This document summarizes a study on using fibrin glue to induce thrombosis of aneurysm sacs during endovascular aneurysm repair (EVAR). The study included 84 patients who underwent EVAR with additional injection of fibrin glue into the aneurysm sac. Follow-up for up to two years found thrombosis of fibrin glue-treated aneurysm sacs in 97.6% of cases. The authors conclude that intraoperative fibrin glue injection is an effective preventive strategy for type II endoleaks and may be considered for routine prevention of type II endoleaks during EVAR.
A New Management For Hypogastric Flow Exclusion In Evar Using An Extension Of...Salvatore Ronsivalle
OUR EXPERIENCE:A NEW MANAGEMENT FOR HYPOGASTRIC FLOW EXCLUSION USING AN EXTENSION OF THE SAC THROMBIZATION PROCEDURE
NOSTRA ESPERIENZA: UN NUOVO MODO DI ESCLUDERE L’ARTERIA IPOGASTRICA USANDO UN' ESTENSIONE DELLA PROCEDURA DI TROMBIZZAZIONE DELLA SACCA (Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
Congress presentation in 2012 10 S.Paulo Vascular Surgery Meeting "AAA WANTED "
Presentazione al congresso 2012 10 S.Paulo Vascular Surgery Meeting "AAA CERCASI"
(Angiologia-Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Angiology- Vascular Surgery -ULSS 15 Alta Padovana)
IMAGES OF A COMPLEX CASE OF MULTIPLE ANEURYSMAL DISEASE IN A 58 YEAR OLD MAN
IMMAGINI DI UN CASO COMPLESSO DI MALATTIA POLINEURISMATICA
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
INTERNATIONAL PRESENTATIONS
ABOUT BELL BOTTOM TECHNIQUE-Presentation of the first custom made flared graft and our experience using Bell Bottom tecnique in abdominal aortic aneurysm with ectatic common iliac artery
PRESENTAZIONI UFFICIALI SULLA TECNICA BELL BOTTOM
Presentazione della prima protesi custom made e nostra esperienza con la tecnica Bell Bottom per gli aneurismi dell'aorta addominale con arterie iliache comuni ectasiche
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
A New Management For Hypogastric Flow Exclusion In Evar Using An Extension Of...Salvatore Ronsivalle
OUR EXPERIENCE:A NEW MANAGEMENT FOR HYPOGASTRIC FLOW EXCLUSION USING AN EXTENSION OF THE SAC THROMBIZATION PROCEDURE
NOSTRA ESPERIENZA: UN NUOVO MODO DI ESCLUDERE L’ARTERIA IPOGASTRICA USANDO UN' ESTENSIONE DELLA PROCEDURA DI TROMBIZZAZIONE DELLA SACCA (Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
Congress presentation in 2012 10 S.Paulo Vascular Surgery Meeting "AAA WANTED "
Presentazione al congresso 2012 10 S.Paulo Vascular Surgery Meeting "AAA CERCASI"
(Angiologia-Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Angiology- Vascular Surgery -ULSS 15 Alta Padovana)
IMAGES OF A COMPLEX CASE OF MULTIPLE ANEURYSMAL DISEASE IN A 58 YEAR OLD MAN
IMMAGINI DI UN CASO COMPLESSO DI MALATTIA POLINEURISMATICA
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
INTERNATIONAL PRESENTATIONS
ABOUT BELL BOTTOM TECHNIQUE-Presentation of the first custom made flared graft and our experience using Bell Bottom tecnique in abdominal aortic aneurysm with ectatic common iliac artery
PRESENTAZIONI UFFICIALI SULLA TECNICA BELL BOTTOM
Presentazione della prima protesi custom made e nostra esperienza con la tecnica Bell Bottom per gli aneurismi dell'aorta addominale con arterie iliache comuni ectasiche
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
Presentation made by Dr. Hiranya A. Rajasinghe about Popliteal Artery Aneurysms: When to Treat Inclusion and Exclusion Criteria for Endovascular Repair
ACUTE STROKE CAUSED BY CARDIAC EMBOLISM- CASO DI STROKE ACUTO DA EMBOLIA CARDIACA
