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Esposito A, Pasqua R, Menna D, Giordano AN, Illuminati G, D’Andrea V. Percutaneous Retrograde Trans-Gluteal Embolization of Type 2 Endoleak Causing Iliac Aneurysm Enlargement after Endovascular Repair: Case Report and Literature Review. J Clin Med 2024; 13:2909. [PMID: 38792450 PMCID: PMC11122112 DOI: 10.3390/jcm13102909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/22/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Late type II endoleaks (T2ELs) arising from the internal iliac artery (IIA) may present during follow-up after endovascular aortic repair (EVAR) of aortoiliac aneurysm and may warrant embolization if enlargement of the aneurysmal sac is demonstrated. When coverage of the IIA ostium has been made due to extensive iliac disease, access options can be challenging. Different treatment options have been reported over recent years, and a careful selection of the best one must be made based on the characteristics of each case. The present study reports a simple and reproducible sheathless percutaneous superior gluteal artery (SGA) access and provides a discussion based on a review of the existing literature on this topic.
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Affiliation(s)
- Andrea Esposito
- Vascular and Endovascular Surgery Division, Cardiovascular Department, San Carlo Hospital, 85100 Potenza, Italy; (A.E.); (D.M.)
| | - Rocco Pasqua
- Vascular and Endovascular Surgery Division, Cardiovascular Department, San Carlo Hospital, 85100 Potenza, Italy; (A.E.); (D.M.)
- Department of Surgery, Sapienza University of Rome, 00185 Rome, Italy; (G.I.); (V.D.)
| | - Danilo Menna
- Vascular and Endovascular Surgery Division, Cardiovascular Department, San Carlo Hospital, 85100 Potenza, Italy; (A.E.); (D.M.)
| | - Antonio Nicola Giordano
- Vascular and Endovascular Surgery Division, Cardiovascular Department, San Carlo Hospital, 85100 Potenza, Italy; (A.E.); (D.M.)
| | - Giulio Illuminati
- Department of Surgery, Sapienza University of Rome, 00185 Rome, Italy; (G.I.); (V.D.)
| | - Vito D’Andrea
- Department of Surgery, Sapienza University of Rome, 00185 Rome, Italy; (G.I.); (V.D.)
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Claudio RE, Zuercher H, Vogler J, Zwiebel B. Transgluteal approach to hypogastric artery aneurysm type II endoleak. J Vasc Surg Cases Innov Tech 2023; 9:101033. [PMID: 38204766 PMCID: PMC10777479 DOI: 10.1016/j.jvscit.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/12/2022] [Indexed: 10/14/2022] Open
Abstract
An enlarging internal iliac artery aneurysm secondary to a type II endoleak after endovascular aortic repair is an uncommon entity. It carries a significant rupture risk and mortality if not addressed. The present patient had had a 6.8-cm, rapidly growing, excluded hypogastric aneurysm. The results included both a failed transarterial approach and successful percutaneous transgluteal internal iliac artery aneurysm embolization using XperCT software (Philips Healthcare, Andover, MA) for guidance. The salient points included that treatment of the "nidus" alone will not be sufficient for complete endoleak embolization, the use of direct endoleak sac angiography might better delineate the inflow and outflow dynamics than conventional transarterial angiography, and XperCT guidance (Philips Healthcare) can facilitate complex endoleak access.
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Affiliation(s)
| | - Hannah Zuercher
- University of South Florida Morsani College of Medicine, Tampa, FL
| | - James Vogler
- Department of Interventional Radiology, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Bruce Zwiebel
- Department of Interventional Radiology, University of South Florida Morsani College of Medicine, Tampa, FL
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3
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Ghasemi-Rad M, Vadvala HV, Lincoln CM, Irani Z. Embolization of Large Internal Iliac Artery Pseudoaneurysm through a Retrograde Trans-Superior Gluteal Arterial Access. Tomography 2022; 8:2107-2112. [PMID: 36136873 PMCID: PMC9498860 DOI: 10.3390/tomography8050177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
The presence of osteal stenosis/occlusion or osteal exclusion by prior interventions poses a challenge to selective catheterization of the internal iliac artery. We describe a case where a retrograde access through the superior gluteal artery (SGA) was used to successfully treat an internal iliac artery pseudoaneurysm (PSA) in a patient when an antegrade catheterization was not feasible due to internal iliac osteal exclusion by an endograft.
