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Shu X, Li Z, Wang W, Li X, Wang W. Endovascular treatment of bilateral common iliac artery aneurysms using bifurcated-unibody stent grafts. Ann Vasc Surg 2014; 28:1790.e5-8. [PMID: 24561211 DOI: 10.1016/j.avsg.2014.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 01/13/2014] [Accepted: 02/08/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Endovascular treatment of bilateral common iliac artery aneurysms (CIAA) is a promising alternative to open surgical repair. However, endovascular treatment is challenging when the CIAAs have short proximal necks and internal iliac artery needs to be preserved. METHODS/RESULTS We report a case of a 62-year-old man who presented with bilateral CIAA with short proximal necks, with the right-side aneurysm extended into the internal iliac artery. The aneurysms were successfully excluded by using a bifurcated-unibody stent graft on the left with preservation of its internal iliac artery; a conventional tubular covered stent was used on the right with occlusion of its internal iliac artery. In addition, an aorta-bi-iliac artery stent was used to provide extended proximal landing zones for the iliac stents. CONCLUSIONS Endovascular repair using an iliac bifurcated-unibody stent graft can be a useful approach for the treatment of CIAAs. An aorta-bi-iliac endograft may also be needed to provide a reliable landing zone when the proximal neck of the iliac aneurysm is short.
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Affiliation(s)
- Xiaojun Shu
- Department of Interventional Radiology, 1st Hospital of Lanzhou University, No. 1, West Donggang Road, Lanzhou City, Gansu Province, China.
| | - Zhengfei Li
- Department of Interventional Radiology, 1st Hospital of Lanzhou University, No. 1, West Donggang Road, Lanzhou City, Gansu Province, China
| | - Weiping Wang
- Department of Interventional and Vascular Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Xiaoqiang Li
- Department of Vascular surgery, 2nd Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Wenhui Wang
- Department of Interventional Radiology, 1st Hospital of Lanzhou University, No. 1, West Donggang Road, Lanzhou City, Gansu Province, China
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A'Court J, Yiannoullou P, Pearce L, Hill J, Donnelly D, Murray D. Rectourethral fistula secondary to a bowel management system. Intensive Crit Care Nurs 2014; 30:226-30. [PMID: 24457039 DOI: 10.1016/j.iccn.2013.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 11/07/2013] [Accepted: 12/17/2013] [Indexed: 11/19/2022]
Abstract
A 67-year-old Caucasian male was admitted under the vascular team with critical lower limb ischaemia. Bypass surgery was performed and he was admitted to the intensive care unit post-operatively. The patient experienced a turbulent post-operative recovery complicated by pneumonia, poor respiratory wean and faecal incontinence. A bowel management system was inserted but after 18 days it was reported faecal matter was bypassing his catheter. A CT scan demonstrated an area of necrosis where the bowel management system had been sited which formed a rectourethral fistula. Bowel management systems are frequently used in intensive care unit settings where a high proportion of patients suffer from faecal incontinence. If used correctly they can reduce skin contamination, infection and maintain patient hygiene. However, appropriate assessment and investigations should be addressed before inserting such devices. This case report highlights serious adverse effects of these devices and describes the first documented case of these devices causing a rectourethral fistula.
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Affiliation(s)
- Jamie A'Court
- Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom.
| | - Petros Yiannoullou
- Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom
| | - Lyndsay Pearce
- Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom
| | - James Hill
- Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom
| | - David Donnelly
- Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom
| | - David Murray
- Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom
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Koike Y, Nishimura JI, Nishimaki H, Hase S, Moriya N, Oshima S, Fujikawa T, Sekine Y. Use of the Endurant Stent Graft System for Ruptured Infrarenal Aortic Aneurysms: Short-term Experience in Nine Patients. J Vasc Interv Radiol 2013; 24:1462-9. [DOI: 10.1016/j.jvir.2013.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 04/13/2013] [Accepted: 04/15/2013] [Indexed: 11/24/2022] Open
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Muradi A, Yamaguchi M, Okada T, Nomura Y, Idoguchi K, Ueshima E, Sakamoto N, Kawasaki R, Okita Y, Sugimoto K. Technical and outcome considerations of endovascular treatment for internal iliac artery aneurysms. Cardiovasc Intervent Radiol 2013; 37:348-54. [PMID: 23842685 DOI: 10.1007/s00270-013-0689-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 06/09/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE This study was designed to analyze the outcomes of endovascular treatment for internal iliac artery aneurysm (IIAA) at mid-term follow-up. METHODS We retrospectively analyzed 33 patients (28 males, mean age 77.4 years) who underwent endovascular treatment of 35 IIAAs (mean diameter 39.8 mm) from 2002 to 2012. We attempted to completely and selectively embolize all distal branches with permanent embolic materials, followed by proximal controls either by stent-graft placement (type 1) or coil embolization (type 2). RESULTS Procedural success rate was 97.1% (n = 34). Complete permanent distal branches embolization was achieved in 27 (79.4%), type 1 in 24 (70.6%), and type 2 in 10 (29.4%) cases. During mean follow-up period of 29.1 months (range, 1.2-92.8), no IIAA-related mortality and stent/stent-graft related complications occurred. Pelvic ischemia occurred and resolved in 8 (25%) patients. Among 32 cases followed by CT, the aneurysm diameter was stable in 18 (56.3%), shrank in 11 (34.4%), and enlarged in 3 (9.4%) cases. In 22 assessed by contrast-enhanced CT, secondary endoleak occurred in 3 (13.6%) cases and 2 required secondary interventions (2/32, 6.3%). Type 1 procedure tends to have better mid-term outcomes. Incomplete permanent distal branches embolization was associated with enlargement and secondary intervention (p = 0.007 and p = 0.042, respectively). The secondary intervention-free rate at 3 years in the complete and incomplete distal embolization group was 100 and 83.3%, respectively (p = 0.128). CONCLUSIONS Endovascular treatment for IIAA is feasible and safe. Complete permanent distal branches embolization is important to achieve satisfactory mid-term outcomes.
