Rutherford's 102: Brachiocephalic Artery Disease: Endovascular Management скачать в хорошем качестве

Rutherford's 102: Brachiocephalic Artery Disease: Endovascular Management

#BrachiocephalicArteryDisease #VascularSurgery #EndovascularTherapy #StrokePrevention #Atherosclerosis #SuprAorticTrunks #CTA #MRA #Stenting #Patency #Rutherfords This video discusses brachiocephalic artery disease (BAD), affecting the innominate, left common carotid, and left subclavian arteries branching from the aorta. Atherosclerosis is the main cause, often seen with carotid or coronary artery disease. Other causes include inflammation (Takayasu arteritis), radiation injury, aneurysms, or dissections. The left subclavian artery is most frequently affected. BAD can reduce blood flow to the arms or brain, potentially causing stroke. Diagnosis involves physical exam and imaging. CTA and MRA are the preferred "workhorses" for detailed visualization and planning, especially for proximal lesions, providing axial views and 3D models. Ultrasound is a good starting point but less detailed for planning interventions. Conventional arteriography is now typically used as a real-time map during interventions rather than primarily for diagnosis. Understanding anatomical variations, like the bovine arch, is crucial for planning. Historically, BAD treatment involved high-risk open chest surgery, followed by extra-anatomic bypasses which were less invasive but potentially less durable. Endovascular techniques, primarily stenting, have revolutionized treatment, offering lower immediate risks, faster recovery, and more options. Balloon angioplasty alone had high restenosis rates. Primary stenting is now the main approach, using balloon-expandable or self-expanding stents depending on the lesion and location. Covered stents are useful for specific cases like aneurysms but generally avoided in areas of external compression. Medical therapy, including dual antiplatelets like aspirin and clopidogrel, is vital, often guided by cerebrovascular disease guidelines. Heparin is used during the procedure. Access can be femoral, brachial, or radial, with radial access gaining popularity due to lower site complications. Careful planning is essential to navigate complex anatomy and avoid complications like cerebral embolization, a major concern. Protecting branches like the vertebral artery during subclavian intervention is paramount. Technical success rates for stenting are high (94-100% for stenosis), with low complication rates, though neurologic events can occur. While endovascular patency might be slightly lower long-term compared to open surgery, failed endo procedures can often be successfully rescued surgically. Long-term follow-up with duplex ultrasound is recommended due to restenosis risk. Treatment decisions are complex, weighing patient factors, anatomy, and lesion characteristics. Endovascular methods are a significant advancement, offering a less invasive first-line approach for many patients.