1
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Charisis N, Bouris V, Rakic A, Landau D, Labropoulos N. A systematic review on endovascular repair of isolated common iliac artery aneurysms and suggestions regarding diameter thresholds for intervention. J Vasc Surg 2021; 74:1752-1762.e1. [PMID: 33617979 DOI: 10.1016/j.jvs.2021.01.064] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Our aim was to systematically review results of endovascular aneurysm repair for isolated common iliac artery aneurysms (CIAA) regarding outcomes and to determine if changes should be made to current diameter threshold recommendations for intervention. METHODS A comprehensive systematic review was performed according to the PRISMA guidelines. PubMed, Scopus, and the Cochrane Central databases were searched. RESULTS Twenty-one studies were deemed eligible and provided data for 879 patients and 981 isolated CIAA treated with endovascular repair. The majority of the patients (90.8%) were males. The weighted mean age of the patients was 71.7 years (range, 37-91 years). The weighted mean diameter for the CIAA was 41. mm 1 (range, 15-110 mm) and for ruptured aneurysms 58.4 mm. The overall technical success rate was 97.6%. The perioperative mortality rate was 0.7%. Secondary patency rates were reported in only four studies and varied between 96.7% and 100%. The overall morbidity rate was 14%, ranging from 0% to 25%. Most of the studies did not report long-term or adequate follow-up data. Rupture of an isolated CIAA at <4 cm diameter was extremely low. CONCLUSIONS Endovascular treatment of isolated CIAA is feasible and safe with a low mortality and excellent technical success rates. Consideration of increasing the diameter threshold for intervention of CIAA to 4 cm should be considered. Studies with longer follow-up and reliable long-term results are needed.
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Affiliation(s)
| | | | - Alexander Rakic
- Division of Vascular Surgery, Stony Brook Hospitall, Stony Brook, NY
| | - David Landau
- Division of Vascular Surgery, Stony Brook Hospitall, Stony Brook, NY
| | - Nicos Labropoulos
- Division of Vascular Surgery, Stony Brook Hospitall, Stony Brook, NY.
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2
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Xiang Y, Chen X, Zhao J, Huang B, Yuan D, Yang Y. Endovascular Treatment Versus Open Surgery for Isolated Iliac Artery Aneurysms: A Systematic Review and Meta-Analysis. Vasc Endovascular Surg 2019; 53:401-407. [PMID: 30895896 DOI: 10.1177/1538574419836835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Yuwei Xiang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiyang Chen
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jichun Zhao
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Huang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ding Yuan
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Yang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
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3
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Kobe A, Andreotti C, Puippe G, Rancic Z, Kopp R, Lachat M, Pfammatter T. Primary Endovascular Elective Repair and Repair of Ruptured Isolated Iliac Artery Aneurysms Is Durable-Results of 72 Consecutive Patients. J Vasc Interv Radiol 2018; 29:1725-1732. [PMID: 30396844 DOI: 10.1016/j.jvir.2018.07.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/18/2018] [Accepted: 07/24/2018] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To evaluate outcome of endovascular elective repair and repair of ruptured isolated iliac artery aneurysms (IIAAs) as a primary treatment strategy. MATERIALS AND METHODS All patients with an IIAA undergoing endovascular treatment were included. Aneurysms were classified according to an anatomic classification and treated with coiling of the internal iliac artery, stent graft placement in the common to external iliac artery, or placement of a bifurcated aortoiliac stent graft. Between November 1996 and November 2015, 72 patients with 85 IIAAs underwent endovascular repair. Mean age was 73.9 years ± 9.2. Common iliac artery was involved in 63 patients (74.1%), internal iliac artery was involved in 21 patients (24.7%), and external iliac artery was involved in 1 patient (1.2%). Mean diameter was 5 cm (range, 2.5-11 cm). Emergency repair was performed in 19 patients owing to rupture (26.4%). RESULTS Overall primary technical success rate was 95.8% with conversion rate to open surgery of 4.2% (all in the emergency group) and in-hospital mortality rate of 1.4%. During mean follow-up of 4.3 years ± 3.3 (median 3.8 y; range, 0-14.2 y), 17 endoleaks were observed (6 type I, 10 type II, 1 type IIIa). Overall reintervention rate was 16.7%. Primary patency rate was 98.6%. During the follow-up period, 22 deaths occurred (30.6%), including 2 aneurysm-related deaths (2.8%). CONCLUSIONS Primary endovascular repair of IIAAs shows excellent results and should be considered as first-line therapy. Surgical backup should be available in emergency cases.
