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Liao H, Zhou E, Tang Y, He C. Endovascular repair of bilateral isolated common iliac artery aneurysms with unsuitable anatomy utilizing an aortic bifurcated unibody endograft and modified sandwich technique to preserve pelvic blood flow: a case series. J Cardiothorac Surg 2024; 19:210. [PMID: 38616244 PMCID: PMC11017656 DOI: 10.1186/s13019-024-02674-2] [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: 08/05/2023] [Accepted: 03/23/2024] [Indexed: 04/16/2024] Open
Abstract
Bilateral isolated common iliac artery aneurysms (CIAAs) are rare, and endovascular repair of CIAAs has emerged as an alternative to traditional open surgical repair. The primary goal of therapy is to exclude the aneurysm sac while maintaining perfusion of at least one internal iliac artery (IIA) to prevent pelvic ischemia. Although the iliac branch device (IBD) has improved the feasibility of preserving the IIA, its applicability is limited to a specific subset of aneurysm anatomy. We present a case series of three patients with bilateral isolated CIAAs in whom preoperative CT scans revealed an absence of a landing zone, the diameter of proximal CIA diameter was less than 13.0 mm, and normal diameter of the nonaneurysmal infrarenal aorta, making it challenging to use an IBD alone or a standard bifurcated aortic endograft to provide a proximal landing zone for iliac artery stenting. To overcome the small diameter of the infrarenal aorta, we implanted an aortic bifurcated unibody endograft. Then, we utilized a balloon-expandable covered stent-graft with overdilation as a modified sandwich technique to create an "eye of the tiger" configuration to prevent gutter leakage. The final angiography performed during the procedure revealed successful exclusion of the aneurysms, with blood flow to the right IIA and no type III endoleak. During the postoperative follow-up period, no patients exhibited symptoms associated with pelvic ischemia. There were no endoleaks or sac expansions on the two-year follow-up CT scans, and all external and internal iliac graft limbs were patent. This study demonstrated that a combination of an aortic bifurcated unibody endograft and a modified sandwich technique can effectively treat bilateral isolated CIAAs with certain anatomical constraints.
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Affiliation(s)
- Haodong Liao
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, CN, China
| | - Enquan Zhou
- Department of Interventional Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, CN, China
| | - Yongjiang Tang
- Department of Vascular Disease, Panzhihua Municipal Central Hospital, Panzhihua, Sichuan, CN, China
| | - Chunshui He
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, Sichuan, CN, China.
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Hariri O, Al Laham O, Mohammad A. A distinguished case of a spontaneously dissecting Left Common Iliac Artery Aneurysm, associated with an Elastinopathy, in a healthy 36-year-old male, successfully treated with open surgical repair - A Case Report. Int J Surg Case Rep 2022; 95:107253. [PMID: 35661499 PMCID: PMC9163487 DOI: 10.1016/j.ijscr.2022.107253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/25/2022] [Accepted: 05/28/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Elastin is a major protein of the Extracellular Matrix (ECM), essential in providing elasticity to the vascular wall, which enables blood vessels to reversibly expand and contract. Several inherited or acquired etiologies, such as elastinopathies and fibrillinopathies negatively impact the objective of the Extracellular Matrix via compromising the Elastin fibers in the Cardiovascular System (CVS) and the skin. Such compromises will have devastating ramifications through the increase in vascular wall stiffness and the inability to properly dissipate energy. This impact on the vascular wall will contribute to the development of arterial aneurysms and dissections. CASE PRESENTATION Our case is of a 36-year-old previously healthy male patient who presented with an acute onset of left lower limb pain associated with cold sensation two days prior to admission. Radiology demonstrated a dissecting aneurysm in the left Common Iliac Artery. CLINICAL DISCUSSION The patient was surgically treated with an Aorto-bi-Femoral Bypass (ABFB). Histopathological analysis of the excised aortic and iliac specimens revealed no Elastin fibers in the vessel walls. CONCLUSION Isolated Iliac aneurysms are a rare entity and are challenging to diagnose preoperatively. In our case, there were no risk factors whatsoever and the patient's history - including family history - was negative. It is vital to establish preoperative diagnostic approaches in such cases and keep them in mind so that we can diminish the morbidity and mortality resultants from the complications.