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Affiliation(s)
- Akhmadu Muradi
- Center for Endovascular Therapy, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan,
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55
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Chun JY, Mailli L, Abbasi MA, Belli AM, Gonsalves M, Munneke G, Ratnam L, Loftus IM, Morgan R. Embolization of the internal iliac artery before EVAR: is it effective? Is it safe? Which technique should be used? Cardiovasc Intervent Radiol 2013; 37:329-36. [PMID: 23771327 DOI: 10.1007/s00270-013-0659-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 05/11/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the clinical outcomes of internal iliac artery (IIA) embolization before endovascular aneurysm repair (EVAR). METHODS Between 2002 and 2011, 88 patients underwent IIA embolization prior to EVAR. Sixty-five patients underwent unilateral and 23 underwent bilateral IIA embolization. A total of 111 IIAs were embolized: 56 were embolized with coils, 41 with Amplatzer plugs, and 14 with a combination of embolic agents. The outcomes were assessed retrospectively by reviewing medical records and follow-up imaging. RESULTS IIA embolization was technically successful in 95.7% of cases. Type 2 endoleak from previously embolized IIAs was seen in 4 cases, and in 1 case this was significant necessitating re-intervention. Buttock claudication was reported in 38% of cases, whereas new onset erectile dysfunction occurred in 10% of cases. No severe ischemic complications, such as spinal cord ischaemia or buttock necrosis, were reported. Analysis comparing unilateral versus bilateral embolization, simultaneous versus sequential embolization, and the type of embolic material used showed no statistical significance. CONCLUSION IIA embolization is technically successful and effective in preventing significant type 2 endoleak in the majority of cases. It is a relatively safe procedure without major complications, but the incidence of buttock claudication and erectile dysfunction remain relatively high, and patients should be consented appropriately. There is no significant benefit for adopting a particular embolization technique, but there is a tendency towards reduced pelvic ischaemia with proximal embolization. Four cases of type II endoleak occurring after technically successful IIA embolization supports the school of thought that IIA should be embolized prior to coverage and extension of the distal landing zone.
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Affiliation(s)
- Joo-Young Chun
- Department of Radiology, St. George's Hospital, London, SW17 0QT, UK,
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56
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Nakai M, Sato M, Sato H, Sakaguchi H, Tanaka F, Ikoma A, Sanda H, Nakata K, Minamiguchi H, Kawai N, Sonomura T, Nishimura Y, Okamura Y. Midterm results of endovascular abdominal aortic aneurysm repair: comparison of instruction-for-use (IFU) cases and non-IFU cases. Jpn J Radiol 2013; 31:585-92. [DOI: 10.1007/s11604-013-0223-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 05/26/2013] [Indexed: 10/26/2022]
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57
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Wu IH, Chan CY, Chen YS, Huang SC, Wang SS, Chi NH. Crossover Chimney Technique to Preserve the Internal Iliac Artery in Abdominal Aortic Aneurysm With Common Iliac Artery Aneurysms. J Endovasc Ther 2013; 20:298-302. [DOI: 10.1583/13-4219r.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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58
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Clinical outcomes after internal iliac artery embolization prior to endovascular aortic aneurysm repair. Surg Today 2013; 44:472-7. [DOI: 10.1007/s00595-013-0572-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 01/16/2013] [Indexed: 10/27/2022]
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59
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Vourliotakis G, Mantas G, Katsargyris A, Aivatidi C, Kandounakis Y. Endovascular reconstruction of iliac artery bifurcation atherosclerotic disease with the kissing technique. Vascular 2013; 21:339-42. [PMID: 23493274 DOI: 10.1177/1708538113478748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2012] [Indexed: 11/16/2022]
Abstract
A 71-year-old male patient with severe left buttock and lower-extremity claudication due to iliac artery bifurcation stenoses was referred to our institution for endovascular treatment. A 'kissing' technique was used in order to dilate the proximal parts of both internal and external iliac arteries and avoid compromization of the internal iliac artery during proximal external iliac artery stenting. A balloon expandable stent was inserted via a left ipsilateral retrograde access to the narrowed origin of the left external iliacartery and a balloon catheter via a right contralateral access inside the origin of the left internal iliac artery. Simultaneous balloons inflation restored full patency of both vessels. Twelve months later the patient is doing well, free of buttock or lower-extremity claudication symptoms. For iliac artery bifurcation atherosclerotic disease, endovascular repair with the 'kissing' technique can achieve a complete bifurcation reconstruction offering significant clinical benefit in selected patients.