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Affiliation(s)
- Adrian Kobe
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland.
| | - Celina Andreotti
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland
| | - Gilbert Puippe
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland
| | - Zoran Rancic
- Division of Vascular Surgery, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland
| | - Reinhard Kopp
- Division of Vascular Surgery, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland
| | - Mario Lachat
- Division of Vascular Surgery, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland
| | - Thomas Pfammatter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland
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4
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Jmal H, Ben Jmaà H, Masmoudi S, Cherif T, Cheikhrouhou H, Maalej A, Elleuch N, Jemel A, Frikha I. [Management of isolated iliac aneurysms: A Tunisian center experience]. JOURNAL DE MÉDECINE VASCULAIRE 2017; 42:349-357. [PMID: 29203041 DOI: 10.1016/j.jdmv.2017.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 06/27/2017] [Indexed: 11/17/2022]
Abstract
Isolated aneurysms of the iliac arteries are rare. The diagnoses of these aneurysms become easier with non-invasive radiologic investigations. The development of endovascular treatment is a recent alternative to surgical treatment. We report our experience in the management of 8 cases of isolated iliac aneurysms in the department of cardiovascular and thoracic surgery of the Habib Bourguiba Hospital of Sfax.
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Affiliation(s)
- H Jmal
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib-Bourguiba, avenue Mmajida-Boulila, 3029 Sfax, Tunisie
| | - H Ben Jmaà
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib-Bourguiba, avenue Mmajida-Boulila, 3029 Sfax, Tunisie.
| | - S Masmoudi
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib-Bourguiba, avenue Mmajida-Boulila, 3029 Sfax, Tunisie
| | - T Cherif
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib-Bourguiba, avenue Mmajida-Boulila, 3029 Sfax, Tunisie
| | - H Cheikhrouhou
- Service d'anesthésie-réanimation, hôpital Habib-Bourguiba, 3029 Sfax, Tunisie
| | - A Maalej
- Service de radiologie, hôpital Habib-Bourguiba, 3029 Sfax, Tunisie
| | - N Elleuch
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib-Bourguiba, avenue Mmajida-Boulila, 3029 Sfax, Tunisie
| | - A Jemel
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib-Bourguiba, avenue Mmajida-Boulila, 3029 Sfax, Tunisie
| | - I Frikha
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib-Bourguiba, avenue Mmajida-Boulila, 3029 Sfax, Tunisie
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5
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Das isolierte Iliakaaneurysma – eine morphologische Klassifikation unter endovaskulären Gesichtspunkten. GEFÄSSCHIRURGIE 2014. [DOI: 10.1007/s00772-013-1266-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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6
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Zhang F, Zhang C, Feng Y, Luo X, Hu L, Liang G, Zhang H, Niu L. Endovascular repair of an infected ruptured isolated iliac artery aneurysm combined with congenital lymphedema: report of a case. Surg Innov 2012; 20:NP25-9. [PMID: 22549906 DOI: 10.1177/1553350612438415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE A novel technique using the reversed iliac leg of a Zenith device has been reported. This study reports a complicated isolated iliac artery aneurysm (IIAA) using this novel technique and reviews the relative literature to discuss current treatment modalities. CASE REPORT A 46-year-old man presented with a mass in the left lower quadrant accompanied by abdominal pain for 60 days. Computer tomography angiography (CTA) revealed a complicated IIAA and a massive retroperitoneal hematoma. Percutaneous puncture and drainage at the hematoma was done. Enterococcus faecium was isolated from the hematoma. The infection was controlled after 2 weeks of drainage and anti-infection treatment. The IIAAs were successfully excluded using the novel technique. The 12-month CTA follow-up was unremarkable. CONCLUSION Using inverted Zenith device legs is safe and effective even in complicated IIAAs. Further studies are warranted before it can become a widely acceptable definitive treatment option.