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Affiliation(s)
- Omar Hariri
- Department of Surgery, Al-Mouwasat University Hospital, Mazzah, Damascus, Syria; Department of Surgery, Al Assad University Hospital, April 17th St. Kafar Sousah, Damascus, Syria.
| | - Omar Al Laham
- Department of Surgery, Al-Mouwasat University Hospital, Mazzah, Damascus, Syria; Department of Surgery, Al Assad University Hospital, April 17th St. Kafar Sousah, Damascus, Syria.
| | - Ammar Mohammad
- Department of Vascular Surgery, Al Assad University Hospital, April 17th St. Kafar Sousah, Damascus, Syria.
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Papadoulas S, Kakkos SK, Ntouvas I, Nikolakopoulos K, Tsantrizos P, Papageorgopoulou C, Kouri N. Custom-Made Bifurcated Prosthetic Graft for Aortoiliac Aneurysm Repair. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2021; 9:88-91. [PMID: 34619797 PMCID: PMC8526147 DOI: 10.1055/s-0041-1725090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Revascularization of the internal iliac artery during open repair of aortoiliac aneurysms can be challenging, especially if there is a significant distance between the orifices of the internal and external iliac arteries owing to common iliac aneurysmal dilatation. We describe a technique involving insertion of an 18-mm tube graft between the proximal aortic neck and aneurysmal common iliac artery bifurcation. Revascularization of the contralateral external iliac artery is accomplished through an 8-mm side arm graft.
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Affiliation(s)
- Spyros Papadoulas
- Department of Vascular Surgery, University Hospital of Patras, Patras, Greece
| | - Stavros K Kakkos
- Department of Vascular Surgery, University Hospital of Patras, Patras, Greece
| | - Ioannis Ntouvas
- Department of Vascular Surgery, University Hospital of Patras, Patras, Greece
| | | | - Polyzois Tsantrizos
- Department of Vascular Surgery, University Hospital of Patras, Patras, Greece
| | | | - Natasa Kouri
- Department of Vascular Surgery, University Hospital of Patras, Patras, Greece
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Papoian SA, Shchegolev AA, Chernaia NR, Khutornoĭ NV, Sazonov MI. [Endoprosthetic repair of iliac artery aneurysm with a branch of the Anaconda stent graft]. ANGIOLOGIIA I SOSUDISTAIA KHIRURGIIA = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:152-157. [PMID: 35050261 DOI: 10.33529/angio2021422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
An iliac artery aneurysm is characterized by arterial lumen dilatation which is more than 1.5 times greater than the normal diameter of the artery. In clinical practice, this pathology is rarely encountered, being associated with arterial hypertension and smoking, and more often observed in men. Its natural course inevitably leads to aneurysmal rupture. Treatment is only operative. Is admissible to use both open and endovascular techniques, with preference given to endovascular interventions using special linear endografts. Presented herein are two clinical case reports concerning endoprosthetic repair of an iliac artery aneurysm with a branch of the bifurcated stent graft Terumo Aortic Anaconda. The operative interventions had no complications in either peri- or postoperative periods. Our experience shows that endoprosthetic repair of an isolated aneurysm of the common iliac artery with a branch of the bifurcated stent graft Terumo Aortic Anaconda combines safety and efficacy and may be used by a wide range of vascular and roentgenoendovascular surgeons.