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Affiliation(s)
| | | | - Athanasios Katsargyris
- Vascular Division, 2nd Department of Propedeutic Surgery, LAIKO Hospital, Athens University Medical School, Athens, Greece
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60
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Igari K, Kudo T, Toyofuku T, Jibiki M, Inoue Y. Successful Endovascular Repair of Ruptured Isolated Bilateral Internal Iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2013; 45:218-9. [DOI: 10.1016/j.ejvs.2012.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 11/06/2012] [Indexed: 10/27/2022]
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Ullery BW, Wang GJ, Woo EY, Cheung AT, McGarvey ML, Carpenter JP, Fairman RM, Jackson BM. No Increased Risk of Spinal Cord Ischemia in Delayed AAA Repair Following Thoracic Aortic Surgery. Vasc Endovascular Surg 2013; 47:85-91. [DOI: 10.1177/1538574412474500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brant W. Ullery
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Grace J. Wang
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Edward Y. Woo
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Albert T. Cheung
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Michael L. McGarvey
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey P. Carpenter
- Division of Vascular and Endovascular Surgery, Department of Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Ronald M. Fairman
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin M. Jackson
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Stokmans RA, Willigendael EM, Teijink JAW, Ten Bosch JA, van Sambeek MRHM, Cuypers PWM. Challenging the evidence for pre-emptive coil embolisation of the internal iliac artery during endovascular aneurysm repair. Eur J Vasc Endovasc Surg 2013; 45:220-6. [PMID: 23305786 DOI: 10.1016/j.ejvs.2012.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 12/06/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES We retrospectively analysed the results of a strategy in which coverage of the internal iliac artery (IIA) during endovascular aneurysm repair (EVAR) was routinely performed without coil embolisation. METHODS From January 2010 until May 2012, 32 patients (96.9% men; mean age 73.0 years, range 52-89 years) underwent EVAR with stent grafts extended into the external iliac artery (EIA), all without prior coil embolisation. Aneurysm morphology was determined on preoperative computed tomography (CT) images. During follow-up, patients were interviewed about buttock claudication, and the occurrence of endoleaks and evolution of aneurysm diameter were recorded. RESULTS At baseline, the mid-common iliac artery (CIA) diameter was 33.5 ± 16.8 mm and seven patients presented with ruptured aneurysms. Mean follow-up was 14.3 ± 7.4 months. There were eight deaths, none related to IIA coverage. Buttock claudication occurred in seven (22.6%) patients, which persisted after 6 months in two cases of bilateral IIA coverage. No Type-I or -II endoleaks occurred related to IIA coverage. Aneurysm growth was not observed. CONCLUSION Endovascular treatment of aortoiliac and iliac aneurysm without pre-emptive coil embolisation of the IIA appears safe and effective. No IIA-related endoleaks or re-interventions occurred in our series. This approach saves operating time, contrast load and costs and may reduce complications. However, a larger population and longer follow-up is required to confirm our findings.
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Affiliation(s)
- R A Stokmans
- Department of Vascular Surgery, Catharina Hospital, Michelangelolaan 2, PO Box 1350, 5602 ZA Eindhoven, The Netherlands
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63
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Duran C, Naoum JJ, Smolock CJ, Bavare CS, Patel MS, Anaya-Ayala JE, Lumsden AB, Davies MG. A Longitudinal View of Improved Management Strategies and Outcomes After Iatrogenic Iliac Artery Rupture During Endovascular Aneurysm Repair. Ann Vasc Surg 2013; 27:1-7. [DOI: 10.1016/j.avsg.2012.04.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 04/09/2012] [Accepted: 04/24/2012] [Indexed: 11/30/2022]
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Mauri G, Poretti D, Pedicini V, Lanza E, Brambilla G. Endovascular treatment of an anastomotic iliac pseudoaneurysm after surgical aortic repair using a Cardiatis multilayer stent. Vascular 2012; 20:290-3. [PMID: 22983545 DOI: 10.1258/vasc.2011.cr0324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The Cardiatis multilayer stent (Cardiatis, Isnes, Belgium) is a cobalt, self-expandable bare stent made of two interconnected layers without any covering that allows a pressure decrease and thrombus formation into an aneurysmal sac, while improving laminar flow in the main artery and surrounding vital branches. We report a case of an anastomotic iliac pseudoaneurysm successfully treated with the deployment of a Cardiatis multilayer stent.
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Affiliation(s)
- Giovanni Mauri
- Università degli Studi di Milano, Facoltà di Medicina e Chirurgia, Scuola di Specializzazione in Radiodiagnostica, Via Festa del Perdono 7, 20122 Milano
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Rand T, Uberoi R, Cil B, Munneke G, Tsetis D. Quality improvement guidelines for imaging detection and treatment of endoleaks following endovascular aneurysm repair (EVAR). Cardiovasc Intervent Radiol 2012; 36:35-45. [PMID: 22833173 DOI: 10.1007/s00270-012-0439-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 06/18/2012] [Indexed: 10/28/2022]
Abstract
Major concerns after aortic aneurysm repair are caused by the presence of endoleaks, which are defined as persistent perigraft flow within the aortic aneurysm sac. Diagnosis of endoleaks can be performed with various imaging modalities, and indications for treatment are based on further subclassifications. Early detection and correct classification of endoleaks are crucial for planning patient management. The vast majority of endoleaks can be treated successfully by interventional means. Guidelines for Imaging Detection and Treatment of endoleaks are described in this article.
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Affiliation(s)
- T Rand
- Department of Radiology, General Hospital Hietzing, Wolkersbergenstr1, 1130, Vienna, Austria.