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Fossaceca R, Guzzardi G, Di Terlizzi M, Divenuto I, Cerini P, Malatesta E, Di Gesù I, Stanca C, Brustia P, Carriero A. Long-term efficacy of endovascular treatment of isolated iliac artery aneurysms. Radiol Med 2012; 118:62-73. [PMID: 22430685 DOI: 10.1007/s11547-012-0813-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 07/06/2011] [Indexed: 10/28/2022]
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8
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Aldin Z, Kashef E, Jenkins M, Gibbs R, Wolfe J, Hamady M. The midterm experience of tapered stent grafts in the endovascular management of iliac artery aneurysms with unfavorable anatomy. Vasc Endovascular Surg 2012; 46:117-22. [PMID: 22344985 DOI: 10.1177/1538574412436698] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report our experience and the midterm results of a modern technique for endovascular management of isolated iliac artery aneurysms (IAAs) with unfavorable neck anatomy, which involves the inversion of an iliac leg of a Zenith stent graft. Patients who underwent endovascular IAA repair from 2002 to 2010 were reviewed. A total of 12 patients, with a mean age of 77.6 years, underwent endovascular repair of 13 IAAs. Mean size of the aneurysms was 54.6 mm (range 34-133 mm). Mean proximal neck diameter was 18 mm (range 15-22 mm). In 7 patients, the length of the proximal neck was <15 mm (10-14 mm). Only 1 patient developed thrombosis of the stent graft immediately after the operation. Patients were followed up for a mean of 31.5 months (range 18-72 months). Our midterm results demonstrate the durability of this technique in the management of iliac aneurysms with unfavorable anatomy.
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Affiliation(s)
- Zaid Aldin
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.
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9
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Malas MB, Robotham D, Qazi U, Lipsitz E, Veith FJ. Endovascular Approach to Treating Common Iliac Artery Aneurysm with Contralateral Aorto-uni-iliac Endograft and a Femoral-femoral Bypass. J Vasc Interv Radiol 2010; 21:1891-5. [PMID: 21050775 DOI: 10.1016/j.jvir.2010.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Revised: 03/10/2010] [Accepted: 09/02/2010] [Indexed: 10/18/2022] Open
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10
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Chemelli A, Hugl B, Klocker J, Thauerer M, Strasak A, Jaschke W, Waldenberger P, Chemelli-Steingruber IE. Endovascular repair of isolated iliac artery aneurysms. J Endovasc Ther 2010; 17:492-503. [PMID: 20681765 DOI: 10.1583/10-3047.1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To retrospectively evaluate a 12-year experience with endovascular repair of isolated iliac artery aneurysm (IAA). METHODS From August 1997 through July 2009, 91 patients (81 men; mean age 71 years, range 31-90) underwent endovascular treatment for isolated IAA at our department. Of these, 77 patients received stent-grafts either alone or in combination with coils or an Amplatzer vascular plug (n = 2); 1 patient received a Smart stent combined with coils, and 13 patients were treated with coil embolization only. The aneurysms were classified according to location: type I = common iliac artery (CIA), type II = internal iliac artery (IIA), type III = CIA and IIA, and type IV = external iliac artery with/without CIA and/or IIA involvement. RESULTS Primary technical success was 90.1% for all aneurysm types and 93.6%, 80%, 88.8%, and 93.3% for types I, II, III, and IV, respectively. Secondary technical success was 96.7% for all types and 97.8%, 95%, 100%, and 93.3%, respectively, for each type. Clinical success was 93.4% for all types and 97.8%, 85%, 100%, and 86.7%, respectively, by type. Complications in 18 (19.8%) patients included 7 type I endoleaks, 3 type II endoleaks, 2 enlarged aneurysm sacs (incomplete embolization), 5 cases of buttock claudication, and 2 stent-graft thromboses. Two patients were converted to open surgery; 10 underwent secondary interventions. Mortality rates were 1.1% (n = 1) at 30 death days and 23.1% (n = 21) over a mean follow-up of 45.9 months (no aneurysm-related death). Cumulative overall survival was 97.7% at 1 year and 47.6% at 10 years. Freedom from aneurysm-related complications was 88.6% at 1 year and 83.5% at 5 years. CONCLUSION Endovascular repair of isolated IAA is a safe and minimally invasive alternative to surgery. However, it may be associated with several complications and must, therefore, be carefully planned.
