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Wang C, Zhou Y, Shao J, Lai Z, Li K, Xu L, Chen J, Yu X, Zhu Z, Wang J, Liu X, Yuan J, Liu B. Midterm Results of a Surgeon-Modified Device to Preserve the Flow of the Internal Iliac Artery During Endovascular Repair of Aneurysm: Single-Center Experiences. Ann Vasc Surg 2023; 91:117-126. [PMID: 36503023 DOI: 10.1016/j.avsg.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/24/2022] [Accepted: 11/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND During endovascular aneurysm repair (EVAR), commercial iliac branch devices (IBDs) have become an inescapable alternative for preserving antegrade internal iliac artery (IIA) blood flow. Due to the different morphological features of aneurysms, commercial IBDs may not be suitable for all patients. Reported experience with the implantation of the new surgeon-modified IBD (sm IBD) is limited. This investigation describes the indications, efficacy, and safety of the sm IBD. METHODS Data from consecutive elective implantations of IBDs in patients between March 2011 and May 2021 in a single center were incorporated. The sm IBDs were indicated in patients with common iliac artery aneurysms (CIAAs) and with a challenging anatomy and in those patients with or without abdominal aortic aneurysm (AAA). RESULTS Fifteen patients (15 male, mean age 67.6 ± 7.9 years) were included. Fifteen sm IBDs were implanted in 1 procedure (100%). Fourteen (93.3%) patients had simultaneous endovascular aneurysm repair (EVAR) and 1 (6.7%) patient previously had a bilateral CIAAs repair by EVAR. The mean common iliac artery (CIA) diameter was 36.6 ± 12.5 mm. Technical success was obtained in all patients (100%). The median operation time was 189.7 ± 78.6 min, with a median fluoroscopy time of 45.3 ± 15.9 min. Axillary artery access was used in 11 (73.3%) procedures. The mean total hospital stay was 5.6 ± 2.8 days, and the postoperative follow-up was 35.4 months (range 2-120). The estimated IIA bridge stent patency at 1 year after operation was 100% and 85.7% ± 13.2% 5 years postoperatively. One (6.7%) IIA branch was occluded, and this patient remained asymptomatic. One patient (6.7%) needed reintervention, and another (6.7%) patient had type II leakage, which is currently under close surveillance. CONCLUSIONS Using an IBD to maintain the pelvic blood flow is an effective and feasible intravascular technique, especially for patients with an abnormal iliac artery anatomy. This novel technique has similar midterm procedural success rate compared to the use of commercial IBDs. Therefore, these devices are more suitable for patients with certain anatomic challenges and can be used as an alternative treatment.
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Affiliation(s)
- Chaonan Wang
- Departments of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Yan Zhou
- Departments of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China; Eight-year Program of Clinical Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiang Shao
- Departments of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Zhichao Lai
- Departments of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Kang Li
- Departments of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Leyin Xu
- Departments of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Junye Chen
- Departments of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China; Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiaoxi Yu
- Eight-year Program of Clinical Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhan Zhu
- Eight-year Program of Clinical Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiaxian Wang
- Eight-year Program of Clinical Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaolong Liu
- Departments of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Jinghui Yuan
- Departments of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Bao Liu
- Departments of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
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Li Y, He C, Zhang H, Zhang X, Zhang X, Zhang T. Endovascular Repair for Abdominal Aortic Aneurysm in Mainland China: A Systematic Review and Meta-Analysis. Ann Vasc Surg 2023; 89:338-352. [PMID: 36343863 DOI: 10.1016/j.avsg.2022.09.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/31/2022] [Accepted: 09/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the safety, applicability, and outcomes of the endovascular aneurysm repair (EVAR) technique for patients in mainland China with abdominal aortic aneurysm (AAA) by performing a systematic review. METHODS We conducted a systematic search using the PubMed, Embase, Chinese National Knowledge Infrastructure, and Chinese Biomedical databases to identify Chinese studies on the management of AAAs using the EVAR technique published in English between January 2000 and December 2020. Two independent observers selected studies for inclusion in the study, assessed the methodological quality of the included studies, and extracted the data. The included studies investigated the clinical outcomes and postprocedural complications of using EVAR techniques. RESULTS Sixteen studies reported a total of 3,024 AAA patients. The follow-up period ranged from 1 to 133 months. The mean follow-up time was 38.5 months, the mean age was 69.2 years, and the mean aneurysm diameter was 56.1 mm. The pooled technical success rate was 95% (95% confidence interval [CI]: 92-96%). The endoleak rate was 7% (95% CI: 6-8%). The rate of endoleak requiring reintervention was 3% (95% CI: 3-4%). The 30-day morbidity rate was 9% (95% CI: 6-14%). The 30-day mortality rate was 2% (95% CI: 1-3%). The follow-up mortality was 5% (95% CI: 3-8%). CONCLUSIONS The results of the study showed that using the EVAR technique for treating patients in mainland China with AAAs produced encouraging mid-term outcomes. Long-term outcomes should be examined in future research.
