed Sayed
I do not have any potential conflict of interest
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Case presentation
• 58 yr old DM, dilated cardiomyopathy
• Obstructive uropathy from an 8cm diameter AAA
• Ureteric stents inserted
• 3 Hemodialysis sessions
• but serum Cr: 3.5 mg/dL
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Endurant II 28mm, 145mm
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Location of lowest renal by IVUS
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Adjustment of the device at the lowest renal under fluoroscopy marked by IVUS catheter
Endurant II 28mm, 145mm
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Confirmation of position by CO2 angiography using Angiodroid® Injection System
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Deployment
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Control CO2 angiogram prior to device release
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Conventional angiogram using 20ml of Ultravist
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Iliac bifurcation marking using IVUS
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Deployment of contralateral limb
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Ipsilateral iliac bifurcation marking
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Control CO2 angiogram
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Control CO2 angiogram after ballooning
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3 months follow up
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Contrast Media Mol Imaging. 2018 Mar 26;2018:7647165. doi: 10.1155/2018/7647165
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Summary
Planning + intervention + follow up with <20ml
>>>>> feasible
• Good quality MRA dicom images can be used for EVAR sizing & planning
• Train your eyes on CO2 images. Prepare the abdomen well!
• Good aortic images with the new software of Angiodroid®
• IVUS is an excellent tool for marking of locations. Get used to its images!
• Ultrasound surveillance
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Thank you for your attention
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Management of a AAA with Obstructive Uropathy by EVAR
Using 20ml of Contrast
Ahmed Sayed MD
A.Sayed, H. Mostafa, K. Elhindawy
Division of Vascular Surgery
Kasr Alainy Hospital Cairo University, Egypt