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Bresler AM, Panthofer A, Kuramochi Y, Olson SL, Eagleton M, Schneider DB, Lyden SP, Blackwelder WC, Uhl CF, Bischoff MS, Matsumura JS, Böckler D. Image-based assessment of aortoiliac aneurysm anatomical characteristics in patients from the global iliac branch study. Langenbecks Arch Surg 2024; 409:135. [PMID: 38649506 PMCID: PMC11035386 DOI: 10.1007/s00423-024-03326-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Endovascular repair is the preferred treatment for aortoiliac aneurysm, with preservation of at least one internal iliac artery recommended. This study aimed to assess pre-endovascular repair anatomical characteristics of aortoiliac aneurysm in patients from the Global Iliac Branch Study (GIBS, NCT05607277) to enhance selection criteria for iliac branch devices (IBD) and improve long-term outcomes. METHODS Pre-treatment CT scans of 297 GIBS patients undergoing endovascular aneurysm repair were analyzed. Measurements included total iliac artery length, common iliac artery length, tortuosity index, common iliac artery splay angle, internal iliac artery stenosis, calcification score, and diameters in the device's landing zone. Statistical tests assessed differences in anatomical measurements and IBD-mediated internal iliac artery preservation. RESULTS Left total iliac artery length was shorter than right (6.7 mm, P = .0019); right common iliac artery less tortuous (P = .0145). Males exhibited greater tortuosity in the left total iliac artery (P = .0475) and larger diameter in left internal iliac artery's landing zone (P = .0453). Preservation was more common on right (158 unilateral, 34 bilateral) than left (105 unilateral, 34 bilateral). There were 192 right-sided and 139 left-sided IBDs, with 318 IBDs in males and 13 in females. CONCLUSION This study provides comprehensive pre-treatment iliac anatomy analysis in patients undergoing endovascular repair with IBDs, highlighting differences between sides and sexes. These findings could refine patient selection for IBD placement, potentially enhancing outcomes in aortoiliac aneurysm treatment. However, the limited number of females in the study underscores the need for further research to generalize findings across genders.
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Affiliation(s)
- Alina-Marilena Bresler
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
| | - Annalise Panthofer
- Department of Surgery, Division of Vascular Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Yuki Kuramochi
- Vascular Surgery Department, Heart Vascular Thoracic Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sydney L Olson
- Department of Surgery, Division of Vascular Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Matthew Eagleton
- Department of Surgery, Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Darren B Schneider
- Department of Surgery, Division of Vascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Sean P Lyden
- Vascular Surgery Department, Heart Vascular Thoracic Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - William C Blackwelder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christian F Uhl
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Moritz S Bischoff
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Jon S Matsumura
- Department of Surgery, Division of Vascular Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Surgery, Division of Vascular Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
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Wanhainen A, Van Herzeele I, Bastos Goncalves F, Bellmunt Montoya S, Berard X, Boyle JR, D'Oria M, Prendes CF, Karkos CD, Kazimierczak A, Koelemay MJW, Kölbel T, Mani K, Melissano G, Powell JT, Trimarchi S, Tsilimparis N, Antoniou GA, Björck M, Coscas R, Dias NV, Kolh P, Lepidi S, Mees BME, Resch TA, Ricco JB, Tulamo R, Twine CP, Branzan D, Cheng SWK, Dalman RL, Dick F, Golledge J, Haulon S, van Herwaarden JA, Ilic NS, Jawien A, Mastracci TM, Oderich GS, Verzini F, Yeung KK. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2024; 67:192-331. [PMID: 38307694 DOI: 10.1016/j.ejvs.2023.11.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVE The European Society for Vascular Surgery (ESVS) has developed clinical practice guidelines for the care of patients with aneurysms of the abdominal aorta and iliac arteries in succession to the 2011 and 2019 versions, with the aim of assisting physicians and patients in selecting the best management strategy. METHODS The guideline is based on scientific evidence completed with expert opinion on the matter. By summarising and evaluating the best available evidence, recommendations for the evaluation and treatment of patients have been formulated. The recommendations are graded according to a modified European Society of Cardiology grading system, where the strength (class) of each recommendation is graded from I to III and the letters A to C mark the level of evidence. RESULTS A total of 160 recommendations have been issued on the following topics: Service standards, including surgical volume and training; Epidemiology, diagnosis, and screening; Management of patients with small abdominal aortic aneurysm (AAA), including surveillance, cardiovascular risk reduction, and indication for repair; Elective AAA repair, including operative risk assessment, open and endovascular repair, and early complications; Ruptured and symptomatic AAA, including peri-operative management, such as permissive hypotension and use of aortic occlusion balloon, open and endovascular repair, and early complications, such as abdominal compartment syndrome and colonic ischaemia; Long term outcome and follow up after AAA repair, including graft infection, endoleaks and follow up routines; Management of complex AAA, including open and endovascular repair; Management of iliac artery aneurysm, including indication for repair and open and endovascular repair; and Miscellaneous aortic problems, including mycotic, inflammatory, and saccular aortic aneurysm. In addition, Shared decision making is being addressed, with supporting information for patients, and Unresolved issues are discussed. CONCLUSION The ESVS Clinical Practice Guidelines provide the most comprehensive, up to date, and unbiased advice to clinicians and patients on the management of abdominal aorto-iliac artery aneurysms.