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66
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Naughton PA, Park MS, Kheirelseid EAH, O’Neill SM, Rodriguez HE, Morasch MD, Madhavan P, Eskandari MK. A comparative study of the bell-bottom technique vs hypogastric exclusion for the treatment of aneurysmal extension to the iliac bifurcation. J Vasc Surg 2012; 55:956-62. [PMID: 22226182 PMCID: PMC3319281 DOI: 10.1016/j.jvs.2011.10.121] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 10/19/2011] [Accepted: 10/26/2011] [Indexed: 12/01/2022]
Abstract
INTRODUCTION A significant proportion of patients undergoing endovascular aneurysm repair (EVAR) have common iliac artery aneurysms (CIAA). Aneurysmal involvement at the iliac bifurcation potentially undermines long-term durability. METHODS Patients with CIAA who underwent EVAR were identified in two teaching hospitals. Bell-bottom technique (BBT; iliac limb ≥20 mm) or internal iliac artery embolization and limb extension to the external iliac artery (IIE + EE) were used. Outcome between these two approaches was compared. RESULTS We identified 185 patients. Indication for EVAR included asymptomatic abdominal aortic aneurysm (AAA) in 157, symptomatic or ruptured aneurysm in 19, and CIAA in nine. Mean AAA diameter was 59 mm. Among 260 large CIAAs that were treated, BBT was used to treat 166 CIAA limbs, and 94 limbs underwent IIE + EE. Total reintervention rates were 11% for BBT (n = 19) and 19.1% for IIE + EE (n = 18; P = .149). Rates of reintervention for type Ib or III endoleak were 4% for BBT (n = 7) and 4% for IIE + EE (n = 4; P > .99). The difference in limb patency rates was not significant. The 30-day mortality rate was 1%. Median follow-up was 22 months. Complications did not differ significantly between the two groups; however, the combined incidence of perioperative complications and reinterventions was higher in the IIE + EE group (49% vs 22%; P = .002). CONCLUSIONS The combined incidence of perioperative complications and reinterventions is significantly higher with IIE + EE than with BBT; therefore, when feasible, BBT is desirable.
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Affiliation(s)
- Peter A. Naughton
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Vascular Surgery, St. James Hospital, Dublin, Ireland
| | - Michael S. Park
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - EAH Kheirelseid
- Department of Vascular Surgery, St. James Hospital, Dublin, Ireland
| | - Sean M. O’Neill
- Department of Vascular Surgery, St. James Hospital, Dublin, Ireland
| | - Heron E. Rodriguez
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mark D. Morasch
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Prakash Madhavan
- Department of Vascular Surgery, St. James Hospital, Dublin, Ireland
| | - Mark K. Eskandari
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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Pavlidis D, Hörmann M, Libicher M, Gawenda M, Brunkwall J. Buttock Claudication After Interventional Occlusion of the Hypogastric Artery—A Mid-Term Follow-Up. Vasc Endovascular Surg 2012; 46:236-41. [DOI: 10.1177/1538574411436329] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Interventional occlusion of the hypogastric artery (HA) can be used for endovascular aneurysm repair (EVAR) in the iliac arteries. Most frequent ischemic complication is buttock claudication (BC). Aim. To investigate the frequency and progression of BC after interventional occlusion of the HA prior to EVAR. Methods. A retrospective analysis was performed in patients with EVAR and occlusion of the HA between September 2004 and August 2010. Acute and persistent BC symptoms were assessed. Results. Fifty-four catheter occlusions of the HA were performed. In 10 cases, claudication could not be evaluated. During a mean follow-up of 17 months, 23 occlusions (52.3%) of the HA showed BC, in 52% symptoms were persistent. Of the 5 patients, 3 patients who underwent bilateral occlusion had BC and in 2 cases, persistent in the follow-up. Conclusion. Buttock claudication after occlusion of the HA prior to EVAR is a frequent complication, which often persists during follow-up. Alternatives that maintain pelvic perfusion should be considered.
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Affiliation(s)
- Daphne Pavlidis
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
| | - M. Hörmann
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
| | - M. Libicher
- Department of Radiology, Diakonie Clinic, Schwäbisch Hall, Germany
| | - M. Gawenda
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
| | - J. Brunkwall
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
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Kim H, Kwon TW, Cho YP, Moon KM. Report of a case of ischemic colitis with bilaterally patent internal iliac arteries after endovascular abdominal aneurysm repair. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 82:200-3. [PMID: 22403756 PMCID: PMC3294116 DOI: 10.4174/jkss.2012.82.3.200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 09/22/2011] [Accepted: 10/05/2011] [Indexed: 11/30/2022]
Abstract
During endovascular aneurysm repair (EVAR), interruption of the internal iliac arteries (IIAs) or the inferior mesenteric artery by stents or embolization is thought to cause colon ischemia. To minimize this risk, attempts have been made to preserve the IIAs using iliac branch devices or IIA revascularization. Here we present our experience of colon ischemia after EVAR in a patient with bilaterally patent IIAs without evidence of embolism. A 70-year-old man had abdominal pain and a ruptured abdominal aortic aneurysm was found. We performed EVAR with custom-made tube grafts preserving the bilateral IIAs. On postoperative day 2, the patient complained of abdominal pain, a sigmoidoscopy was performed revealing colon ischemia. On laparotomy, transmural infarction of the sigmoid colon was found and resected. Because IIA preservation cannot guarantee protection against colon ischemia, surgeons should maintain a high level of suspicion and use surveillance liberally after EVAR for early diagnosis of colon ischemia, even if both IIAs are preserved.
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Affiliation(s)
- Hyangkyoung Kim
- Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Zastrow C, Motaganahalli RL, Matsumura JS. Femoral-femoral stabilizing buddy wire for embolization of the internal iliac artery. J Vasc Surg 2012; 55:1526-8. [PMID: 22209616 DOI: 10.1016/j.jvs.2011.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Revised: 10/03/2011] [Accepted: 11/01/2011] [Indexed: 10/14/2022]
Abstract
Internal iliac artery (IIA) embolization is performed in a variety of clinical scenarios, most commonly in patients undergoing endovascular aneurysm repair (EVAR) with an iliac artery aneurysm or inadequate distal landing zone. In these patients, IIA embolization with iliac limb extension is often performed. While IIA embolization can be routinely performed with either ipsilateral or contralateral femoral arterial access, it can be challenging in some patients with an acutely angulated aortic or iliac bifurcation and in patients with short or ectatic common iliac arteries. In this select group of patients with difficult anatomy, IIA embolization can be challenging and may lead to increased radiation exposure and contrast administration. Having a sheath precisely positioned and stabilized at the internal iliac artery origin will facilitate embolization of the IIA. This report describes a novel technique in which crossover femoral-femoral artery buddy wire placement achieves stable positioning of large sheaths for concurrent IIA embolization at the time of EVAR.