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Affiliation(s)
- Mohammad Ghasemi-Rad
- Department of Radiology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Harshna V. Vadvala
- Department of Radiology and Radiological Science, Johns Hopkins Hospital, Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD 21287, USA
| | - Christie M. Lincoln
- Department of Radiology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Zubin Irani
- Department of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA 02114, USA
- Correspondence:
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4
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Vialonga M, Grieff AN, Beckerman WE. Late Open Repair of a Massive Common Iliac Artery Aneurysm after Endovascular Failure. Ann Vasc Surg 2021; 79:443.e1-443.e4. [PMID: 34656712 DOI: 10.1016/j.avsg.2021.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 08/06/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022]
Abstract
Giant Common Iliac Artery Aneurysms (CIAA) are an uncommon pathology that may present as a late complication after endovascular aortic repair secondary to aneurysmal degeneration with endoleak. We present an unusual case of a patient presenting 9 years after index endovascular CIAA exclusion with a painless abdominal mass found to be a 20+ cm CIAA secondary to type II endoleak from a recanalized coil embolized hypogastric artery. The patient underwent open aneurysmorrhaphy with ligation of the hypogastric artery.
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Affiliation(s)
- Mason Vialonga
- Division of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ
| | - Anthony N Grieff
- Division of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ
| | - William E Beckerman
- Division of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ
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Rynio P, Falkowski A, Witowski J, Kazimierczak A, Wójcik Ł, Gutowski P. Simulation and Training of Needle Puncture Procedure with a Patient-Specific 3D Printed Gluteal Artery Model. J Clin Med 2020; 9:jcm9030686. [PMID: 32143426 PMCID: PMC7141337 DOI: 10.3390/jcm9030686] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/11/2020] [Accepted: 02/25/2020] [Indexed: 12/16/2022] Open
Abstract
The puncture of the gluteal artery (GA) is a rare and difficult procedure. Less experienced clinicians do not always have the opportunity to practice and prepare for it, which creates a need for novel training tools. We aimed to investigate the feasibility of developing a 3D-printed, patient-specific phantom of the GA and its surrounding tissues to determine the extent to which the model can be used as an aid in needle puncture planning, simulation, and training. Computed tomography angiography scans of a patient with an endoleak to an internal iliac artery aneurysm with no intravascular antegrade access were processed. The arterial system, including the superior GA with its division branches, and pelvic area bones were 3D printed. The 3D model was embedded in the buttocks-shaped, patient-specific mold and cast. The manufactured, life-sized phantom was used to simulate the GA puncture procedure and was validated by 13 endovascular specialists. The printed GA was visible in the fluoroscopy, allowing for a needle puncture procedure simulation. The contrast medium was administered, simulating a digital subtraction angiography. Participating doctors suggested that the model could make a significant impact on preprocedural planning and resident training programs. Although the results are promising, we recommend that further studies be used to adjust the design and assess its clinical value.
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Affiliation(s)
- Paweł Rynio
- Department of Vascular Surgery, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.K.); (P.G.)
- Correspondence:
| | - Aleksander Falkowski
- Department of Radiology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.F.); (Ł.W.)
| | - Jan Witowski
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501 Kraków, Poland;
| | - Arkadiusz Kazimierczak
- Department of Vascular Surgery, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.K.); (P.G.)
| | - Łukasz Wójcik
- Department of Radiology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.F.); (Ł.W.)
| | - Piotr Gutowski
- Department of Vascular Surgery, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.K.); (P.G.)