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Banks CA, Blakeslee-Carter J, Beck AW, Pearce BJ. Hybrid Pelvic Revascularization in Complex Aortoiliac Aneurysm Repair. Ann Vasc Surg 2024; 99:356-365. [PMID: 37890769 DOI: 10.1016/j.avsg.2023.08.044] [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: 05/07/2023] [Revised: 07/31/2023] [Accepted: 08/28/2023] [Indexed: 10/29/2023]
Abstract
Revascularization of complex pelvic vascular anatomy presents an ongoing clinical challenge when treating aortoiliac disease. As vascular surgeons continue to intervene upon increasingly complex aortoiliac pathology, the role of pelvic revascularization is important for the preservation of pelvic organ function and prevention of devastating spinal cord ischemia. In this study we describe the indications, techniques, and clinical outcomes of a novel hybrid pelvic revascularization repair that focuses on optimizing revascularization while limiting pelvic surgical dissection during the management of complex aortic pathology in patients physiologically or anatomically unsuitable for traditional pelvic revascularization techniques.
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Affiliation(s)
- C Adam Banks
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Juliet Blakeslee-Carter
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Benjamin J Pearce
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL.
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Lee H, Lee JM, Cho S, Hong J. The Use of an Iliac Branch Device: Single-Center Study of Endovascular Preservation of Internal Iliac Artery Flow. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:1339-1349. [PMID: 38107681 PMCID: PMC10721431 DOI: 10.3348/jksr.2023.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/17/2023] [Accepted: 06/30/2023] [Indexed: 12/19/2023]
Abstract
Purpose To determine the efficacy and safety of iliac branch device (IBD) implantation and to evaluate its limitations based on 7 years of experience in a single center. Materials and Methods This single-center study included patients with bilateral common iliac artery aneurysms (CIAAs). We investigated follow-up CT and reviewed the internal iliac artery (IIA) patency and complications related to IBD. A retrospective analysis was performed and the overall survival rate and freedom from reintervention rate were reported according to the Kaplan-Meier method. Results Of the 38 patients with CIAAs, only 10 (12 CIAAs) were suitable for IBD treatment. Five patients underwent unilateral IBD insertion with contralateral IIA embolization, and three (60%) showed claudication; however, symptoms resolved within 6 months. The 7-year freedom from IBD-related reintervention rate was 77.8%. No procedure-related deaths occurred. Conclusion IBD has good technical success and long-term patency rates; however, anatomical factors frequently limit its application, particularly in Asians. Additionally, unilateral IIA embolization showed relatively mild complications and a good prognosis; therefore, it can be performed safely for anatomically complex aortoiliac aneurysms.