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Sadeghi-Azandaryani M, Strube H, Chappell D, Treitl M, Hinske LC, Steckmeier B, Heyn J. Endovascular treatment of abdominal aortic aneurysms combined with bilateral common and internal iliac aneurysms. Catheter Cardiovasc Interv 2011; 78:802-8. [PMID: 21523883 DOI: 10.1002/ccd.23093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Combined aneurysms of aortic and iliac arteries are rare with a prevalence of less than 0.1%. However, these combined aneurysms are associated with a high incidence of thrombosis, distal embolism, or rupture. Endovascular repair is a therapeutic option and includes embolization of the internal iliac artery in numerous cases. Embolization of the internal iliac artery may cause severe ischemia with hip and buttock complications in 2-5%. Therefore, preservation of internal iliac arteries is essential to reduce complications. PATIENT AND METHOD We describe in detail an endovascular procedure for combined abdominal aortic (diameter of 8.6 cm) and bilateral common and internal iliac aneurysm (diameter of the left side: 6.4 cm; diameter of the right side: 4.3 cm) in a 44-year-old patient caused by media necrosis Erdheim-Gsell. The blood flow of both internal arteries was preserved in this patient. RESULT Operation was done without any complications. Conversion to an open procedure was not necessary. During follow up (3, 6, and 12 months after operation) the patient did not develop any signs of severe hip and buttock complications. Furthermore, sonography and CT angiography revealed a good blood flow via the internal and external iliac arteries. CONCLUSION Endovascular repair of abdominal aortic aneurysms combined with bilateral common and internal iliac aneurysms offers a promising minimal invasive procedure. Most importantly, this technique is less invasive than open operations and reduces complications by preserving the pelvic perfusion.
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71
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Hosaka A, Kato M, Kato I, Isshiki S, Okubo N. Outcome after concomitant unilateral embolization of the internal iliac artery and contralateral external-to-internal iliac artery bypass grafting during endovascular aneurysm repair. J Vasc Surg 2011; 54:960-4. [DOI: 10.1016/j.jvs.2011.03.266] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 03/17/2011] [Accepted: 03/17/2011] [Indexed: 10/18/2022]
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72
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Hypogastric preservation with Viabahn stent graft during endovascular aneurysm repair. J Vasc Surg 2011; 54:504-6. [DOI: 10.1016/j.jvs.2010.12.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 12/03/2010] [Accepted: 12/13/2010] [Indexed: 11/23/2022]
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73
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Pua U, Tan K, Rubin BB, Sniderman KW, Rajan DK, Oreopoulos GD, Lindsey TF. Iliac branch graft in the treatment of complex aortoiliac aneurysms: early results from a North American institution. J Vasc Interv Radiol 2011; 22:542-9. [PMID: 21463759 DOI: 10.1016/j.jvir.2011.01.429] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2010] [Revised: 12/18/2010] [Accepted: 01/01/2011] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To describe early experience with the use of iliac branch grafts (IBGs) in aortoiliac aneurysm repair. MATERIALS AND METHODS From July 2007 to August 2009 (25 months), 14 patients (13 men, one woman) with a mean age of 70.1 years (range, 59.3-80.0 y) were treated with IBGs. Indications were abdominal aneurysm with common iliac artery (CIA) involvement (n = 11), juxtarenal aortic aneurysm with CIA involvement (n = 1), and bilateral CIA and internal iliac artery (IIA) aneurysms (n = 1). Postoperative endoleaks and patency rate were determined with computed tomography within 1 month of implantation and 1 year thereafter, with concurrent clinical evaluation for pelvic ischemia. Mean follow-up period was 18.7 months (range, 6-35 mo). RESULTS Technical success rate, as defined by successful implantation of IBG with no intraprocedural type I or type III endoleak, was 86% (12 of 14). A total of 14 IBGs were successfully deployed in 12 patients. Two cases of technical failure were related to excessive iliac tortuosity. The mean hospitalization duration was 6.5 days (range, 3-14 d), with zero mortality at 30 days. There were two cases of type II endoleak treated conservatively and a single case of IBG-related type III endoleak that required repeat intervention. The rest of the stent-implanted aortic and iliac aneurysms remained stable in size, with no aneurysm rupture or death recorded. All stent-implanted iliac branches remained patent on follow-up. None of the patients who received IBGs had new symptoms of pelvic ischemia. CONCLUSIONS Iliac branch graft placement is a feasible technique with excellent short-term results in the treatment of aortoiliac aneurysms.
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Affiliation(s)
- Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
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74
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Spinal cord ischemia after endovascular repair of infrarenal abdominal aortic aneurysm: a rare complication. Case Rep Med 2011; 2011:954572. [PMID: 21765849 PMCID: PMC3135247 DOI: 10.1155/2011/954572] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Accepted: 04/26/2011] [Indexed: 11/18/2022] Open
Abstract
Neurologic deficit secondary to spinal cord ischemia after elective infrarenal, endovascular aneurysm repair (EVAR), consists a rare and rather disastrous complication. The etiology of such neurologic complication seems to be multifactorial, making this event unpredictable and foremost unpreventable. We report a case of paraparesis and bladder dysfunction that occurred immediately after the EVAR procedure. Prompt management by conservative or invasive methods seems to be important for the reversal of the neurologic deficit and the optimization of patient's outcome.