(Angiologia-Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Angiology- Vascular Surgery -ULSS 15 Alta Padovana)
J ENDOVASC THER 2005;12:579–582- Tecnical Note-Fibrin Glue Aneurysm Sac Embolization
at the Time of Endografting
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
Presentation made by Dr. Hiranya A. Rajasinghe about Popliteal Artery Aneurysms: When to Treat Inclusion and Exclusion Criteria for Endovascular Repair
ACUTE STROKE CAUSED BY CARDIAC EMBOLISM- CASO DI STROKE ACUTO DA EMBOLIA CARDIACA
(Angiologia-Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Angiology- Vascular Surgery -ULSS 15 Alta Padovana)
J ENDOVASC THER 2005;12:579–582- Tecnical Note-Fibrin Glue Aneurysm Sac Embolization
at the Time of Endografting
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
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Phoenix 2008 Cannes Meet 2009 PREVENTION OF ENDOLEAK TYPE II WITH BIOMATERIALSSalvatore Ronsivalle
INTERNATIONAL PRESENTATIONS
ABOUT PREVENTION OF ENDOLEAK TYPE II WITH BIOMATERIALS -
PRESENTAZIONI UFFICIALI SULLA PREVENZIONE DELL'ENDOLEAK DI TIPO II MEDIANTE UTILIZZO DI BIOMATERIALI
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
Intraoperative Intrasac Thrombin Injection to Prevent Type II Endoleak After Endovascular Abdominal Aortic
Aneurysm Repair
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(Vascular Surgery -ULSS 15 Alta Padovana)
FUNNEL TECHNIQUE, J ENDOVASC THER 2006;13:775–778- Case Report-Funnel Techniq...Salvatore Ronsivalle
FUNNEL TECHNIQUE: A WAY OUT IN ABDOMINAL AORTIC ANEURYSM WITH ECTATIC PROXIMAL NECK.
TECNICA FUNNEL: UNA SOLUZIONE ALTERNATIVA IN ANEURISMA DELL'AORTA ABDOMINALE CON COLLETTO PROSSIMALE ECTASICO.
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
J ENDOVASC THER 2012;19:128–130-Letters to he Editors-Type II Endoleak: From Treatment of a Complication to Prevention
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
Our project, our experience and our results at December 31 st 2013
Il nostro progetto, la nostra esperienza ed i nostri risultati aggiornati al 31.12.2013
(Angiologia-Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Angiology- Vascular Surgery -ULSS 15 Alta Padovana)
Gestione Multidisciplinare Integrata In Un Caso Complesso Di Piede DiabeticoSalvatore Ronsivalle
MULTISCIPLINARY MANAGEMENT OF A DIABETIC FOOT COMPLEX CASE-
GESTIONE MULTIDISCIPLINATA INTEGRATA IN UN CASO COMPLESSO DI PIEDE DIABETICO
(Angiologia-Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Angiology- Vascular Surgery -ULSS 15 Alta Padovana)
Ann Vasc Surg 2012; 26: 141-148-Selected technique- Funnel Technique for EVAR: ‘‘A Way Out’’ for Abdominal Aortic Aneurisms With Ectatic Proximal Necks
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
BRACHIO-FEMORAL LOOP AND CABLE TECHNIQUE FOR EVAR: a way out which allows the device to advance with ease, consenting a more
precise releasing of the endograft main body and positioning of the prosthetic
contralateral leg
ACCESSO BRACHIO FEMORALE E TECNICA DELLA FUNIVIA: soluzione che permette all'introduttore di avanzare facilmente e consente un rilascio più preciso del corpo principale dell'endoprotesi ed il posizionamento della gambetta controlaterale
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
Our project, our experience and our results at December 31 st 2013
Il nostro progetto, la nostra esperienza ed i nostri risultati aggiornati al 31.12.2013
(Angiologia-Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Angiology- Vascular Surgery -ULSS 15 Alta Padovana)
J ENDOVASC THER 2010;17:517–524-Clinical Investigation- Aneurysm Sac ‘‘Thrombization’’ and Stabilization