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Chen X, Zhao J, Huang B, Yuan D, Yang Y. Giant Hypogastric Aneurysm Induced by Type-II Endoleak Presenting 4 Years after Endovascular Repair: A Case Report. Ann Vasc Surg 2019; 63:458.e7-458.e11. [PMID: 31622754 DOI: 10.1016/j.avsg.2019.08.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/22/2019] [Accepted: 08/22/2019] [Indexed: 02/05/2023]
Abstract
Bilateral isolated hypogastric aneurysm (HA) is a rare type of abdominal aneurysm. Endovascular repair has become predominant compared with surgical repair because of its minimal invasiveness. However, type-II endoleak after procedure may lead to continuous enlargement of HA and rupture. Herein, we report a rare case involving a very large HA induced by type-II endoleak after endovascular repair. A 68-year-old male patient underwent endovascular repair of bilateral isolated HAs 4 years ago. Stent grafts were used to block the orifices of bilateral HAs, and main distal outflows were embolized with coils. In the absence of a 4-year follow-up, he returned to the clinic with symptoms of lower abdominal pain and frequent urination. Computer tomography angiography revealed a giant left HA with a maximum diameter of 18 cm combined with the enlargement of the left common iliac artery (CIA) induced by type-II endoleak. The right isolated HA decreased from 5.5 cm to 3 cm. Angiography was performed, and multiple arteries from the middle sacral and external iliac arteries were detected as the sources of type-II endoleak. Considering the compression effect, surgical repair of the left giant HA was performed. Thrombus was removed from the giant aneurysm, and the distal outflows of HA were sutured. As the left CIA was enlarged, a prosthetic graft was interposed through the inner side of the previous cover stent to revascularize the external iliac artery. The patient had an uneventful postoperative clinical course and was discharged from the hospital 7 days after operation. Treatments of HA induced by type-II endoleak require regular patient follow-ups to monitor specific conditions, particularly the embolization of distal outflows. Surgical repair remains the first choice for HA with compression symptoms.
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Affiliation(s)
- Xiyang Chen
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jichun Zhao
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Bin Huang
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
| | - Ding Yuan
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yi Yang
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Thomas RP, Köcher M, Černa M, Utíkal P. Unusual Access for the Treatment of Iliac Artery Aneurysm in Association with Type II Endoleak After Endovascular Repair of an Aortoiliac Aneurysm. Cardiovasc Intervent Radiol 2018; 42:313-316. [DOI: 10.1007/s00270-018-2102-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/24/2018] [Indexed: 11/28/2022]
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8
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Worgul CA, Wu G, Kansal N. Percutaneous Access of an Expanding Internal Iliac Artery Aneurysm via a Direct Posterior Transgluteal Approach. Ann Vasc Surg 2018; 55:311.e1-311.e4. [PMID: 30287291 DOI: 10.1016/j.avsg.2018.07.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/06/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Internal iliac artery aneurysms (IIAAs) are rare, comprising 0.3% of all aortoiliac aneurysms. Endovascular management is associated with lower morbidity and mortality than open repair. We present a 91-year-old female with a rapidly expanding 8.2-cm IIAA who previously underwent incomplete endovascular treatment, using endovascular aneurysm repair, to exclude the right internal iliac artery (IIA). Transarterial access to the IIAA was not possible secondary to the iliac limb of the endograft over the origin of the IIA. We recommended that the patient undergo embolization and coiling of the IIAA via a direct percutaneous transgluteal approach. METHODS With the patient in a prone position, under fluoroscopic guidance, a 10-cm long, 18-gauge needle was placed through the gluteus muscle into the right IIAA. Needle location was confirmed by angiography and a 6-French sheath was advanced into the aneurysm. Selective catheterization of the native aorta was accomplished around the occluded limb of the previously placed endograft. Aortography confirmed robust filling of 2 large lumbar arteries with brisk runoff through branches of the IIA. Coil embolization was used to treat both the lumbar arteries causing aortic endoleak, as well as the outflow branches of the IIAA. RESULTS Completion angiography revealed static flow in the aorta and aneurysm, with minimal flow through the inflow and outflow tracts. At a 1-month follow-up appointment, repeat computed tomography angiography revealed resolution of the endoleak and no blood flow within the aneurysm. There have only been a few case reports utilizing alternative access to an IIAA. Although computed tomography and ultrasound-guided techniques have been described in the literature, a percutaneous, fluoroscopy-guided, transgluteal approach to access the IIAA is a new and unique approach. CONCLUSIONS In patients who are not candidates for open or standard endovascular repair with a large, inaccessible IIAA, a transgluteal approach to directly access the aneurysm sac may offer a less invasive and successful management strategy.