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75
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Angiletta D, Marinazzo D, Guido G, Greco L, Regina G. Spinal cord, bowel, and buttock ischemia after endovascular aneurysm repair. Ann Vasc Surg 2011; 25:980.e15-9. [PMID: 21621970 DOI: 10.1016/j.avsg.2010.12.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 12/03/2010] [Accepted: 12/27/2010] [Indexed: 11/29/2022]
Abstract
A 66-year-old man with multiple comorbidities presented with a juxtarenal perianastomotic aortic aneurysm 10 years after open abdominal aortic aneurysm repair. The aneurysmal disease also involved both iliac bifurcations, the right internal iliac artery, the left common femoral artery (CFA) up to its bifurcation, and the homolateral popliteal artery. We performed bilateral internal iliac artery coil embolization 1-month apart. Later, we performed aortouniiliac endografting extending to the right external iliac artery and placement of an endovascular plug in the left external iliac artery. A right CFA to left femoral bifurcation bypass graft was then constructed after ligation of the left CFA aneurysm. After recovering from anesthesia and despite sequential hypogastric embolization, the patient developed postoperative paraplegia, buttock ischemia, and ischemic colitis and died on postoperative day 5. The possible pathogenic mechanisms involved in the onset of these ischemic complications are discussed in this article.
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Affiliation(s)
- Domenico Angiletta
- Department of Vascular and Endovascular Surgery, University of Bari, Bari, Italy
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76
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Cherry RA, Goodspeed DC, Lynch FC, Delgado J, Reid SJ. Intraoperative angioembolization in the management of pelvic-fracture related hemodynamic instability. J Trauma Manag Outcomes 2011; 5:6. [PMID: 21569480 PMCID: PMC3113950 DOI: 10.1186/1752-2897-5-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 05/13/2011] [Indexed: 11/23/2022]
Abstract
Background This case series report discusses patients presenting with hemorrhage and hemodymanic compromise due to severe pelvic fractures and undergoing intraoperative angioembolization (IAE) with other resuscitative procedures. Methods We used portable digital subtraction fluoroscopy units for IAE in patients with severe pelvic hemorrhage and hemodynamic instability (5/03-4/09). Data was collected on demographics, injury severity, resource utilization, and outcomes at our Level 1 trauma center. Results There were 6,538 adult admissions with 912 having pelvic fractures and 65 of these undergoing pelvic angioembolization. Twelve hemodynamically compromised patients (10 males, 2 females) had intraoperative pelvic angiography (age: 22-79 years; mean 51.3 ± 17.4). Injury severity score (ISS) was 37.5 ± 8.4 (22-50). Mean emergency department (ED) length of stay (LOS) was 57.4 min ± 47.9 with 10 patients transported directly to the OR and 2 to the SICU prior to OR. Ten of 12 patients underwent exploratory laparotomy followed by angioembolization. Mortality was 50%. Among the 6 survivors (ISS 22 - 50), all had a pre-op CT scan, five had an initial base deficit <13, and four were transfused ≤ 6 units pre-incision/pre-procedure. Four of the 6 survivors had unilateral embolization. In contrast, all 6 non-survivors (ISS 29-41) required massive transfusion prior to OR (>6 units PRBCs) with 4 having a based deficit >13. Three of these patients bypassed CT and five underwent bilateral internal iliac embolization (BIIE). Conclusions IAE for severe pelvic hemorrhage can be successfully performed concurrently with exploratory laparotomy, pelvic packing or other resuscitative procedures. Patients most likely to benefit have a base deficit <13, and do not require massive transfusion prior to IAE or suffer from a vertically unstable pelvis fracture.
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Affiliation(s)
- Robert A Cherry
- University of Wisconsin Hospital & Clinics Department of Orthopaedics & Rehabilitation 1685 Highland Avenue Madison, WI 53705 (608) 263-9456, USA.
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77
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Bae SH, Han DK, Baek HJ, Park SJ, Chang NK, Kook H, Hwang TJ. Selective embolization of the internal iliac arteries for the treatment of intractable hemorrhage in children with malignancies. KOREAN JOURNAL OF PEDIATRICS 2011; 54:169-75. [PMID: 21738551 PMCID: PMC3127151 DOI: 10.3345/kjp.2011.54.4.169] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 10/14/2010] [Accepted: 12/29/2010] [Indexed: 11/27/2022]
Abstract
Purpose Acute internal hemorrhage is an occasionally life-threatening complication in pediatric cancer patients. Many therapeutic approaches have been used to control bleeding with various degrees of success. In this study, we evaluated the efficacy of selective internal iliac artery embolization for controlling acute intractable bleeding in children with malignancies. Methods We retrospectively evaluated the cases of 6 children with various malignancies (acute lymphoblastic leukemia, acute myelogenous leukemia, chronic myelogenous leukemia, T-cell prolymphocytic leukemia, Langerhans cell histiocytosis, and rhabdomyosarcoma), who had undergone selective arterial embolization (SAE) of the internal iliac artery at the Chonnam National University Hwasun Hospital between January 2004 and December 2009. SAE was performed by an interventional radiologist using Gelfoam® and/or Tornado® coils. Results The patients were 5 boys and 1 girl with median age of 6.9 years (range, 0.7-14.8 years) at the time of SAE. SAE was performed once in 4 patients and twice in 2, and the procedure was unilateral in 2 and bilateral in 4. The causes of hemorrhage were as follows: hemorrhagic cystitis (HC) in 3 patients, procedure-related internal iliac artery injuries in 2 patients, and tumor rupture in 1 patient. Initial attempt at conservative management was unsuccessful. Of the 6 patients, 5 (83.3%) showed improvement after SAE without complications. Conclusion SAE may be a safe and effective procedure for controlling acute intractable hemorrhage in pediatric malignancy patients. This procedure may obviate the need for surgery, which carries an attendant risk of morbidity and mortality in cancer patients with critical conditions.
