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Kamel

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Kamel

  1. 1. Kamel KECHABTIA Radiologie Vasculaire interventionnelle Chirurgie vasculaire Hôpital Pontoise ARMVOP sept 2013 Anévrismes iliaques AP-HP
  2. 2. AP-HP IMAGERIE • ANGIOSCANNER: • TECHNIQUE • INDICATION • CONTRE INDICATION • FUSION D’IMAGE
  3. 3. AP-HP Imagerie pré interventionnelle US Echo de contraste Angio SCANNER Angio IRM
  4. 4. AP-HP Salle de RI
  5. 5. AP-HPBILAN TDM D’AAA • DIAMETRE ANTERO POST • COLLET • ARTERES VISCERALES (RENALES,MESENTERIQUES,LOMBAI ES • AXES ILIAQUES • AORTE THORACIQUE AVEC SYNCHRONISATION ECG ET TSA
  6. 6. AP-HP Imagerie Pré RI Collet proximal Collet disatal
  7. 7. AP-HP
  8. 8. AP-HP Des nouvelles techniques qui exigent plus de sécurité (outils de guidage) et plus de précision Des temps d’acquisition plus rapide Une qualité d’image accrue Une gestion de la dose efficace (médecin, patient, protocole adapté, …) Des systèmes évolutifs Confort de travail plus important (fusion, rapidité, interface, ergonomie, …)
  9. 9. AP-HPImagerie 3D perinterventionnelle
  10. 10. AP-HP ANGIO IRM • ALTERNATIVE EN CAS DE CONTRE INDICATION IODE • DISPONIBILTÉ • COMPATIBILITÉ ENDOPROTHES AORTIQUES
  11. 11. AP-HP SURVEILLANCE • DELAIS • REPRODUCTIBILITÉ DES RESULTAS • FUITES ET TYPES
  12. 12. AP-HP CONCLUSION • IMAGERIE PRÉ INTERVENTIONNELLE ET EXPERTISE VASCULAIRE
  13. 13. AP-HP
  14. 14. AP-HP Anevrysme aorto iliaq • Mr HL 79 ans • AAA 87 mm,IPD 35 mm • FR + • HBP
  15. 15. AP-HP EMBOLISATION PLUG II
  16. 16. AP-HP Andurant MEDTRONIK
  17. 17. AP-HP
  18. 18. AP-HP
  19. 19. AP-HP Anévrysme IP • Mr G 75 ans • Triple pontage • AOMI • Anevrysme IPD 54 mm
  20. 20. AP-HP Traitement combiné endoprothese et embolisation
  21. 21. AP-HP TRAITEMENT DES ANEVRYSMES
  22. 22. AP-HP
  23. 23. AP-HP • Mr B A 66 ans • Opéré 2006 AAA /Aorto Bi Iliaq • Anévrysme IPD 34-36mm • IPG 16 mm • Traitement : - Chirurgie ? - Endovasculaire ?
  24. 24. AP-HP Angio-scanner
  25. 25. AP-HP
  26. 26. AP-HP
  27. 27. AP-HP Angioseal 8F
  28. 28. AP-HP Conclusion • Selection précise de l’anatomie • Évaluation du risque chirurgical • Suivie en imagerie à long terme
  29. 29. AP-HP Questions ouvertes …. • Imagerie: – Volumétrie du sac – Diagnostic de fuite et charactérisation (echo contraste …) • Stratégie thérapeutique – Traiter plus tot ? – Ou arreter les indications EVAR – Y a t il un age limite (85 ans ? 90 ans ….)
  30. 30. AP-HP Résultats • Evolution des matériels – Tissu de converture – Stent de support (rigidité/souplesse) – Calibre d’introduction

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