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Affiliation(s)
- S A Papoian
- Department of Hospital Surgery of Paediatric Faculty, N.I. Pirogov Russian National Research Medical University of the RF Ministry of Public Health, Moscow, Russia; Department of Vascular Surgery, Municipal Clinical Hospital named after F.I. Inozemtsev, Moscow, Russia
| | - A A Shchegolev
- Department of Hospital Surgery of Paediatric Faculty, N.I. Pirogov Russian National Research Medical University of the RF Ministry of Public Health, Moscow, Russia
| | - N R Chernaia
- Department of Roentgenosurgical Methods of Diagnosis and Treatment, N.V. Sklifosovsky Research Institute of Emergency Medicine, Moscow, Russia
| | - N V Khutornoĭ
- Department of Hospital Surgery of Paediatric Faculty, N.I. Pirogov Russian National Research Medical University of the RF Ministry of Public Health, Moscow, Russia
| | - M Iu Sazonov
- Department of Vascular Surgery, Municipal Clinical Hospital named after F.I. Inozemtsev, Moscow, Russia
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Khilchuk A, Vlasenko S, Muradyan M, Agarkov M, Abdulkarim D, Shcherbak S, Gladyshev D, Sarana A, Litvinovskii S, Kovalik V. CT-fusion-guided endovascular repair of iatrogenic common iliac artery aneurysm: A case report. Radiol Case Rep 2019; 14:1394-1400. [PMID: 31700554 PMCID: PMC6823823 DOI: 10.1016/j.radcr.2019.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/04/2019] [Accepted: 09/04/2019] [Indexed: 11/28/2022] Open
Abstract
We present a case of a CT-fusion-guided endovascular repair of an iatrogenic common iliac artery aneurysm in a 60-year-old male with a history of robotic prostatectomy with wide lymphadenectomy. Taking into account iatrogenic nature, rapid evolvement, previous surgical intervention, and oncological history, our team, including vascular and endovascular surgeons, refused open surgery in favor of endovascular iliac repair. We coiled the ipsilateral hypogastric artery and then deployed 2 Fluency Plus stent grafts from the common iliac into the external iliac artery. All manipulations were made under CT-fusion vascular mask control, which provided precise neck positioning, a minimal contrast infusion, reduced radiation dose, and better overall control. Our results suggest that anatomically suitable isolated iliac aneurysms can be successfully and safely treated with CT-fusion-guided endovascular repair without major perioperative and mid-term complications. The case is highlighting the potential complexity of repeated surgery with previously operated patients and the necessity of surgical and endovascular team interactions, especially in case of iatrogenic vascular complications.
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Affiliation(s)
- Anton Khilchuk
- Department of Interventional Radiology, Saint-Petersburg City Hospital №40, Borisova str. 9, Sestroretsk, Saint-Petersburg 197706, Russian Federation.,Medical Faculty, Saint-Petersburg State University, Saint-Petersburg, Russian Federation.,Endovascular and Arrhythmology Department, Russian National Research Center of Surgery Named After Academician B.V. Petrovsky, Moscow, Russian Federation
| | - Sergei Vlasenko
- Department of Interventional Radiology, Saint-Petersburg City Hospital №40, Borisova str. 9, Sestroretsk, Saint-Petersburg 197706, Russian Federation.,Medical Faculty, Saint-Petersburg State University, Saint-Petersburg, Russian Federation
| | - Musheg Muradyan
- Department of Interventional Radiology, Saint-Petersburg City Hospital №40, Borisova str. 9, Sestroretsk, Saint-Petersburg 197706, Russian Federation
| | - Maksim Agarkov
- Department of Interventional Radiology, Saint-Petersburg City Hospital №40, Borisova str. 9, Sestroretsk, Saint-Petersburg 197706, Russian Federation
| | - Dana Abdulkarim
- Department of Interventional Radiology, Saint-Petersburg City Hospital №40, Borisova str. 9, Sestroretsk, Saint-Petersburg 197706, Russian Federation
| | - Sergei Shcherbak
- Medical Faculty, Saint-Petersburg State University, Saint-Petersburg, Russian Federation
