Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3609_Библиотеки_им_академика_М_И_Перельмана

Overall, the goal of VAA treatment, whether endovascular, laparoscopic, or open surgical, is to prevent aneurysm (or pseudoaneurysm) rupture while maintaining adequate end­organ perfusion. Endovascular approaches to VAA repair are generally preferred over their laparoscopic and open sur­gical counterparts, but determination of endovascular candi­dacy should be considerate of inow vasculature, outow vasculature, branch vessels arising from the aneurysm, as well as morphology of the aneurysm. Depending on which organ is involved, the etiology of the aneurysm, and indi­vidualized patient anatomies, various endovascular approaches can be considered, such as coil embolization, liquid embolization, and vascular plugs. For more challeng­ing vascular anatomy, balloon- or stent-assisted coiling can be performed. Various types of stents can be used to exclude aneurysms including stent grafts and ow-diverting stents. In order to overcome some of the technical challenges from a transfemoral approach due to some of the downward angu­lations from the visceral vasculature, one can consider a torqueable guidesheath from a transfemoral approach or radial, brachial, or even axillary access. For excessive tortu­osity, as seen in the splenic bed, one can also consider using exible neuro distal access catheters. General anesthesia may be needed to minimize patient movement and obtain high- quality imaging, which is often necessary to ensure clinical and technical success with complex endovascular repairs.