in EVAR: A Technique to Reduce the Risk of Type II Endoleak
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
MULTIDISCIPLINARY MANAGEMENT IN A COMPLEX CASE OF A BILATERAL TIBIAL ARTERY ANEURYSMS
GESTIONE MULTIDISCIPLINARE IN UN CASO COMPLESSO DI ANEURISMI TIBIALI BILATERALE - MARZO 2009
(Angiologia-Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Angiology- Vascular Surgery -ULSS 15 Alta Padovana)
A view of prevention: congress presentation at Società Italiana di Chirurgia Vascolare Milano 2009
Uno sguardo alla prevenzione: presentazione al congresso della Società Italiana di Chirurgia Vascolare Milano nel 2009
(Angiologia-Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Angiology- Vascular Surgery -ULSS 15 Alta Padovana)
ECHOCOLORDOPPLER IN CAROTID SURGERY
ECOCOLORDOPPLER PER LA CHIRURGIA CAROTIDEA
MINERVA CARDIOANGIOLOGICA NOVEMBRE 2000
(Angiologia-Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Angiology- Vascular Surgery -ULSS 15 Alta Padovana)
PRESENTAZIONE AL CONGRESSO DI FIRENZE 2010: DIECI ANNI DI FOLLOW UP CON ECOCO...Salvatore Ronsivalle
CONGRESS PRESENTATION IN FLORENCE EVAR 2000-2010 TEN YEAR FOLLOW UP WITH ECHOCOLORDOPPLER
PRESENTAZIONE AL CONGRESSO DI FIRENZE 2000-2010: DIECI ANNI DI FOLLOW UP CON ECOCOLORDOPPLER
(Angiologia-Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Angiology- Vascular Surgery -ULSS 15 Alta Padovana)
TYPE II ENDOLEAK: FROM TREATMENT OF COMPLICATION TO PREVENTIONSalvatore Ronsivalle
Congress presentation in 10°S.Paulo 2010 Vascular Surgery Meeting
Presentazione al 10 congresso di Chirurgia Vascolare di S.Paulo 2010
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
Centralization of flow in aortic dissectionIvo Petrov
New concept of totally endovascular treatment of complex cases of type A and B aortic dissection.
Modern minimally invasive approach to treat aortic dissection.
Congress presentation in S.PAULO 2010
DOES ANEURYSM SAC STABILIZATION DURING EVAR REDUCE THE INCIDENCE OF ENDOLEAKS?
Presentazione al congresso di S.Paulo 2010
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
ALISEO Treatment Of Iatrogenic Artery Pseudoaneurysm By Ultrasound Guided Fib...Salvatore Ronsivalle
Treatment Of Iatrogenic Artery Pseudoaneurysm By Ultrasound Guided Fibrin Glue Injection
Trattamento dello pseudoaneurisma iatrogeno mediante iniezione coguidata di colla di fibrina-
XXXIII° Congresso Nazionale della Società Italiana di Cardiologia Invasiva Porto Antico di Genova, Centro Congressi-3 ottobre 2012 Treatment of iatrogenic artery pseudoaneurysm by ultrasound guided fibrin glue injection: a single center experience Francesca Faresin; Francesca Franz; Marco Zennaro; Enrico Favaretto; Luigi Pedon; Salvatore Ronsivalle; Division of Vascular Surgery,Division of Cardiology, Cittadella Hospital, Padua, Italy-
(Angiologia-Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Angiology- Vascular Surgery -ULSS 15 Alta Padovana)
PERIPHERAL ARTERIOPATY AND DIABETES: EPIDEMIOLOGY, DIAGNOSIS AND THERAPEUTIC PATH
ARTERIOPATIA PERIFERICA E DIABETE: EPIDEMIOLOGIA, EZIOPATOGENESI, DIAGNOSI E PERCORSO TERAPEUTICO
(Angiologia-Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Angiology-Vascular Surgery-ULSS 15 Alta Padovana)
ROUTINE USE OF CAROTID SHUNT
USO ROUTINARIO DELLO SHUNT CAROTIDEO
MINERVA CARDIOANGIOLOGICA NOVEMBRE 2000
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(Angiology- Vascular Surgery -ULSS 15 Alta Padovana)
GIUV PALERMO 1999-ECOCOLORDOPPLER PER LA CHIRURGIA CAROTIDEASalvatore Ronsivalle
ECHOCOLORDOPPLER IN CAROTID SURGERY