| | - Dmitrii Gladyshev
- Medical Faculty, Saint-Petersburg State University, Saint-Petersburg, Russian Federation.,General Surgery Department, City Hospital №40, Saint-Petersburg, Russian Federation
| | - Andrei Sarana
- Medical Faculty, Saint-Petersburg State University, Saint-Petersburg, Russian Federation
| | - Sergei Litvinovskii
- Department of Cardiovascular Surgery, City Hospital №40, Saint-Petersburg, Russian Federation
| | - Vladislav Kovalik
- Pavlov First Saint-Petersburg State Medical University, Saint-Petersburg, Russian Federation
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Date Y, Takano T, Fujii T, Terasaki T, Sakaguchi M. Double D Technique: An Innovative Modified Bifurcated Stent Graft Deployment Strategy for an Isolated Common Iliac Artery Aneurysm With a Challenging Renal Artery Anatomy. Vasc Endovascular Surg 2019; 53:613-616. [PMID: 31307324 DOI: 10.1177/1538574419862671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Endovascular aneurysm repair (EVAR) for an isolated common iliac artery aneurysm (iCIAA) sometimes requires a bifurcated stent graft (SG). In EVAR, it is essential to preserve the renal artery (RA). However, this is challenging in cases of anatomical variation. The double D technique (DDT) can be used in anatomically inadequate cases with a commercially approved bifurcated SG. Here, we report the repair of iCIAA in the presence of a challenging RA anatomy, through EVAR using the DDT. CASE REPORT An 84-year-old woman was diagnosed with a maximal 35-mm diameter left iCIAA and a nonaneurysmal aorta by computed tomography (CT), which also showed that the right RA arose 50-mm above the aortic bifurcation. The DDT was chosen because commercially approved bifurcated SGs typically require a distance of >70 mm from the proximal position to the aortic bifurcation. Postoperative CT showed excellent results with no endoleaks or SG kinking and occlusion, as well as preservation of robust blood flow to the right RA. CONCLUSION Endovascular aneurysm repair using the DDT can be an alternative option for treatment of iCIAA with a challenging RA anatomy.
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Affiliation(s)
- Yusuke Date
- 1 Department of Cardiovascular Surgery, Nagano Red Cross Hospital, Nagano, Japan
| | - Tamaki Takano
- 1 Department of Cardiovascular Surgery, Nagano Red Cross Hospital, Nagano, Japan
| | - Taishi Fujii
- 1 Department of Cardiovascular Surgery, Nagano Red Cross Hospital, Nagano, Japan
| | - Takamitsu Terasaki
- 1 Department of Cardiovascular Surgery, Nagano Red Cross Hospital, Nagano, Japan
| | - Masayuk Sakaguchi
- 1 Department of Cardiovascular Surgery, Nagano Red Cross Hospital, Nagano, Japan
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Taneva GT, Torsello G, Donas KP. Insights and Clinical Implications from the pELVIS Registry for the Treatment of Aneurysms Involving the Iliac Bifurcation. VASCULAR AND ENDOVASCULAR REVIEW 2019. [DOI: 10.15420/ver.2018.22.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The pErformance of iLiac branch deVIces for aneurysmS (pELVIS) Registry is the largest retrospective analysis of prospectively collected data on the use of iliac branch devices (IBD) for the treatment of iliac and aortoiliac aneurysms. It shows the feasibility of the technique with good short- and mid-term results. The most common anatomical challenge for IBD use is the presence of aneurysmal deterioration of the internal iliac arteries (IIA). Experience acquired in the registry treating concomitant aneurysmal lesions of the IIA provides significant information on the performance of IBDs for this specific clinical presentation. Treatment of isolated aneurysms in the common iliac artery without extension to the infrarenal aorta showed favourable results with lower costs, and lower use of irradiation and contrast media. Overall, the relatively low procedure-related complications and repeat interventions show broad applicability of the technique. Further analysis is required to evaluate the longstanding performance of IBD.