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Affiliation(s)
- Yue Li
- Department of Cardio-Vascular Surgery, Air Force Medical Center of People's Liberation Army, Beijing, China
| | - Changshun He
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, China
| | - Hongchao Zhang
- Department of Cardio-Vascular Surgery, Air Force Medical Center of People's Liberation Army, Beijing, China
| | - Xuemin Zhang
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, China
| | - Xiaoming Zhang
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, China
| | - Tao Zhang
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, China.
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A systematic review and meta-analysis of the clinical effectiveness and safety of unilateral versus bilateral iliac branch devices for aortoiliac and iliac artery aneurysms. J Vasc Surg 2022; 76:1089-1098.e8. [PMID: 35314303 DOI: 10.1016/j.jvs.2022.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/04/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Iliac branch devices (IBDs) have been utilized in the treatment of aortoiliac and isolated iliac artery aneurysms. The aims of this systematic review and meta-analysis were to investigate the clinical effectiveness and safety of IBDs. METHODS A systematic review of the literature was conducted by identifying studies in the Medline, EMBASE, and Cochrane databases regarding the outcomes of IBDs in aortoiliac or isolated iliac artery aneurysms between May 2006 and December 2020. Individual studies were evaluated for the following major outcomes: technical success, 30-day mortality, primary patency, endoleak, reintervention, and rates of pelvic ischemia. Furthermore, sub-group meta-analyses were performed to compare the pelvic ischemic events in patients with bilateral IBDs, unilateral IBDs and bilateral internal iliac artery (IIA) embolization/coverage. RESULTS 45 studies with a total of 2736 patients undergoing unilateral or bilateral IBDs met inclusion criteria and were included in the analysis. The pooled technical success rate of IBD was 98.0% (CI: 97.3-98.7%). Following IBD treatment, the 30-day mortality rate was 0.4% (CI: 0.07-0.70%); 30-day patency was 98.4% (CI: 97.7-99.0%); buttock claudication developed in 1.84% (CI: 1.26-2.41%); endoleak occurred in 11.9% (CI: 9.2-14.7%) and re-intervention in 7.6% (CI: 5.65-9.58%). Furthermore, in the patients with bilateral iliac artery involvement the pooled estimate rates of buttock claudication were 0.7% in bilateral IBD group, 7.9% in unilateral IBD with contralateral IIA embolization patients and 33.8% in bilateral IIA embolization/coverage patients, which were statistically significant among the three groups. Sexual dysfunction was 5.0% in bilateral IIA occlusion group, which was significantly higher than that in IBD groups. CONCLUSIONS The utilization of IBDs in treatment of aortoiliac or isolated iliac artery aneurysms is associated with high technical success rates as well as low incidences of pelvic ischemia. The risk of postoperative buttock claudication can be further decreased with both IIA preservation if patients are anatomically suitable for bilateral IBDs.
