Contemporary Management of Aorto-iliac Aneurysms in the Endovascular Era

Colonic ischemia after endovascular exclusion of an aortoiliac aneurysm using an iliac branch device

PURPOSE

To present the first case of colonic ischemia (CI) after endovascular exclusion of an aortoiliac aneurysm using an iliac branch device (IBD).

CASE REPORT

A 69-year-old male patient with an abdominal aortic and right common iliac artery aneurysm underwent endovascular repair with an IBD. Completion angiography demonstrated good patency in 2 of the 3 main branches of the right internal iliac artery (IIA) whereas the left IIA patency was preserved. Preoperatively, the inferior mesenteric artery (IMA) was patent. Postoperatively, the patient presented moderate CI. He was treated conservatively and discharged 15 days later with recession of the symptoms.

CONCLUSION

Although preservation of bilateral iliac artery patency is considered to diminish the incidence of pelvic ischemia, in case of an exclusion of a patent IMA, collaterals may not be adequate to ensure blood supply to the left colon.

Endovascular aneurysm repair with preservation of the internal iliac artery using the iliac branch graft device

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.