TÍnh kích cỡ và lên kế hoạch cho đặt stent graft ĐMC bụng

Aortic Aneurysm Morphology Imaging: A Key to Success Planning for EVAR Boonprasit Kritpracha, MD Department of Surgery, Prince of Songkla University A Fundamental Shift Open Surgery Direct access Direct observation Stable technology Endovascular Remote control Indirect imaging Evolving devices A Fundamental Shift Vascular Surgery Exposure before 1990 Vascular Surgery Exposure after 1990 important zones Neck Proximal anchoring zone Iliac arteries Distal “seal” zone Imaging is Critical AAA Endograft Planning Patient selection Device selection – type, ? Extensions Additional procedures – IIA coil embolization Bell-bottom procedure Surveillance Endoleak,   aneurysm size Morphological changes – aorta, device Device failure – migration, wire fracture, etc Preoperative imaging studies CT scan Arteriogram Magnetic Resonance Arteriography Intravascular Ultrasound Computerized Image Post-processing & 3-D Imaging AAA Endograft Planning CT scan + Arteriogram Diameter Length Details: thrombus Details: tortuosity calcifications branches Axial CT Scan Problems • Slice Thickness • Axial slice artifact • Length error • Measurement process Slice Thickness 10 mm Slice Thickness mm Axial 28 mm 33 mm 27 mm 23 mm Axial 23 mm 27 mm DR Reformatted Diameters of Iliac Arteries 32 mm 20 mm Also need reformatted CT slices!! Axial CT Scan Problems • Axial slice artifact • Length error • Measurement process Length measured by axial CT slices x thickness 138 mm 216 mm Axial CT Scan Problems • Axial slice artifact • Length error • Measurement process Diameter Measurements Measuring on small Axial Slices contributes to exaggerated errors Clinical Evidence % Error: 10%+ Error: >+/- 2.5mm Arteriography Problems • Magnification error • Parallax • Thrombus effect • Catheter position error • Foreshortening • Projection error • Contrast cover-up Parallax & Magnification Important during procedure - up to cm Can cause endograft failure Need consistent system of control Thrombus effect AAA diameter is 61 mm Thrombus effect Perception of angle depends on projection 78 AP o Lateral Arteriography length measurement artifact AAA Endograft Planning CT scan + 3-D reconstruction Diameter Length Cases ... Surgery Exposure after 1990 important zones Neck Proximal anchoring zone Iliac arteries Distal “seal” zone Imaging is Critical AAA Endograft Planning Patient selection Device selection – type,... cover-up Parallax & Magnification Important during procedure - up to cm Can cause endograft failure Need consistent system of control Thrombus effect AAA diameter is 61 mm Thrombus effect Perception... Arteriography Intravascular Ultrasound Computerized Image Post-processing & 3-D Imaging AAA Endograft Planning CT scan + Arteriogram Diameter Length Details: thrombus Details: tortuosity calcifications