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Affiliation(s)
- Andreas Chemelli
- Departments of Radiology, Innsbruck Medical University, Innsbruck, Austria
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11
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Zayed HA, Attia R, Modarai B, Clough RE, Bell RE, Carrell T, Sabharwal T, Reidy J, Taylor PR. Predictors of reintervention after endovascular repair of isolated iliac artery aneurysm. Cardiovasc Intervent Radiol 2010; 34:61-6. [PMID: 20464554 DOI: 10.1007/s00270-010-9876-0] [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] [Received: 12/15/2009] [Accepted: 04/15/2010] [Indexed: 11/25/2022]
Abstract
The objective of this study was to identify factors predicting the need for reintervention after endovascular repair of isolated iliac artery aneurysm (IIAA). We reviewed prospectively collected database records of all patients who underwent endovascular repair of IIAA between 1999 and 2008. Detailed assessment of the aneurysms was performed using computed tomography angiography (CTA). Follow-up protocol included CTA at 3 months. If this showed no complication, then annual duplex scan was arranged. Multivariate analysis and analysis of patient survival and freedom from reintervention were performed using Kaplan-Meier life tables. Forty IIAAs (median diameter 44 mm) in 38 patients were treated (all men; median age 75 years), and median follow-up was 27 months. Endovascular repair of IIAA was required in 14 of 40 aneurysms (35%). The rate of type I endoleak was significantly higher with proximal landing zone (PLZ) diameter >30 mm in the aorta or >24 mm in the common iliac artery or distal landing zone (DLZ) diameter >24 mm (P = 0.03, 0.03, and 0.0014, respectively). Reintervention rate (RR) increased significantly with increased diameter or decreased length of PLZ; increased DLZ diameter; and endovascular IIAA repair (P = 0.005, 0.005, 0.02, and 0.02 respectively); however, RR was not significantly affected by length of PLZ or DLZ. Freedom-from-reintervention was 97, 93, and 86% at 12, 24, and 108 months. There was no in-hospital or aneurysm-related mortality. Endovascular IIAA repair is a safe treatment option. Proper patient selection is essential to decrease the RR.
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Affiliation(s)
- Hany A Zayed
- Guy's and St. Thomas' NHS Foundation Trust, First floor, North wing, Westminster Bridge Road, SE1 7EH, London, UK.
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12
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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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13
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Amato ACM, Melissano G, Liu X, Civilini E, Chiesa R. Endovascular approach for isolated common iliac aneurysm and severe kyphoscoliosis. J Vasc Bras 2009. [DOI: 10.1590/s1677-54492009000300017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
We report the case of a 72-year-old patient presenting with an isolated common iliac aneurysm with occlusion of contralateral common iliac artery and severe kyphoscoliosis. Because of high risk for open surgery due to chronic obstructive pulmonary disease, this patient was treated with an endovascular approach using an aortomonoiliac stent graft, followed by a femoro-femoral crossover bypass. This report illustrates the usefulness of a minimally invasive approach, and feasibility even for patients with difficult anatomy.
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14
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Kato T, Takagi H, Kawai N, Sekido Y, Umemoto T. Ruptured isolated external iliac artery true aneurysm associated with cystic medial necrosis: report of a case. Surg Today 2009; 39:705-9. [PMID: 19639439 DOI: 10.1007/s00595-008-3898-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Accepted: 07/23/2008] [Indexed: 11/25/2022]
Abstract
We report a case of a ruptured isolated true external iliac artery aneurysm (EIAA). A 78-year-old woman was admitted to our institution in a shock state after the sudden onset of severe pain in the right hypogastric region. A pulsating mass was found in her right lower abdomen. Computed tomography (CT) with contrast medium showed an isolated EIAA, 40 mm in diameter, with a massive retroperitoneal hematoma. She underwent emergency resection of the aneurysm and reconstruction of the affected artery, without any complications. Histological examination confirmed a true aneurysm caused by cystic medial necrosis (CMN). She had no ocular, cardiac, or orthopedic abnormalities. We review the literature on isolated true aneurysms of the external iliac artery, which are extremely rare, and discuss their clinical manifestations.
