Rutherford's 111: Aortoiliac Disease: Endovascular Treatment скачать в хорошем качестве

Rutherford's 111: Aortoiliac Disease: Endovascular Treatment

#AIOD #AortoiliacDisease #EndovascularTreatment #VascularSurgery #Stenting #Angioplasty #StentGraft #RutherfordsVascular #Claudication #CLTI #DrGregoryWeir Based on Rutherford's Vascular Surgery textbook, this video deep dives into the endovascular treatment of Aortoiliac Occlusive Disease (AIOD). Historically treated with open surgery, pioneers in balloon angioplasty and stent technology shifted practice towards less invasive methods. Endovascular procedures are now usually the first line for most AIOD patients, even some complex cases, due to technological advancements and improved outcomes. Indications for endovascular treatment include lifestyle-limiting claudication, critical limb ischemia (rest pain or tissue loss), vasculogenic impotence, atheroembolization, and improving inflow for downstream bypasses. Evaluation involves history, physical exam, non-invasive tests (like ABI, pressure gradients), and detailed imaging (CTA, MRA, Duplex) to assess blockage location, length, and crucial factors like calcification and common femoral artery (CFA) disease. The TAS classification (TAS A/B vs C/D) helps guide treatment complexity. While there are no absolute contraindications, relative ones include severe calcification or a hostile abdomen. Techniques involve gaining arterial access, crossing the blockage using wires and catheters, and confirming flow restriction with pressure measurements. Treatment typically involves angioplasty and stenting. Different stent types (balloon-expandable, self-expanding, covered/stent grafts) are chosen based on lesion characteristics. Stent grafts show better patency for complex (TAS C/D) lesions. Bifurcation lesions often require techniques like kissing balloons or stents. Significant CFA disease requires a hybrid approach, combining open CFA endarterectomy with iliac stenting, for durable results. Outcomes are generally good, especially for simpler lesions. Primary stenting offers better patency than angioplasty alone. Predictors of failure include severe external iliac artery disease, kidney problems, and untreated CFA disease. Complications can occur (access site issues, rupture, dissection, embolization). Post-procedure, essential lifelong care includes risk factor management, antiplatelet/statin therapy (potentially with rivaroxaban), and regular follow-up with clinical exam and Duplex ultrasound. Decision-making is guided by patient factors, anatomy, and complexity, often following algorithms like those in Rutherford's.