Interventions aortoiliac by mohamed omar

Interventions for peripheral ischemia: Aorto-iliac segment : 

Interventions for peripheral ischemia: Aorto-iliac segment Mr.Mohamed Omar Elfarok , M.Sc, FRCSENG,FRCSED How to do it, step by step techniques, pitfalls

Technical Elements : 

Technical Elements Front wall stick. Pulsatile blood flow before wire advancement. Wire exits needle without resistance. Use of fluoroscopic guidance.

Landmarks : 

Landmarks Goal is access in common femoral art. Medial inferior aspect of femoral head. Point of maximal pulse in > 90%. Confirm with fluoroscopy (if in doubt).

Considerations in PVD : 

Considerations in PVD Known aorto-iliac disease or prior AFB. Consider brachial or radial access. Review any previous angiography. Aorto-femoral graft may be used for access, avoid retrograde access into blind limb of iliac artery.

Considerations in PVD : 

Considerations in PVD Beware of brachiocephalic brachiocephalic disease in patients with occlusive aorto patients with occlusive aorto-iliac disease. Increased risk of stroke with catheter manipulation in tortuous subclavian vessels.

Beware of the Femoral AccessComplications !!! : 

Beware of the Femoral AccessComplications !!! Hematoma, bleeding, & transfusion. Pseudoaneurysm. AV fistula. Thrombosis. Infection.

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Ischemia, thrombosis, embolisation. Conservative therapy, heparization. Surgical repair, embolectomy. Percutaneous lysis, mechanical Thrombectomy, or balloon inflation to tack , up a dissection flap. Beware of the Brachial AccessComplications !!!

Local complications of FA access: 2-10% : 

Local complications of FA access: 2-10% Hematoma (1-10%) Pseudoaneurysm(1-6%) AV fistula (<1%) Retroperitoneal hemorrhage(0.2 –0.9%) Vessel laceration (<1%) (Free bleeding) Intimal dissection (Ante-or retro-grade) Acute vessel closure(<1%) (Thrombosis of small artery lumen) Thickening of the perivascular tissues Neural damage Infection Venous thrombosis Pericatheter clot Complication rate persistent over several decades

Why Access Still # 1 Cause of CathComplications -50 Years Later : 

Why Access Still # 1 Cause of CathComplications -50 Years Later Puncture technique Sheath management Adjunctive drug therapy Risk factors Age, gender, comorbidity Coexistent vascular disease Compression time Competent closure

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The treatment of iliac lesions with retrograde (ipsilateral) access Self expandable Stent

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The treatment of iliac lesions with retrograde (ipsilateral) access Cont. Self expandable Stent

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The treatment of iliac lesions with retrograde (ipsilateral) access Balloon expandable Stent

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The treatment of iliac lesions with retrograde (ipsilateral) access Cont. Balloon expandable Stent !!Protect the BeS when crossing the lesion with Guiding Cath.!!

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The treatment of iliac lesions with retrograde (ipsilateral) access Cont. Balloon expandable Stent

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Crossover technique for the treatment of iliac lesions without retrograde ipsilateral access Self expandable Stent

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Crossover technique for the treatment of iliac lesions without retrograde ipsilateral access Cont. Self expandable Stent

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Crossover technique for the treatment of iliac lesions without retrograde ipsilateral access Cont. Self expandable Stent

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Crossover technique for the treatment of iliac lesions without retrograde ipsilateral access Balloon expandable Stent

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Crossover technique for the treatment of iliac lesions without retrograde ipsilateral access Cont. Balloon expandable Stent

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Crossover technique for the treatment of iliac lesions without retrograde ipsilateral access Cont. Balloon expandable Stent !!Protect the BeS when crossing the lesion with Guiding Cath.!!

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Crossover technique for the treatment of iliac lesions without retrograde ipsilateral access Cont. Balloon expandable Stent

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Treatment of stenotic lesions ofaortoiliac bifurcation Self expandable Stent

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Treatment of stenotic lesions ofaortoiliac bifurcation Cont. Self expandable Stent

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Treatment of stenotic lesions ofaortoiliac bifurcation Balloon expandable Stent

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Treatment of stenotic lesions of aortoiliac bifurcation Cont. Balloon expandable Stent !!Protect the BeS when crossing the lesion with Guiding Cath.!!

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Treatment of aort-ilio-femoro-popliteal lesions by humeral route

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Treatment of aort-ilio-femoro-popliteal lesions by humeral route Cont.

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Treatment of aort-ilio-femoro-popliteal lesions by humeral route Cont.