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Affiliation(s)
- Takayoshi Kato
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
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15
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McFarlane MEC, Plummer J, Simpson L, Roberts P, Kirby X, Downes R, Antoine N. Internal iliac artery aneurysmo-colonic fistula: a rare presentation of massive lower gastrointestinal haemorrhage: report of a case. Eur Surg 2009. [DOI: 10.1007/s10353-009-0466-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Power AH, Rapanos T, Moore R, Cina CS. Anaconda Endovascular Limbs for the Treatment of Isolated Iliac Artery Aneurysms. Vascular 2009; 17:23-8. [PMID: 19344579 DOI: 10.2310/6670.2009.00003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this article is to report the feasibility and preliminary results of the treatment of isolated iliac artery aneurysms (IAAs) with Anaconda limbs (Vascutek Ltd., Inchinnan, Renfrewshire, Scotland). A prospective cohort is reported of consecutive IAAs treated by two senior surgeons from May to December 2006. One or more Anaconda limbs were used, and internal iliac arteries were embolized if necessary. Twelve IAAs in 11 patients were treated. The average IAA diameter was 4.3 ± 1.1 cm, and the average diameter of stent used was 14 ± 2.5 mm, with an average total length of 97 ± 25 mm. At a mean follow-up of 12 ± 4 months, there were no graft-related complications, graft occlusions, or requirements for reintervention. Endovascular treatment for isolated IAAs under local anesthesia using Anaconda limbs is feasible, safe, and effective. However, as with all new technology, longer follow-up data are necessary.
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Affiliation(s)
- Adam H. Power
- *Division of Vascular Surgery, McMaster University, Hamilton, Ontario; †Division of Vascular Surgery, University of Calgary, Calgary, Alberta; and ‡Division of Vascular Surgery, University of Toronto, and Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario
| | - Theodore Rapanos
- *Division of Vascular Surgery, McMaster University, Hamilton, Ontario; †Division of Vascular Surgery, University of Calgary, Calgary, Alberta; and ‡Division of Vascular Surgery, University of Toronto, and Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario
| | - Randy Moore
- *Division of Vascular Surgery, McMaster University, Hamilton, Ontario; †Division of Vascular Surgery, University of Calgary, Calgary, Alberta; and ‡Division of Vascular Surgery, University of Toronto, and Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario
| | - Claudio S. Cina
- *Division of Vascular Surgery, McMaster University, Hamilton, Ontario; †Division of Vascular Surgery, University of Calgary, Calgary, Alberta; and ‡Division of Vascular Surgery, University of Toronto, and Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario
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17
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Klonaris C, Verikokos C, Avgerinos ED, Bellos J, Katsargyris A, Liapis CD. Stent-graft repair of isolated iliac aneurysms with wide or ectatic necks with use of inverted zenith device legs. J Vasc Interv Radiol 2009; 20:403-6. [PMID: 19157905 DOI: 10.1016/j.jvir.2008.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 11/11/2008] [Accepted: 11/13/2008] [Indexed: 11/18/2022] Open
Abstract
Although there is considerable experience in the management of iliac artery aneurysms (IAAs) accompanying abdominal aortic aneurysms, less is known about endovascular management of isolated IAAs. The distal landing zone can be secured if necessary by extending the graft to the external iliac artery, but the proximal landing zone remains a challenging issue, on which technical success is dependent. The present report describes a novel technique for endovascular management of isolated IAAs with wide proximal necks for which no commercially available grafts with fitting sizes exist: inversion of the iliac leg of a Zenith device.
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Affiliation(s)
- Chris Klonaris
- First Department of Surgery, University of Athens, Laikon Hospital, Athens, Greece.
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18
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Bakoyiannis CN, Tsekouras NS, Economopoulos KP, Bastounis EA. A hybrid approach using a composite endovascular and open graft procedure for a symptomatic common femoral aneurysm extending well above the inguinal ligament. J Vasc Surg 2008; 48:461-4. [DOI: 10.1016/j.jvs.2008.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Revised: 02/25/2008] [Accepted: 03/11/2008] [Indexed: 11/28/2022]
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19
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Huang Y, Gloviczki P, Duncan AA, Kalra M, Hoskin TL, Oderich GS, McKusick MA, Bower TC. Common iliac artery aneurysm: Expansion rate and results of open surgical and endovascular repair. J Vasc Surg 2008; 47:1203-1210; discussion 1210-1. [PMID: 18514838 DOI: 10.1016/j.jvs.2008.01.050] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Revised: 01/22/2008] [Accepted: 01/25/2008] [Indexed: 10/22/2022]
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20
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Bacharach JM, Slovut DP. State of the art: management of iliac artery aneurysmal disease. Catheter Cardiovasc Interv 2008; 71:708-14. [PMID: 18360870 DOI: 10.1002/ccd.21507] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although relatively uncommon, isolated iliac artery aneurysms are associated with significant risk of rupture and death. Clinical presentation can be confusing and ultrasound or CT imaging is paramount in establishing the diagnosis and anatomical extent of disease. Important considerations prior to intervention include determination of proximal neck, involvement of the internal iliac artery, and status of the contralateral internal iliac artery. Endovascular repair has evolved as the first choice treatment option for patients with anatomically suitable iliac artery aneurysms. In uncommon circumstances when endovascular treatment may result in significant pelvic ischemia or the primary symptoms are related to extrinsic compression of adjacent structures, surgical repair may be the preferred option.