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Affiliation(s)
| | - George Wu
- Division of Interventional Radiology, Good Samaritan Medical Center, Brockton, MA
| | - Nikhil Kansal
- Division of Vascular and Endovascular Surgery, St. Elizabeth's Medical Center, Boston, MA
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9
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Embolization of a Previously Excluded Symptomatic Internal Iliac Aneurysm Through the Iliac Vein. Cardiovasc Intervent Radiol 2017; 40:1954-1957. [PMID: 28681223 DOI: 10.1007/s00270-017-1737-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 06/27/2017] [Indexed: 10/19/2022]
Abstract
A 69-year-old man was referred urgently for a 58-mm enlarging painful right internal iliac artery (IIA) aneurysm. Since exclusion through proximal IIA coverage and distal IIA branches embolization had been previously performed, aneurysm sac puncture through the iliac vein was decided. The ipsilateral common femoral vein was antegradely punctured, and a 16.5 G Ross modified Colapinto needle from a transjugular intrahepatic access set was used to puncture the sac and fill the aneurysm with coils. Embolization of an IIA aneurysm through the iliac vein may represent an alternative when prior IIA aneurysm exclusion has been performed.
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10
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Hsu MY, Su TW, Su IH, Ko PJ, Chu SY. Management of Type II Endoleak From Internal Iliac Artery Immediately After Endovascular Aneurysm Repair. Vasc Endovascular Surg 2017; 51:47-50. [PMID: 28100155 DOI: 10.1177/1538574416687736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Inadvertent coverage of origin of internal iliac artery (IIA) during endovascular aneurysm repair may lead to type II endoleak. Except for open surgery, the endovascular solution is limited. We report a case with such complication that was successfully treated with coil embolization using retrograde extrastent approach. This is a new technique that has not been reported before, and as such, had been useful in the treatment of type II endoleak from IIA as an alternative to open ligation of IIA origin.
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Affiliation(s)
- Ming-Yi Hsu
- 1 Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ta-Wei Su
- 2 Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - I-Hao Su
- 1 Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Jen Ko
- 2 Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Sung-Yu Chu
- 1 Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Merchant M, Shah R, Resnick S. Direct aneurysm sac catheterization and embolization of an enlarging internal iliac aneurysm using cone-beam CT. Diagn Interv Radiol 2016; 21:252-5. [PMID: 25858522 DOI: 10.5152/dir.2014.14332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Since cone-beam computed tomography (CT) has been adapted for use with a C-arm system it has brought volumetric CT capabilities in the interventional suite. Although cone-beam CT image resolution is far inferior to that generated by traditional CT scanners, the system offers the ability to place an access needle into position under tomographic guidance and use the access to immediately begin a fluoroscopic procedure without moving the patient. We describe a case of a "jailed" enlarging internal iliac artery aneurysm secondary to abdominal aortic aneurysm repair, in which direct percutaneous puncture of the internal iliac artery aneurysm sac was performed under cone-beam CT guidance.
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Affiliation(s)
- Monish Merchant
- Department of Radiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA.