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Affiliation(s)
- Sul Hee Bae
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea
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78
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Wu Z, Raithel D, Ritter W, Qu L. Preliminary Embolization of the Hypogastric Artery to Expand the Applicability of Endovascular Aneurysm Repair. J Endovasc Ther 2011; 18:114-20. [DOI: 10.1583/10-3223.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Nakai M, Nakata K, Sato M, Ikoma A, Minamiguchi H, Kawai N, Sonomura T, Hatada A, Nishimura Y, Okamura Y. Sequential Dilatation of the Superior Gluteal Artery Following Coil Embolization of the Internal Iliac Artery and Endovascular Abdominal Aneurysm Repair: A Case Report. Ann Vasc Dis 2011; 4:134-8. [DOI: 10.3400/avd.cr.10.01038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 02/03/2011] [Indexed: 11/13/2022] Open
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Uberoi R, Tsetis D, Shrivastava V, Morgan R, Belli AM. Standard of Practice for the Interventional Management of Isolated Iliac Artery Aneurysms. Cardiovasc Intervent Radiol 2010; 34:3-13. [PMID: 21161661 DOI: 10.1007/s00270-010-0055-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 10/15/2010] [Indexed: 11/30/2022]
Affiliation(s)
- Raman Uberoi
- Department of Interventional Radiology, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
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81
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Bilateral Internal Iliac Artery Ligation as a Damage Control Approach in Massive Retroperitoneal Bleeding AfterPelvic Fracture. ACTA ACUST UNITED AC 2010; 69:1507-14. [DOI: 10.1097/ta.0b013e3181d74c2f] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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82
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Karthikesalingam A, Hinchliffe RJ, Malkawi AH, Holt PJ, Loftus IM, Thompson MM. Morphological Suitability of Patients With Aortoiliac Aneurysms for Endovascular Preservation of the Internal Iliac Artery Using Commercially Available Iliac Branch Graft Devices. J Endovasc Ther 2010; 17:163-71. [DOI: 10.1583/09-2942.1] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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83
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Oderich GS, Ricotta JJ. Novel Surgeon-Modified Hypogastric Branch Stent Graft to Preserve Pelvic Perfusion. Ann Vasc Surg 2010; 24:278-86. [DOI: 10.1016/j.avsg.2009.10.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 10/13/2009] [Accepted: 10/19/2009] [Indexed: 11/17/2022]
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Karthikesalingam A, Hinchliffe RJ, Holt PJE, Boyle JR, Loftus IM, Thompson MM. Endovascular aneurysm repair with preservation of the internal iliac artery using the iliac branch graft device. Eur J Vasc Endovasc Surg 2009; 39:285-94. [PMID: 19962329 DOI: 10.1016/j.ejvs.2009.11.018] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2009] [Accepted: 11/17/2009] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Aortoiliac aneurysms comprise up to 43% of the specialist endovascular caseload. In such cases endovascular aneurysm repair (EVAR) requires distal extension of the aortoiliac endograft beyond the ostium of the internal iliac artery (IIA) and into the external iliac artery, conventionally necessitating the embolisation of one or both IIA. This has been associated with a wide range of complications, and the use of an Iliac Branch-graft Device (IBD) offers an appealing endovascular solution. DESIGN Medline, trial registries, conference proceedings and article reference lists were searched to identify case series reporting IBD use. Data were extracted for review. RESULTS Nine series have reported the use of IBD in a total of 196 patients. Technical success was 85-100%. Median operating times were 101-290min and median contrast dose was 58-208g, with no aneurysm-related mortality. Claudication developed in 12/24 patients after IBD occlusion. One type I endoleak and two type III endoleaks occurred and were managed endovascularly. Re-occlusion occurred in 24/196 patients. CONCLUSION IBD was performed with high technical success rates and encouraging mid-term patency. Formalised risk stratification and morphological data are required to identify the group of patients who will benefit most. Cost-effectiveness appraisals are needed for this technique.
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85
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Pratesi G, Pulli R, Fargion A, Marek J, Troisi N, Dorigo W, Innocenti AA, Pratesi C. Alternative Hybrid Reconstruction for Bilateral Common and Internal Iliac Artery Aneurysms Associated With External Iliac Artery Occlusion. J Endovasc Ther 2009; 16:638-41. [DOI: 10.1583/09-2778.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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86
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Lin PH, Chen AY, Vij A. Hypogastric Artery Preservation during Endovascular Aortic Aneurysm Repair: Is It Important? Semin Vasc Surg 2009; 22:193-200. [DOI: 10.1053/j.semvascsurg.2009.07.012] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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87
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Nicholls MJ, McPherson S. External-to-internal iliac stent-graft: medium-term patency following exclusion of a retrogradely perfused common iliac aneurysm. Cardiovasc Intervent Radiol 2009; 33:849-52. [PMID: 19657691 DOI: 10.1007/s00270-009-9669-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2009] [Revised: 07/02/2009] [Accepted: 07/09/2009] [Indexed: 12/01/2022]
Abstract
Following complicated aortic aneurysm surgery a complete left iliac occlusion resulted in buttock claudication. A retrogradely perfused right common iliac aneurysm expanded. Exclusion was by external-to-internal iliac stent-graft. No deterioration in claudication occurred with medium-term stent-graft patency.
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Affiliation(s)
- Marcus John Nicholls
- Department of Radiology, York Hospitals NHS Foundation Trust, Wigginton Road, York YO31 8HE, UK.