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Affiliation(s)
- Gergana T Taneva
- Department of Vascular Surgery, St Franziskus Hospital Münster, Münster, Germany
| | - Giovanni Torsello
- Department of Vascular Surgery, St Franziskus Hospital Münster, Münster, Germany
| | - Konstantinos P Donas
- Department of Vascular Surgery, St Franziskus Hospital Münster, Münster, Germany
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8
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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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Fargion AT, Masciello F, Pratesi C, Pratesi G, Torsello G, Donas KP, Austermann M, Weiss K, Bosiers M, Dorigo W, Cao P, Ferrer C, Ippoliti A, Barbante M, Pitoulias GA, Verzini F, Parlani G, Simonte G, Kölbel T, Tsilimparis N, Haulon S, Branzan D, Schmidt A. Results of the multicenter pELVIS Registry for isolated common iliac aneurysms treated by the iliac branch device. J Vasc Surg 2018; 68:1367-1373.e1. [DOI: 10.1016/j.jvs.2018.02.032] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/17/2018] [Indexed: 10/28/2022]
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10
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Maltezos C, Galyfos G, Kerasidis S, Geropapas G, Makris N. Staged Endovascular Repair of Isolated Bilateral Internal Iliac Artery Aneurysms: A Case Report. Int J Angiol 2016; 25:e156-e159. [PMID: 28031685 PMCID: PMC5186299 DOI: 10.1055/s-0035-1566741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
This report aims to present an unusual case with isolated bilaterally located internal iliac artery aneurysms (IIAAs) that were incidentally detected. Owing to the high surgical risk of the patient and anatomical location of the aneurysms, an endovascular management was preferred. Initially, the patient underwent a percutaneous embolization of the right-sided aneurysm with coiling. A stent-graft deployment covering the orifice of the left-sided internal iliac artery and occluding the ipsilateral aneurysm followed 1 month later. The patient remains asymptomatic after 6 months. Endovascular management has been associated with lower morbidity and hospital stay compared with open repair for IIAAs, although both techniques show satisfying early and mid-term results. Especially for bilaterally located aneurysms, a staged strategy decreases the risk for ischemic complications. Finally, endovascular methods should be preferred when there are no compression symptoms or in cases of higher surgical risk.
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Affiliation(s)
| | - George Galyfos
- Department of Vascular Surgery, ‘KAT’ General Hospital of Athens, Athens, Greece
| | - Stavros Kerasidis
- Department of Vascular Surgery, ‘KAT’ General Hospital of Athens, Athens, Greece
| | - Georgios Geropapas
- Department of Vascular Surgery, ‘KAT’ General Hospital of Athens, Athens, Greece
| | - Nikolaos Makris
- Department of Radiology, ‘KAT’ General Hospital of Athens, Athens, Greece
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11
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Buck DB, Bensley RP, Darling J, Curran T, McCallum JC, Moll FL, van Herwaarden JA, Schermerhorn ML. The effect of endovascular treatment on isolated iliac artery aneurysm treatment and mortality. J Vasc Surg 2015; 62:331-5. [PMID: 25943454 DOI: 10.1016/j.jvs.2015.03.027] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/11/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Isolated iliac artery aneurysms are rare, but potentially fatal. The effect of recent trends in the use of endovascular iliac aneurysm repair (EVIR) on isolated iliac artery aneurysm-associated mortality is unknown. METHODS We identified all patients with a primary diagnosis of iliac artery aneurysm in the National Inpatient Sample from 1988 to 2011. We examined trends in management (open vs EVIR, elective and urgent) and overall isolated iliac artery aneurysm-related deaths (with or without repair). We compared in-hospital mortality and complications for the subgroup of patients undergoing elective open and EVIR from 2000 to 2011. RESULTS We identified 33,161 patients undergoing isolated iliac artery aneurysm repair from 1988 to 2011, of which there were 9016 EVIR and 4933 open elective repairs from 2000 to 2011. Total repairs increased after the introduction of EVIR, from 28 to 71 per 10 million United States (U.S.) population (P < .001). EVIR surpassed open repair in 2003. Total isolated iliac artery aneurysm-related deaths, due to rupture or elective repair, decreased after the introduction of EVIR from 4.4 to 2.3 per 10 million U.S. population (P < .001). However, urgent admissions did not decrease during this time period (15 to 15 procedures per 10 million U.S. population; P = .30). Among elective repairs after 2000, EVIR patients were older (72.4 vs 69.4 years; P = .002) and were more likely to have a history of prior myocardial infarction (14.0% vs 11.3%; P < .001) and renal failure (7.2% vs 3.6%; P < .001). Open repair had significantly higher rate of in-hospital mortality (1.8% vs 0.5%; P < .001) and complications (17.9% vs 6.7%; P < .001) and a longer length of stay (6.7 vs 2.3 days; P < .001). CONCLUSIONS Treatment of isolated iliac artery aneurysms has increased since the introduction of EVIR and is associated with lower perioperative mortality, despite a higher burden of comorbid illness. Decreasing iliac artery aneurysm-attributable in-hospital deaths are likely related primarily to lower elective mortality with EVIR rather than rupture prevention.