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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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Karelis A, Sonesson B, Gallitto E, Tsilimparis N, Forsell C, Leone N, Silingardi R, Mesnard T, Sobocinski J, Isernia G, Resch T, Gargiulo M, Dias NV. Iliac Branch Devices in the Repair of Ruptured Aorto-iliac Aneurysms: A Multicenter Study. J Endovasc Ther 2023:15266028221149922. [PMID: 36683380 DOI: 10.1177/15266028221149922] [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: 01/24/2023]
Abstract
PURPOSE To evaluate the outcomes of preserving the internal iliac artery (IIA) with iliac branched devices (IBDs) during acute endovascular repair of ruptured aortoiliac aneurysms. MATERIAL AND METHODS This is a multicenter retrospective review of all consecutive patients undergoing acute endovascular repair of ruptured aortoiliac aneurysm with an IBD at 8 aortic centers between December 2012 and June 2020. A control group was used where the IIA was intentionally occluded from the same study period. The main outcome measures were 30-day mortality, major adverse events, technical success, and clinical success. Secondary outcomes were buttock claudication, primary patency, primary-assisted and secondary patency of the IBD, occurrence of endoleak types I/III, and reintervention. Values are presented as numbers and percentages or interquartile range in parenthesis. RESULTS Forty-eight patients were included in the study: 24 with IBD and 24 with IIA occlusion. There was no difference in demographics, cardiovascular risk factors, and aneurysm extent. Twenty (83%) of them were hemodynamically stable during the procedure as opposed to 14 (58%, p=.23) with the IIA occlusion. Technical success was achieved in all cases with a procedure time of 180 (133-254) minutes, 45 (23-65) of which were from IBD. There were 2 (8%) deaths during the first 30 days and 2 (8%) major complications unrelated to the IBD, whereas in the IIA occlusion, the figures were 10 (42%) and 7 (29%), respectively. No patient in the IBD group developed buttock claudication compared to 8 (57%, p<.0001) in the IIA occlusion group; 1 (4%) patient developed bowel ischemia on both groups, with 1 in the IIA occlusion group needing resection. The median follow-up duration was 17 months (interquartile range 2-39) for the IBD group, with a primary patency of 60±14% at 3 years that went up to 92±8% with reinterventions (8 reinterventions in 6 patients). When the first 90 days were disregarded, there were no differences in survival between the groups. CONCLUSION IBD is a valid alternative for maintaining the pelvic circulation for endovascular aortic aneurysm repair of ruptured aortoiliac aneurysms. The technical success and midterm outcomes are very satisfactory but require patient selection particularly regarding hemodynamic stability. The reintervention rate is considerable, mandating continuous follow-up. CLINICAL IMPACT This multicenter study demonstrates that ruptured aortoiliac aneurysms do not necessarily require mandatory occlusion of hypogastric arteries. Iliac branch devices are shown to be a valid alternative in highly selected cases, with good midterm results, even if reinterventions are required in a significant proportion of patients.
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Affiliation(s)
- Angelos Karelis
- Vascular Center, Department of Thoracic Surgery and Vascular Diseases, Skåne University Hospital, Malmö, Sweden
| | - Björn Sonesson
- Vascular Center, Department of Thoracic Surgery and Vascular Diseases, Skåne University Hospital, Malmö, Sweden
| | - Enrico Gallitto
- Division of Vascular Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Nikolaos Tsilimparis
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Claes Forsell
- Department of Cardiothoracic Surgery and Cardiothoracic Anesthesia, Linköping University Hospital, Linköping, Sweden
| | - Nicola Leone
- Department of Vascular Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto Silingardi
- Department of Vascular Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Thomas Mesnard
- Department of Vascular Surgery, Aortic Centre, CHU Lille, Lille, France
- Inserm, CHU Lille, Université de Lille, Lille, France
| | | | - Giacomo Isernia
- Unit of Vascular and Endovascular Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Timothy Resch
- Department of Vascular Surgery, Faculty of Health and Medical Sciences, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mauro Gargiulo
- Division of Vascular Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Nuno V Dias
- Vascular Center, Department of Thoracic Surgery and Vascular Diseases, Skåne University Hospital, Malmö, Sweden
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Hwang D, Yun WS, Kim HK, Huh S. Off-label use of an iliac branch device and a reversed iliac limb for a patient with a unilateral common iliac artery aneurysm and a narrow distal aorta: A case report. Medicine (Baltimore) 2023; 102:e32640. [PMID: 36637963 PMCID: PMC9839253 DOI: 10.1097/md.0000000000032640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Current bifurcated aortic endografts are unsuitable for patients with a narrow distal aorta except AFX2, which is unavailable in South Korea. An iliac branch device (IBD) was introduced to exclude iliac aneurysms while preserving the pelvic circulation. With advancements in endovascular techniques, various attempts for outside instructions for use have been reported to be practicable in certain patients. PATIENT CONCERNS A 58-year-old man was referred to our emergency room with an incidentally found left common iliac artery aneurysm (CIAA) in a general checkup. DIAGNOSES Computed tomography angiogram showed a narrow distal aorta that tapered from 20 mm just below the renal artery to 13 mm at aortic bifurcation and a left isolated CIAA with a maximal diameter of 40 mm and 70 mm in length. INTERVENTIONS After left hypogastric artery embolization, the Cook IBD was placed at the aortic bifurcation, and the Bard Covera Plus stent-graft was deployed from the IBD cuff to the left external iliac artery. Then, a reversed Medtronic Endurant iliac limb was implanted into the infrarenal aorta down to the proximal IBD. OUTCOMES The stent grafts were patent without endoleak at the 6-month follow-up. LESSONS In selected patients with an isolated CIAA with a narrow distal aorta, IBD can be used as a main body at the aortic bifurcation for successful aneurysm exclusion. However, considering the application of outside instructions for use, special attention and careful planning must be taken before the procedure.
