Interventional Management of Complications after EVAR with the Aid of CEUS - SD

Patient Monitoring and Initial Measurements

We have already spoken about injection of free green glue.

I just want to show you how it looks.

We do this by monitoring. If you look at this rhythm, starting from the year 2005, this patient with a rhythm about 4.7 to 2.4 0.2 centimeter without the sand graft.

Later, the A rhythm was rising about 5.2 to 4.4 centimeter.

We see a similar landmark for measurements.

Treatment with Stent Graft

We decide to make a treatment of patient not ENT graft.

We see here the was five, no we have got the ENT graft.

Inside we see the perfusion of the stand graft.

We see the diameter was four 5.7 to 4.5 centimeter and four years later there was rising of the diameter to 6.8 centimeters due to the fact that this patient has got an endo leak.

Detection of Endoleak

Starting with the gray scale, we couldn't see any ole.

Then we use the step by step technique.

We see here flow inside of the stand graft of we see a little bit will flow here but could also be a pulsation artifact.

And the next step we inject contrast.

You see the perfusion of the stent graft. That was fine.

We wait a little bit so we could exclude and type three end leak.

Then the first bubbles arrived here a couple of seconds later there.

The first bubbles arrived here.

You see it there and if you wait, you see that the complete aneurysm is nearly filled with contrast.

So it's a huge end leak.

Therefore we are also seen as in the CT ex simulation, there's the end leak in the odd aneurysm sac.

Treatment of Endoleak

What we have done, we use a needle and puncture the endo leak directly.

We have done the examination just before the examination so we know directly where is the feeding vessel.

We bring these needle as close as possible to the endo leak.

Then we monitor if we have really placed the needle correctly.

So we inject over the puncture needle ultrasound agents.

So we see it that's over the needle and we fill this aneurysm by contrast science, ultrasound By bubbles.

You can see really nice.

That was the PO correct position of the needle.

You are in the an aneurysm sac. No ization of contrast.

Major information. Do it again and see the contrast.

Inside you see complete filling the aneurysm with ultrasound agents with contrast bubbles here.

And this is the control.

Afterwards you'll see it's nearly complete closed.

It's a little bit air inside due to the fact that you have to do the puncture of this aneurysm.

Summary

We can do the summarize.

This clot technique is helpful if you have got an gro aneurysm.

This treatment is very easy and you can really good monitor it by contrast ultrasound.

But also we have to speak about that.

This is forever and off-label use of the application for this thrombin.

But we do often off-label application.

And this patient or this patient, these are very helpful for our patient.

Thank you much for your attention.