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(Angiologia-Chirurgia Vascolare-ULSS 15 Alta Padovana)
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Congress presentation in Cuneo 2009 about INTERNIST IN VASCULAR SURGERY
Presentazione al congresso di Cuneo 2009: L'INTERNISTA IN CHIRURGIA VASCOLARE
(Angiologia-Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Angiology- Vascular Surgery -ULSS 15 Alta Padovana)
CHIMNEY TECHNIQUE IN ABDOMINAL AORTIC ANEURYSM WITH RENAL ARTERIES INVOLVEMENT
TECNICA CHIMNEY IN ANEURISMA DELL’AORTA ADDOMINALE CON COINVOLGIMENTO DELLE ARTERIE RENALI
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Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
1. MODULAR EXTENSION INTO
EXTERNAL ILIAC ARTERY
+
HYPOGASTRIC ARTERY
EMBOLIZATION
PHOENIX 2005–FIRST OFFICIAL PRESENTATION AT
INTERNATIONAL CONGRESS XVIII
2. Department of Cardiovascular DiseaseDepartment of Cardiovascular Disease
Civic Hospital, Cittadella (PD), ItalyCivic Hospital, Cittadella (PD), Italy
S Ronsivalle, F Faresin, F Pettenuzzo, M Riggi, R Lipari, L PedonS Ronsivalle, F Faresin, F Pettenuzzo, M Riggi, R Lipari, L Pedon
M. ZanchettaM. Zanchetta
XVIII International CongressXVIII International Congress
Endovascular InterventionEndovascular Intervention
Phoenix Feb 16 2005
Preventive treatment of type IIPreventive treatment of type II
endoleak using fibrin glue in patientsendoleak using fibrin glue in patients
undergoing endovascular treatmentundergoing endovascular treatment
for abdominal aortic aneurysmsfor abdominal aortic aneurysms
3. MODULAR EXTENSION INTO
EXTERNAL ILIAC ARTERY
+
HYPOGASTRIC ARTERY
EMBOLIZATION
PHOENIX 2006 – PRESENTATION AT INTERNATIONAL CONGRESS XIX
4. M. ZanchettaM. Zanchetta
Dipartimento di Malattie CardiovascolariDipartimento di Malattie Cardiovascolari
Ospedale Civile Cittadella (PD)Ospedale Civile Cittadella (PD)
1919thth
INTERNATIONAL CONGRESSINTERNATIONAL CONGRESS
ENDOVASCULAR INTERVENTIONSENDOVASCULAR INTERVENTIONS
Phoenix February 15 2006
Preventive treatment of type II endoleakPreventive treatment of type II endoleak
by using the fibrin glue at the time ofby using the fibrin glue at the time of
endografting: two years’ experienceendografting: two years’ experience
5. Background:Background:
Management of type II endoleakManagement of type II endoleak
Preoperative coil embolization (IMA, LA)Preoperative coil embolization (IMA, LA)
Intriguing thrombogenic sponge at theIntriguing thrombogenic sponge at the
time of aortomonoiliac endograftingtime of aortomonoiliac endografting
Embotherapy: - transarterial (vascular coils)Embotherapy: - transarterial (vascular coils)
- translumbar (liquid embolic- translumbar (liquid embolic
agent)agent)
Laparoscopic retroperitoneal branch ligationLaparoscopic retroperitoneal branch ligation
Conservative or surgical approachesConservative or surgical approaches
Choke E. J Cardiovasc Surg 2004;45:349-66Choke E. J Cardiovasc Surg 2004;45:349-66
6. Aim of the studyAim of the study
To report the two years’ experience of theTo report the two years’ experience of the
intraoperative fibrin glue ( Tissucolintraoperative fibrin glue ( Tissucol®®
)) aneurysmaneurysm
sac embolization in order to primarily preventsac embolization in order to primarily prevent
reperfusion type II endoleakreperfusion type II endoleak
TTo describe the technical details and mid-termo describe the technical details and mid-term
clinical results of this new techniqueclinical results of this new technique
7. Baseline characteristics of patientsBaseline characteristics of patients