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88
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Noorani A, Cooper DG, Walsh SR, Sadat U, Varty K, Boyle JR, Hayes PD. Comparison of Aortomonoiliac Endovascular Aneurysm Repair Versus a Bifurcated Stent-Graft: Analysis of Perioperative Morbidity and Mortality. J Endovasc Ther 2009; 16:295-301. [DOI: 10.1583/08-2645.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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89
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Afonso CT, Procópio RJ, Navarro TP, Kleinsorge GHD, Rodrigues BDES, Rodrigues MAG. Aneurisma de artéria ilíaca interna roto: relato de caso. J Vasc Bras 2009. [DOI: 10.1590/s1677-54492009005000006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aneurismas isolados da artéria ilíaca interna são raros, acometem 0,1% da população e correspondem a 1% dos aneurismas aorto-ilíacos. Na maioria das vezes, os pacientes são assintomáticos, mas podem apresentar dor abdominal, massa pulsátil no hipogástrio ou na fossa ilíaca, sintomas compressivos urinários, gastrointestinais ou neurológicos. Podem ocasionar quadro de abdome agudo, principalmente quando há ruptura. O diagnóstico precoce dos aneurismas isolados de artéria ilíaca interna é incomum, sendo identificados quando mais volumosos ou rotos, o que aumenta significativamente sua morbimortalidade e torna seu prognóstico mais reservado. Dessa forma, representam um desafio terapêutico. A ligadura cirúrgica tem sido o tratamento mais comum, entretanto a cirurgia endovascular tem mostrado bons resultados, inclusive nos aneurismas rotos. É relatado caso de aneurisma de artéria ilíaca interna isolado roto diagnosticado durante laparotomia para abordagem de abdome agudo.
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Wibmer A, Meyer B, Albrecht T, Buhr HJ, Kruschewski M. Improving Results of Elective Abdominal Aortic Aneurysm Repair at a Low-Volume Hospital by Risk-Adjusted Selection of Treatment in the Endovascular Era. Cardiovasc Intervent Radiol 2009; 32:918-22. [DOI: 10.1007/s00270-009-9538-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Revised: 01/19/2009] [Accepted: 02/04/2009] [Indexed: 11/28/2022]
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91
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Contemporary Management of Aorto-iliac Aneurysms in the Endovascular Era. Eur J Vasc Endovasc Surg 2009; 37:182-8. [DOI: 10.1016/j.ejvs.2008.11.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Accepted: 11/03/2008] [Indexed: 11/19/2022]
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92
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van Groenendael L, Zeebregts CJ, Verhoeven ELG, van Sterkenburg SMM, Reijnen MMPJ. External-to-internal iliac artery endografting for the exclusion of iliac artery aneurysms: an alternative technique for preservation of pelvic flow? Catheter Cardiovasc Interv 2009; 73:156-60. [PMID: 19156879 DOI: 10.1002/ccd.21763] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The purpose of this study was to describe an alternative endovascular procedure to exclude iliac artery aneurysms, preserving perfusion to the internal iliac artery. CASES Two patients, considered unfit for open repair, underwent endovascular repair of iliac artery aneurysms. One of these occurred after previous placement of a bifurcated prosthesis. In both cases the aneurysms were excluded using a nitinol stent covered with expanded polytetrafluoroethylene from the external to the internal iliac artery. Using this technique, the internal iliac arteries were perfused in a retrograde manner. Both interventions were technically successful. The external-to-internal endograft remained patent after 6 and 16 months, respectively. CONCLUSION Endovascular placement of a stent-graft from the external iliac artery into the internal iliac artery may offer an alternative and minimal invasive alternative for the management of common and internal iliac artery aneurysms. With the use of this technique, pelvic perfusion is preserved. Further studies are warranted to appraise the advantages and risk of this approach for iliac artery aneurysms.
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Affiliation(s)
- Laura van Groenendael
- Division of Vascular Surgery, Department of Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, The Netherlands
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93
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Bratby MJ, Morgan RA. Reply to “A Word of Caution Before Killing Hypogastric Arteries”. Cardiovasc Intervent Radiol 2008. [DOI: 10.1007/s00270-008-9299-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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94
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Rayt HS, Bown MJ, Lambert KV, Fishwick NG, McCarthy MJ, London NJM, Sayers RD. Buttock Claudication and Erectile Dysfunction After Internal Iliac Artery Embolization in Patients Prior to Endovascular Aortic Aneurysm Repair. Cardiovasc Intervent Radiol 2008; 31:728-34. [PMID: 18338212 DOI: 10.1007/s00270-008-9319-3] [Citation(s) in RCA: 203] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Revised: 02/11/2008] [Accepted: 02/15/2008] [Indexed: 01/13/2023]
Affiliation(s)
- H S Rayt
- Division of Cardiovascular Sciences, Vascular Surgery Research Group, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester, LE2 7LX, UK.
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A Word of Caution Before Killing Hypogastric Arteries. Cardiovasc Intervent Radiol 2008; 31:835; author reply 836. [DOI: 10.1007/s00270-008-9300-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2007] [Accepted: 01/09/2008] [Indexed: 10/22/2022]
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96
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Endovascular aneurysm repair: current and future status. Cardiovasc Intervent Radiol 2008; 31:451-9. [PMID: 18231829 DOI: 10.1007/s00270-008-9295-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Revised: 12/01/2007] [Accepted: 12/06/2007] [Indexed: 10/22/2022]
Abstract
Endovascular aneurysm repair has rapidly expanded since its introduction in the early 1990s. Early experiences were associated with high rates of complications including conversion to open repair. Perioperative morbidity and mortality results have improved but these concerns have been replaced by questions about long-term durability. Gradually, too, these problems have been addressed. Challenges of today include the ability to roll out the endovascular technique to patients with adverse aneurysm morphology. Fenestrated and branch stent-graft technology is in its infancy. Only now are we beginning to fully understand the advantages, limitations, and complications of such technology. This paper outlines some of the concepts and discusses the controversies and challenges facing clinicians involved in endovascular aneurysm surgery today and in the future.
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