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Affiliation(s)
- Dominique B Buck
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rodney P Bensley
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Jeremy Darling
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Thomas Curran
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - John C McCallum
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Frans L Moll
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
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12
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Tsotetsi SC, Mulaudzi TV, Sikhosana MH, de Vries JPPM. Endovascular interventions for human immunodeficiency virus-associated iliac artery aneurysms. Vascular 2014; 23:570-4. [PMID: 25416750 DOI: 10.1177/1708538114560457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Aneurysms associated with human immunodeficiency virus (HIV) are pseudo-aneurysms and the pathology is unique to HIV vasculopathy. We report outcomes of endovascular therapy for HIV iliac artery aneurysms in a series of patients to augment the sparse literature on these aneurysms. METHODS The records from January 2010 to December 2013 of all patients treated for HIV-related iliac artery aneurysms were extracted from a prospectively maintained database at our institution. RESULTS Preprocedural, periprocedural, and postprocedural data were retrieved for five black patients (three males and two females), who were treated for HIV-associated iliac artery aneurysms. All patients underwent endovascular therapy. There were seven aneurysms (three common iliac arteries, three internal, and one external). Pain was a common presenting feature, and two patients presented with rupture. One patient was receiving antiretroviral therapy, and one patient was receiving treatment for pulmonary tuberculosis. Three patients had significant weight loss. The average hemoglobin value was 8 g/dl. Six aneurysms were managed with covered stents and one (internal iliac artery) with coil embolization. There were no procedure-related complications, and only one patient required a blood transfusion. Symptoms resolved in all patients. One re-intervention was required for stent thrombosis after 30 days. CONCLUSION Endovascular therapy for the HIV-associated iliac artery aneurysm has good short-term results and avoids pelvic dissection with its associated morbidity and mortality.
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Affiliation(s)
- S C Tsotetsi
- Department of Vascular Surgery, Steve Biko Academic Hospital, South Africa
| | - T V Mulaudzi
- Department of Vascular Surgery, Steve Biko Academic Hospital, South Africa
| | - M H Sikhosana
- Department of Vascular Surgery, Steve Biko Academic Hospital, South Africa
| | - J P P M de Vries
- Department of Vascular Surgery, St. Antonius Hospital, The Netherlands
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13
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Complex common and internal iliac or aortoiliac aneurysms and current approach: individualised open-endovascular or combined procedures. Int J Vasc Med 2014; 2014:178610. [PMID: 25328706 PMCID: PMC4195433 DOI: 10.1155/2014/178610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 07/12/2014] [Accepted: 07/14/2014] [Indexed: 11/17/2022] Open
Abstract
Objective. Bilateral internal iliac artery aneurysms constitute the utmost configuration of infrarenal aortoiliac disease. We detail characteristic aortoiliac disease patterns and reconstructive techniques we have used, along with a visualized decision-making chart and a short review of the literature. Material and Methods. A retrospective, observational study of twelve clinical cases of patients with aortoiliac disease are described. Two patients had a common iliac artery aneurysm and were managed by the application of inversed stent-grafts; another case was repaired by the insertion of a standard bifurcated stent-graft flared in the right common iliac artery and with an iliac branched device in the left iliac arterial axis. Open approach was used in 5 cases and in 4 cases a combination of aortouniliac stent-grafting with femoral-femoral bypass was applied. Results. Technical success was 100%. One endoleak type Ib in a flared iliac limb was observed and corrected by internal iliac embolism and use of an iliac limb stent-graft extension. We report 100% patency rate during 26.3 months of followup. Conclusion. Individualized techniques for the management of isolated iliac or aortoiliac aneurismal desease with special concern in maintaining internal iliac artery perfusion lead to elimination of perioperative complications and long-term durability and patency rates.