(June 2003 - December 2005)(June 2003 - December 2005)
Characteristic N° = 84 patients
■ Male sex (N°, %) 94%
■ Age (yr) 73.8 ± 7.8
■ Body-mass index 26.6 ± 4.1
■ IMA (N°) 10
■ LA per patient (paired) 1-3
■ Comorbidity
- Diabetes mellitus 9.6 %
- Tabacco use 55.1 %
- Hypertension 54.5 %
- Hyperlipidemia 52.6 %
- Carotid artery disease 15.2 %
- Cardiac disease 46.6 %
- Renal disease 8.4 %
- Pulmonary disease 27.7 %
11. Target side-branchTarget side-branch
occlusion monitoringocclusion monitoring
Angiography (OEC 9800, GE Healthcare, MI, FL)
IVUS (AcuNav, Siemens, Mountain View, CA)
to demonstrate
1. pre-fibrin glue injecton patency and direction of
flow into the aneurysm sac
2. post-fibrin glue injection embolization of aneurysm
sac and thrombosis of type II endoleak
12. Complex type II leakComplex type II leak Lacking outflow vesselsLacking outflow vessels
Direct angiographic monitoring ofDirect angiographic monitoring of
aneurysm sac embolizationaneurysm sac embolization
Angiography of aneurysm sacAngiography of aneurysm sac
Pre-FG injection Post-FG injection
13. Indirect ultrasound monitoring ofIndirect ultrasound monitoring of
aneurysm sac embolizationaneurysm sac embolization
IVUS of aneurysm sacIVUS of aneurysm sac
Pre-FG injection Post-FG injectionBaseline IVUS
Empty
aneurysm sac
Intrasac flow velocity
from inflow vessels
Type II endoleak
thrombosis
14. Two year follow-up
At discharge, 3, 6, 12, 18, 24 months and annually
thereafter:
■ Clinical examination
■ Serum creatinine
■ Abdominal x-ray
■ CT-scan
■ Echo-color Doppler
N°patients
Mean follow-up:
14.4 ± 8.7 months
0
20
40
60
80
100
0 3 6 12 18 24
Months
18. Type No (%) Cause of perigraft flow
■ Type I 1 (1.2%) Inadequate proximal seal
■ Type II 2 (2.4%) Flow from lumbar arteries
■ Type III 0 -
■ Type IV 0 -
Reporting standards for endovascularstandards for endovascular
AAA repair endoleakAAA repair endoleak
Chaikof EL. J Vasc Surg 2005;35:1048-60
20. 20
30
40
50
60
70
0 3 6 9 12 15 18 21 24
AAA size and change in diameter
by interval
SERIAL CHANGE OF TRANSVERSE ANEUSYSM DIAMETER
Time after stent grafting (months)
Aneurysmdiameter(mm)
No. of patients 84 76 65 50 44 31
p=0.051 p=0.001
REMODELING INDEX
0.92 0.97 0.98 0.97 0.98
21. Study conclusionsStudy conclusions
Intraoperative fibrin glue aortic aneurysm sac
embolization appears to be a suitable procedure
This “ad hoc” preventive strategy provides easy,
effective and durable aortic side-branch occlusion
Our two year follow-up confirms thrombosis of
fibrin glue-treated aneurysm sacs in 97.6% of cases
This approach may be considered a strategy for
routine preventive treatment of type II endoleaks
22. Fibrin glue injection technique toFibrin glue injection technique to
induce aneurysm sac thrombosisinduce aneurysm sac thrombosis
■ The access to the excluded aortic sac was obtained by leaving
the guidewire between the prosthesis and the native aorta during
the endovascular procedure
■ A 23 mm long 5F brite tip introducer sheath was advanced over
the guidewire and 5 ml of fibrin glue (Tissucol) was injected by
means of dedicated double-lumen catheter (Duplocat®
)
Zanchetta M . J Endovasc Ther 2005;12:579-82Zanchetta M . J Endovasc Ther 2005;12:579-82
Editor's Notes
I am going to talk about our experience with the intraoperative use of fibrin glue in patients undergoing endovascular abdominal aneurysm repair in order to prevent type II endoleak
I would like to talk about our two years experience on the preventive treatment of type II endoleaks by using the fibrin glue at the time of endografting.