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12
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Pfabe FP. Ausschaltung eines persistierenden Endoleaks Typ IIb eines A.-iliaca-interna-Aneurysmas nach primär chirurgischer Versorgung. GEFÄSSCHIRURGIE 2016. [DOI: 10.1007/s00772-016-0117-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Vaillant M, Bartoli MA, Soler R, Barral PA, Jacquier A, Sarlon Bartoli G, Magnan PE. Emergency Embolization of a Ruptured Aneurysm of the Internal Iliac Artery by Direct Ultrasound-Guided Puncture: Report of a Case. Ann Vasc Surg 2015; 31:205.e1-4. [PMID: 26627319 DOI: 10.1016/j.avsg.2015.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/13/2015] [Accepted: 08/15/2015] [Indexed: 11/29/2022]
Abstract
We report the emergency embolization of a ruptured aneurysm of the internal iliac artery in a patient at high surgical risk. Admission computed tomography scan showed that the ostium of the aneurysmal internal iliac artery was covered by a covered stent. In this patient, we chose to carry out an embolization of the aneurysm and its efferent arteries by direct puncture of the aneurysmal sac using an antero-external abdominal approach under ultrasound guidance. Short-term results were favorable and we consider that this technique is one of the therapeutic options to discuss in such situation.
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Affiliation(s)
- Michael Vaillant
- Department of Vascular Surgery, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - Michel Alain Bartoli
- Department of Vascular Surgery, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France.
| | - Raphaël Soler
- Department of Vascular Surgery, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - Pierre-Antoine Barral
- Department of Radiology, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - Alexis Jacquier
- Department of Radiology, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - Gabrielle Sarlon Bartoli
- Department of Vascular Surgery, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - Pierre-Edouard Magnan
- Department of Vascular Surgery, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France
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Kabutey NK, Siracuse JJ, Gill H, Kundi R, Meltzer AJ, Schneider DB. Percutaneous transgluteal coil embolization of bilateral internal iliac artery aneurysms via direct superior gluteal artery access. J Vasc Surg 2014; 60:226-9. [DOI: 10.1016/j.jvs.2013.06.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 05/29/2013] [Accepted: 06/05/2013] [Indexed: 11/28/2022]
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15
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Novel Treatment of an Enlarging Internal Iliac Artery Aneurysm in Association with a Type 2 Endoleak via Percutaneous Embolisation of the Superior Gluteal Artery through a Posterior Approach. Case Rep Vasc Med 2013; 2013:861624. [PMID: 23841015 PMCID: PMC3694376 DOI: 10.1155/2013/861624] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 05/27/2013] [Indexed: 11/18/2022] Open
Abstract
Internal iliac artery (IIA) aneurysms, while rare, carry a significant risk of mortality if they rupture. Endovascular intervention is now the preferred method of treatment for IIAs; however, due to technical considerations, this is not always feasible. We report a case of a patient who developed an enlarging IIA aneurysm in association with a type 2 endoleak supplied by multiple feeding arteries where conventional endovascular treatment was not possible. A novel method of effectively treating the IIA aneurysm with a posterior approach via image-guided puncture of the superior gluteal artery was employed. Five arteries supplying the superior gluteal from the contralateral internal iliac artery were selectively catheterised and coiled before the aneurysmal sac was embolised. The patient made an uneventful recovery, and follow-up imaging demonstrated resolution of the endoleak and decompression of the aneurysmal sac. This case demonstrates that the posterior approach is a safe and viable method of treating internal iliac artery aneurysm when traditional endovascular approaches are technically possible.
