0830_Garg.pdf

1、Division of Vascular and Endovascular SurgeryEndoleak Management:When and How to InterveneKaran Garg,MDAssociate Professor of SurgeryDivision of Vascular Surgery New York University Langone Medical Center New York,NYDivision of Vascular and Endovascular SurgeryDisclosures Cook,Shockwave,Gore consult

2、ant/speaker/clinical trials None relevant to this talk!Division of Vascular and Endovascular SurgeryEVAR Minimally invasive Favorable outcomes BUT Endoleaks!Can require interventionsDivision of Vascular and Endovascular SurgeryType I Endoleak Attachment Site FlowType I Endoleak is related to an inco

3、mpetent seal at one or more of the graft attachment sites and thus represent a direct communication of the aneurysm sac to aortic pressures.Division of Vascular and Endovascular SurgeryType II Endoleak Branch FlowType II Endoleak represents the maintenance of liquid blood in the sac based on tributa

4、ry flow with differential back pressures in two or more tributaries allowing continued flow across the aneurysm.As with all collateral circuits,the pulse pressure and mean pressure can be quite variable.It does not represent a direct communication of the AAA sac to the aortic pressure and is general

5、ly not considered to be related to the graft.Division of Vascular and Endovascular SurgeryType III Endoleak Graft Defect or Modular Disconnection Type III Endoleak represent incompetence in the body of the graft as a result of perforation and/or modular disjunction.This represents a direct communica

6、tion of the aneurysm sac to the aortic pressure and is considered“graft related”.Division of Vascular and Endovascular SurgeryType IV Endoleak Fabric“Porosity”Type IV Endoleak describe a phenomenon where contrast can be seen to generally emanate from the graft and is felt to be a result of porosity