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Li Z, Zhou M, Wang G, Yuan T, Wang E, Zhao Y, Shu X, Zhang Y, Lin P, Fu W, Wang L. A Multicenter Assessment of Anatomic Suitability for Iliac Branched Devices in Eastern Asian Patients With Unilateral and Bilateral Aortoiliac Aneurysms. Front Cardiovasc Med 2022; 8:763351. [PMID: 35047573 PMCID: PMC8762359 DOI: 10.3389/fcvm.2021.763351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/07/2021] [Indexed: 11/21/2022] Open
Abstract
Objective: This study aims to assess the suitability of four types of commercial iliac branch device systems to treat Eastern Asian abdominal aortic aneurysm (AAA) patients with bilateral or unilateral common iliac artery aneurysms (CIAAs). Methods: Patients with a coexisting AAA and a unilateral or bilateral CIAAs who underwent endovascular aneurysm repair (EVAR) at two tertiary centers in China from 2015 to 2017 were reviewed. Morphology of lesions was measured and the anatomic suitability for Cook iliac branch device (IBD), Gore iliac branch endoprosthesis (IBE), Lifetech iliac branch stent graft (IBSG), and Jotec IBD was evaluated according to the latest instructions for use. Results: Seventy-six patients with AAA were enrolled, including 35 bilateral CIAAs, 41 unilateral CIAAs. A hundred and eleven lesions were investigated aggregately: 16.2, 28.8, 21.6, and 19.8% met the criteria for Cook IBD, Gore IBE, Lifetech IBSG, and Jotec IBD, respectively. A total of 34 (44.7%) patients could be treated for at least one lateral lesion. The diameter of the internal iliac artery (IIA) was the most common restriction for IBD application. Additionally, the IIA diameter of lesions in the bilateral group was significantly larger compared with the unilateral group (P < 0.001). Based on the anatomical characteristics alone, it is likely that IBDs will be more suitable for unilateral lesions than bilateral ones (P < 0.05). However, there was no difference between the suitability for patients with unilateral or bilateral CIAAs (P > 0.05). Conclusions: Less than half of Eastern Asian patients with aortoiliac aneurysms were eligible for IBD application. This was primarily due to the IIA diameter failing to meet the criteria. And thus, the suitability of lesions in bilateral group was significantly lower than that in the unilateral group. Aiming to expand the indications and optimize the design of the iliac branch devices, IIA diameter and the anatomical characteristics of the bilateral lesions should be considered deliberately.
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Affiliation(s)
- Zheyun Li
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Vascular Surgery Institute of Fudan University, Shanghai, China
| | - Min Zhou
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Guili Wang
- Department of Vascular Surgery, Affiliated Jinan Central Hospital of Shandong First Medical University, Jinan, China
| | - Tong Yuan
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Vascular Surgery Institute of Fudan University, Shanghai, China
| | - Enci Wang
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Vascular Surgery Institute of Fudan University, Shanghai, China
| | - Yufei Zhao
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Vascular Surgery Institute of Fudan University, Shanghai, China
| | - Xiaolong Shu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Vascular Surgery Institute of Fudan University, Shanghai, China
| | - Yuchong Zhang
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Vascular Surgery Institute of Fudan University, Shanghai, China
| | - Peng Lin
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Vascular Surgery Institute of Fudan University, Shanghai, China
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Vascular Surgery Institute of Fudan University, Shanghai, China
- Department of Vascular Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
- *Correspondence: Weiguo Fu
| | - Lixin Wang
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Vascular Surgery Institute of Fudan University, Shanghai, China
- Department of Vascular Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
- Lixin Wang