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16
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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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17
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Millon A, Paquet Y, Ben Ahmed S, Pinel G, Rosset E, Lermusiaux P. Midterm Outcomes of Embolisation of Internal Iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2013; 45:22-7. [DOI: 10.1016/j.ejvs.2012.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 10/08/2012] [Indexed: 10/27/2022]
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18
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Abderhalden S, Rancic Z, Lachat ML, Pfammatter T. Retrograde hypogastric artery embolization to treat iliac artery aneurysms growing after aortoiliac repair. J Vasc Interv Radiol 2012; 23:873-7. [PMID: 22720892 DOI: 10.1016/j.jvir.2012.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Revised: 03/29/2012] [Accepted: 04/05/2012] [Indexed: 11/25/2022] Open
Abstract
Transarterial embolization of the feeding internal iliac artery branches via the hypogastric-femoral collateral pathway was feasible in four patients with expanding iliac artery aneurysms and occluded internal iliac artery origins after aortoiliac repair.
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Affiliation(s)
- Susanne Abderhalden
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
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Patel SD, Perera A, Law N, Mandumula S. Case report. A novel approach to the management of a ruptured Type II endoleak following endovascular repair of an internal iliac artery aneurysm. Br J Radiol 2012; 84:e240-2. [PMID: 22101591 DOI: 10.1259/bjr/42137038] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Endovascular repair of isolated iliac artery aneurysms is an established safe and effective management option. Type II endoleak is a potential complication, but rarely results in significant morbidity or mortality. We report a case of a patient who presented with a ruptured internal iliac artery aneurysm secondary to a Type II endoleak. To our knowledge this and the following method of managing this have not been previously reported. Established methods of managing endoleaks, such as intravascular transfemoral embolisation and open or laparoscopic ligation, were not possible. Therefore, we resorted to a novel approach to this type of aneurysm and successfully performed a transcutaneous direct puncture and embolisation of the superior gluteal artery.
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Affiliation(s)
- S D Patel
- Department of Vascular Surgery, Chase Farm Hospital, Enfield, London, UK.
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Antoniou GA, Nassef AH, Antoniou SA, Loh CYY, Turner DR, Beard JD. Endovascular treatment of isolated internal iliac artery aneurysms. Vascular 2011; 19:291-300. [PMID: 22048976 DOI: 10.1258/vasc.2011.ra0050] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of the paper is to evaluate the outcome of endovascular treatments for isolated internal iliac artery aneurysms. A systematic review of the literature using public domain databases was undertaken. All studies reporting on endovascular treatment of isolated hypogastric artery aneurysms were considered. Experience from our institution was involved in the data analysis. The primary outcome measures were technical success, perioperative, and overall mortality and morbidity. Data were extracted from 30 articles fulfilling the selection criteria, and the study cohort consisted of 55 patients having undergone treatment of 59 internal iliac artery aneurysms. Ten patients (18%) were treated on an urgent or emergency basis for a ruptured aneurysm. Technical success was achieved in 71% of the cases. The most common reason for technical failure was incomplete exclusion of the aneurysm sac. Thirty-day mortality occurred in one patient (2%). The 30-day morbidity rate was 20%, and was mostly associated with insufficiency of the pelvic circulation. One aneurysm-related death occurred during a mean follow-up period of 13 months (range 0.5–56 months). Open surgical intervention for aneurysm-related complications was required in five patients. In conclusion, endovascular treatment of isolated internal iliac artery aneurysms is an effective alternative option, with satisfactory early and mid-term results.
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Affiliation(s)
- George A Antoniou
- Vascular Institute, Northern General Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - Ahmed H Nassef
- Vascular Institute, Northern General Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - Stavros A Antoniou
- Department of General and Visceral Surgery, Krankenhaus ‘Maria v. d. Aposteln’ Neuwerk, Mönchengladbach, Germany
| | - Charles Yuen Yung Loh
- Vascular Institute, Northern General Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - Douglas R Turner
- Vascular Institute, Northern General Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - Jonathan D Beard
- Vascular Institute, Northern General Hospital, Sheffield Teaching Hospitals, Sheffield, UK
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Embolization of an Internal Iliac Artery Aneurysm after Image-Guided Direct Puncture. Cardiovasc Intervent Radiol 2010; 35:807-14. [DOI: 10.1007/s00270-010-0061-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 11/19/2010] [Indexed: 10/18/2022]
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