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Igari K, Kudo T, Toyofuku T, Jibiki M, Inoue Y. Comparison between endovascular repair and open surgery for isolated iliac artery aneurysms. Surg Today 2014; 45:290-6. [DOI: 10.1007/s00595-014-0971-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 02/14/2014] [Indexed: 11/29/2022]
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Uberoi R, Tsetis D, Shrivastava V, Morgan R, Belli AM. Standard of Practice for the Interventional Management of Isolated Iliac Artery Aneurysms. Cardiovasc Intervent Radiol 2010; 34:3-13. [PMID: 21161661 DOI: 10.1007/s00270-010-0055-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 10/15/2010] [Indexed: 11/30/2022]
Affiliation(s)
- Raman Uberoi
- Department of Interventional Radiology, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
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Sena Ruiz F, Lozano Vilardell P, Merino Mairal O, Riera Vázquez R. Evolución del diámetro iliaco tras resección de aneurisma aórtico e interposición de injerto aorto-aórtico. ANGIOLOGIA 2010. [DOI: 10.1016/s0003-3170(10)70052-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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17
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Torsello G, Schönefeld E, Osada N, Austermann M, Pennekamp C, Donas KP. Endovascular Treatment of Common Iliac Artery Aneurysms Using the Bell-Bottom Technique: Long-term Results. J Endovasc Ther 2010; 17:504-9. [DOI: 10.1583/10-3112.1] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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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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Giant iliac artery aneurysm. Open Med (Wars) 2010. [DOI: 10.2478/s11536-008-0059-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractIsolated iliac artery aneuryms are very rare vascular malformations. They can remain unnoticed for long periods of time because of their deep location in the pelvic region. Most of the patients present to the clinic with rupture of the aneurysm, and thus the condition has a very high mortality rate. We report here the case of an 84-year-old man with giant iliac artery aneuryms who was treated successfully by aneurysmectomy and aortoiliac bypass.
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Ferreira J, Canedo A, Brandão D, Maia M, Braga S, Chaparro M, Barreto P, Vaz G. Isolated iliac artery aneurysms: six-year experience. Interact Cardiovasc Thorac Surg 2009; 10:245-8. [PMID: 19910361 DOI: 10.1510/icvts.2009.218305] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To review the experience of our institution in repairing isolated iliac artery aneurysm (isolated IAA) in the last six years. METHODS The medical records of patients who underwent isolated IAA repair were reviewed, to obtain information on patients' demographics, vascular risk factors, type of treatment and outcome. RESULTS A total of 11 patients with 16 aneurysms, all men, with a mean age of 69.2+/-6.0 years were treated. The mean diameter was 3.7+/-1.0 cm (3.5+/-1.1 cm at elective repair; 5.7+/-2.9 cm on the emergency cases). The majority of aneurysms were at the common iliac artery and 27.3% of them were multiple. The diagnosis of multiple aneurysms was performed 10 years later, compared with the mean age of the diagnosis of single aneurysms, and this difference is statistically significant. Seven (63.6%) had elective operations, and one elective endovascular repair. Analysing the vascular risk factors, it was evident that hypertension was the most prevalent and the diagnosis of aneurysm was done 10 years sooner in the smoker patients. There was no postoperative death in this series. The mean follow-up period was of 21 months, and during it, one patient developed a non-infection anastomotic aneurysm of common femoral artery, one died with a myocardial infarction, one presented with limb graft thrombosis and another was lost. CONCLUSION This series contributes to a better characterization of a rare pathology demonstrating that both surgical and endovascular treatment can be performed with very low morbidity and mortality.
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Affiliation(s)
- Joana Ferreira
- Department of Angiology and Vascular Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
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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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Patel NV, Long GW, Cheema ZF, Rimar K, Brown OW, Shanley CJ. Open vs. endovascular repair of isolated iliac artery aneurysms: A 12-year experience. J Vasc Surg 2009; 49:1147-53. [PMID: 19237261 DOI: 10.1016/j.jvs.2008.11.101] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 11/26/2008] [Accepted: 11/26/2008] [Indexed: 11/19/2022]
Affiliation(s)
- Niyant V Patel
- Division of Vascular Surgery, Department of Surgery, William Beaumont Hospital, Royal Oak, Mich. 48073, USA
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