Untill now, the management of type II endoleak still remains contentious, varying from early or late percutaneous interventions to conservative or surgical approaches.
Our pourpose is to report the two year experience of intraoperatve Fibrin Glue AAA sac embolization in order to prevent reperfusion type II endoleak and to describe the technical details and mid-term clinical results of this new technique.
Between June 2003 and December 2005, 98 consecutive patients, 70% males, mean age 68, underwent elective intraoperatve Fibrin Glue AAA sac embolization. On the preoperative angiogram, there were 10 patent inferior mesenteric arteries, and the number of paired lumbar arteries ranged from 3 to 6 vessels per patient.
Before endovascular procedure, all patients underwent angiographic and contrast-enhanced computed tomographic studies in order to delineate aneurysm morphologic characteristics and to plan intervention.
There were were forty two bifurcated Talent and forty one bifurcated AneuRx devices used in our series. Moreover, fifteen iliac extensions were deployed by using the bell-button technique.
Our fibrin glue injection technique to induce aneurysm sac thrombosis has been recently described in the JET. Briefly, the access to the excluded aortic sac was obtained by leaving the guidewire between the prosthesis and the native aorta during the endovascular procedure. After bifurcated stent-graft implantation, a 23 mm long 5F brite tip introducer sheath was advanced over the guidewire and 5 ml of fibrin glue was injected by means of dedicated double-lumen catheter.
Target side-branches occlusion monitoring was performed by means of angiography and, in selected cases, by means of IVUS in order to demonstrate pre-FG injecton patency as well as direction of flow into the aneurysm sac, and post-FG injection thrombosis of aneurysm sac as well as no type II endoleak.
This is an example of direct angiographic monitoring of aneurysm sac embolization showing a pre-FG injection complex type II leak, and a post-FG injection absent of outflow vessels.
This is an example of indirect IVUS monitoring of aneurysm sac embolization showing a baseline empty aneurysm sac, a pre-FG injection intrasac flow velocity from inflow vessels , and a post-FG injection type II endoleak thrombosis.
At the follow-up, clinical examination, serum creatinine control, abdonimal x-ray, CT-scan and Echo-color Duppler US were performed at the discharge and scheduled at 3, 6, 12 months and annually thereafter. The mean follow-up was 10.5 months.
According to reporting standards for endovascular AAA repair complications, in our series we encountered 2 deployment-related and 3 systemic complications, and only 1 FG aneurysm sac embolization failure.
Intraoperative fibrin glue aortic aneurysm sac embolization appears to be a suitable procedure. This preventive “ad hoc” strategy provides easy aortic side branch occlusion. Two years follow-up confirms thrombosis of fibrin glue-treated aneurysm sacs in 99% of our cases. This approach may be a strategy for routine
treatment of type II endoleaks.
Our fibrin glue injection technique to induce aneurysm sac thrombosis has been recently described in the JET. Briefly, the access to the excluded aortic sac was obtained by leaving the guidewire between the prosthesis and the native aorta during the endovascular procedure. After bifurcated stent-graft implantation, a 23 mm long 5F brite tip introducer sheath was advanced over the guidewire and 5 ml of fibrin glue was injected by means of dedicated double-lumen catheter.