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Affiliation(s)
- J Michael Bacharach
- Departments of Vascular Medicine and Cardiology, North Central Heart Institute, Sioux Falls, South Dakota 57108, USA.
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21
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Chaer RA, Barbato JE, Lin SC, Zenati M, Kent KC, McKinsey JF. Isolated iliac artery aneurysms: A contemporary comparison of endovascular and open repair. J Vasc Surg 2008; 47:708-713. [PMID: 18381130 DOI: 10.1016/j.jvs.2007.11.008] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Revised: 11/01/2007] [Accepted: 11/08/2007] [Indexed: 11/18/2022]
Affiliation(s)
- Rabih A Chaer
- Columbia/Weill Cornell Division of Vascular Surgery, New York Presbyterian Hospital, New York, NY 10032, USA
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Moro-Mayor A, Barreiro-Veiguela J, Pintos-Moreu M, Lojo-Rocamonde I. Exclusión endovascular de un pseudoaneurisma ilíaco gigante sintomático. ANGIOLOGIA 2008. [DOI: 10.1016/s0003-3170(08)01005-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Pitoulias GA, Donas KP, Schulte S, Horsch S, Papadimitriou DK. Isolated iliac artery aneurysms: endovascular versus open elective repair. J Vasc Surg 2007; 46:648-54. [PMID: 17764880 DOI: 10.1016/j.jvs.2007.05.047] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Accepted: 05/30/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare endovascular and open repair of isolated or solitary iliac artery aneurysms (SIAAs). METHODS We present the results of 55 patients with 58 SIAAs that were treated between January 1998 and December 2005 in two European university hospitals. In one center, the standard procedure, if not contraindicated, was endovascular repair, and 32 (58.2%) consecutive patients with 33 SIAAs were treated by using only endovascular techniques (endovascular iliac aneurysm repair; EVIAR). In the second center, 23 (41.8%) consecutive patients with 25 SIAAs were treated by conventional surgical techniques because advanced endovascular skills were not available before late 2005. EVIAR included coil embolization of the hypogastric artery in 13 of the 33 cases with aneurysmal involvement of the internal iliac artery. In the "open" group of patients, midline laparotomy and a transperitoneal approach with bifurcated aortoiliac graft replacement was performed in 4 cases, and a lower lateral abdominal incision with a retroperitoneal approach and iliac replacement was performed in 19 cases. RESULTS The mean follow-up period was similar in both groups (EVIAR, 35.3 +/- 21.3 months; open, 31.3 +/- 19.9 months). The two groups of patients had similar demographic and clinical characteristics compared with previous reported series, and data analysis revealed a statistically significant difference between the two groups only in hypertension. The early and mid-term outcomes and especially the 3-year primary patency rates were also similar between the two groups (EVIAR, 97%; open, 100%). In the EVIAR group, there was no evidence of endoleaks, kinking, or graft migration, and 26 aneurysms remained stable, whereas in 7 aneurysms a slight decrease in size (>10% in diameter) was observed. Comparison of operative time, intraoperative blood loss, and postoperative hospital stay revealed significant differences (P < .001) in favor of the endovascular group. Secondary intervention was not necessary in any patient in either group during the entire follow-up period. CONCLUSIONS Elective management with endovascular or open techniques of isolated iliac aneurysms can be accomplished with very low morbidity and mortality rates. Better intraoperative and early postoperative outcomes, as well as the durable mid-term results in our EVIAR-treated patients, indicate that endovascular techniques could be offered as first-line therapy of SIAAs.
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Affiliation(s)
- Georgios A Pitoulias
- "G. Gennimatas" Hospital, Second Surgical Department, Division of Vascular Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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