tailieunhanh - Endovascular Aneurysm Repair - part 9

Lý do để Hoàn toàn Dựa trên IVUS cho các thủ tục cấy Was Việc giảm thiết bị kỹ thuật và nhân sự để Đạt được thiết lập nhanh chóng và dễ dàng với khoảng năm-đồng hồ-sẵn sàng. Trong một nghiên cứu chúng tôi đào tạo Chứng minh sự tương đương của IVUS để sửa chữa chứng phình động mạch trong Endovascular | Systematic and exclusive use of intravascular ultrasound for endovascular aneurysm repair I 109 endoleak on CT scan but the entire thoraco-abdominal aorta which was extensively calcified increased in diameter and the patient was therefore unfit to undergo any further interventional procedure. Discussion The rationale to rely entirely on IVUS for the implantation procedure was the reduction of technical equipment and personnel in order to achieve an easy and quick setup with around-the-clock availability. In a former study we demonstrated the equivalence of IVUS to arteriography in endovascular aneurysm repair 4 and this study supports the feasibility of an exclusively IVUS-based repair without confirmatory or completion arteriography. Based on IVUS the target site of deployment including the left renal vein and the adjacent renal artery orifices was identified in all cases without any difficulties. We also consider IVUS useful in verifying the proper position of the guide wire in the main graft body after canulation of the contralateral limb as experienced by others 9 . Regarding quality control IVUS was effective in visualizing incomplete expansion in some endoprostheses due to a 360 cross-sectional view. Arteriography alone or indirect evaluation of graft stenosis such as pullback pressure gradient measurements 10 would probably have missed it. In addition we appreciated the fact as it enabled US to renounce completely contrast dye for the implantation procedure in patients with a known prevalence of 13 to 21 renal failure 11 12 . A drawback of this IVUS-based strategy is the risk of missing endoleaks and thus their prompt treatment. Indeed we noted a high rate of early endoleaks particularly attachment site endoleaks. Although the complication of endoleaks is nowadays reduced to 2-3 in centers of excellence a metaanalysis of clinical studies demonstrated endovascular aneurysm repair still to be associated with 24 endoleaks mainly owing to an ineffective proximal

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