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Huang TY, Yeh CH, Wang YC, Cheng YT, Feng PC. Progressing left-side sciatica revealing a common iliac artery mycotic aneurysm in an elderly patient: A CARE-compliant case report. Medicine (Baltimore) 2020; 99:e22476. [PMID: 33031278 PMCID: PMC7544384 DOI: 10.1097/md.0000000000022476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Sciatica is usually caused by lumbar spine disease; the incidence of sciatica from extra-spinal causes is noted to be only about 0.09%. PATIENT CONCERNS We report a case of a 92-year-old man who came to the neurologist outpatient department due to left buttock pain and numbness that radiated to the left lower leg in the recent 6 months and progressed rapidly over 10 days. DIAGNOSIS We arranged magnetic resonance imaging for lumbar nerve lesion. Magnetic resonance imaging showed a common iliac artery mycotic aneurysm, at about 6.3 cm in diameter, which compressed the psoas muscle, nerve plexus, and vein. INTERVENTIONS We used a left-side iliac bifurcation stent graft of 12 mm in diameter for aneurysm repair. An internal iliac artery with a stent graft of 10 mm x 5 cm. An abdomen aortic aneurysm stent was inserted, 1 cm beneath the right renal artery from the right side femoral artery. OUTCOMES After endovascular repair and 4 weeks of antibiotic treatment, he could walk again, and no sciatica was noted. We repeated computed tomography 5 months after the operation and noted that the size of the iliac artery aneurysm decreased without stent graft migration or extravasation. Our patient recovered from sciatic and left leg weakness; above all, he could walk again. LESSONS We suggest practitioners check for common iliac artery aneurysms in the diagnosis of symptoms mimicking spinal cord origin sciatica, especially in elder patients.
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Affiliation(s)
- Tzu-Yen Huang
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital at Keelung
- Department of Biomedical Engineering, National Taiwan University
| | - Chi-Hsiao Yeh
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital at Keelung
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital at Linkou
- College of Medicine, Chang Gung University, Taiwan
| | - Yao-Chang Wang
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital at Keelung
| | - Yu-Ting Cheng
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital at Linkou
| | - Pin-Chao Feng
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital at Linkou
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He Y, Zhang H, Sun G, Cao L, Wang X, Ge Y, Liu X, Jia X, Ma X, Xiong J, Wu Y, Wei R, Jia S, Guo W. Application of a Reversed Off-the-Shelf Iliac Branched Device Stent in Revascularization of the Renal Artery Originating from the False Lumen. Ann Vasc Surg 2020; 67:569.e1-569.e7. [PMID: 32234399 DOI: 10.1016/j.avsg.2020.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/12/2020] [Accepted: 03/14/2020] [Indexed: 10/24/2022]
Abstract
Fenestrated/branched endovascular aneurysm repair is a feasible and effective treatment option for patients with postdissection thoracoabdominal/abdominal aneurysm. However, this technique is cumbersome when the target vessel originates from the false lumen. We herein report our primary experiences in utilizing a reversed off-the-shelf iliac branched device (IBD) stent to reconstruct the renal artery originating from the false lumen. This technique was performed in 3 patients (all men; 49, 46, and 45 years old) in our center. After deployment of the main aortic endograft, the distal re-entry in the common iliac artery was dilated by a balloon. The off-the-shelf IBD was then reversely deployed to allow for deployment of the bridging stent graft. Finally, the IBD and the bridging stents were assembled and the IBD was connected to the main graft. No migration of the IBDs occurred, and all target vessels remained patent during follow-up. Utilization of a reversed off-the-shelf IBD for the renal artery originating from the false lumen is a feasible option, especially for patients with specific anatomical characteristics of postdissection aortic aneurysms.
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Affiliation(s)
- Yuan He
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Hongpeng Zhang
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Guoyi Sun
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Long Cao
- Department of General Surgery, Chinese PLA No. 983 Hospital, Tianjin, People's Republic of China
| | - Xinhao Wang
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yangyang Ge
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xiaoping Liu
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xin Jia
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xiaohui Ma
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Jiang Xiong
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Ye Wu
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Ren Wei
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Senhao Jia
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Wei Guo
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China.
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