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Affiliation(s)
- Deokbi Hwang
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Woo-Sung Yun
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, South Korea
- * Correspondence: Woo-Sung Yun, Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, 130 Dongduk-ro, Jung-gu, Daegu 41944, South Korea (e-mail: )
| | - Hyung-Kee Kim
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Seung Huh
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, South Korea
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Franklin RN, Timi JRR, Baumgardt G, Bortoluzzi C, Galego G, Oderich GS, Silveira PG. Laboratory "In-vitro" Evaluation of the Parallel Stent Graft Association for the Iliac Sandwich Technique. Cardiovasc Intervent Radiol 2022; 45:1377-1384. [PMID: 35778578 DOI: 10.1007/s00270-022-03182-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/11/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVES The Iliac Sandwich is an off-label technique that uses parallel stent grafts to treat aortoiliac aneurysms. The purpose of this experimental study is to evaluate the conformability and juxtaposition of stent grafts combinations used in this technique through in-vitro mechanical evaluation, computed tomography (CT) analyses, and a controlled pulsatile flow system. METHODS The combinations of two Viabahn® ("V-V") or Viabahn® and Excluder® iliac extension ("V-E") were analysed using CT imaging with measurement of the gutter area by two independent analysts before and after balloon angioplasty. In a second phase, the parallel stent combinations were also evaluated using CT imaging after being implanted in the aortic aneurysm model with a pulsatile flow system with controlled temperature, viscosity, and density. RESULTS The "V-E" group had a better conformability when compared to the "V-V" group, ensuring smaller gutter areas (0.0064 cm2 ± 0.01 vs. 0.0228 cm2 ± 0.03, p < 0.001). Post dilatation with two non-compliant balloons resulted in enlargement of the gutter area (Area A, p 0.065; Area B, p 0.071). Conversely, post dilatation with a non-compliant balloon for the internal iliac component and a compliant balloon for the external iliac device reduced the gutter area (Area A, p 0.008; Area B, p 0.010). CONCLUSION The combination of Viabahn® and Excluder® iliac extension device ("V-E") had a smaller gutter area compared to two Viabahn® parallel stents for the Iliac Sandwich Technique. Post dilatation using a non-compliant balloon for the internal iliac device and a compliant balloon for the external iliac provided superior conformability and juxtaposition.
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Affiliation(s)
- Rafael Narciso Franklin
- Coris Cirurgia Vascular e Endovascular, Rua Menino Deus, 63 sala 504, Baia Sul Medical Center, Centro, Florianópolis, SC, 88020-210, Brazil. .,Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil.
| | | | | | - Cristiano Bortoluzzi
- Coris Cirurgia Vascular e Endovascular, Rua Menino Deus, 63 sala 504, Baia Sul Medical Center, Centro, Florianópolis, SC, 88020-210, Brazil
| | - Gilberto Galego
- Coris Cirurgia Vascular e Endovascular, Rua Menino Deus, 63 sala 504, Baia Sul Medical Center, Centro, Florianópolis, SC, 88020-210, Brazil.,Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Gustavo S Oderich
- The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Pierre Galvagni Silveira
- Coris Cirurgia Vascular e Endovascular, Rua Menino Deus, 63 sala 504, Baia Sul Medical Center, Centro, Florianópolis, SC, 88020-210, Brazil.,Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
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9
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Bahroloomi D, Qato K, Nguyen N, Schreiber-Gregory D, Conway AM, Giangola G, Carroccio A. External iliac artery extension causes greater aneurysm sac regression than the bell-bottom technique or iliac branch endoprosthesis for repair of concomitant infrarenal aortic and iliac artery aneurysm. J Vasc Surg 2022; 76:132-140. [PMID: 34998943 DOI: 10.1016/j.jvs.2021.12.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Aneurysmal extension of abdominal aortic aneurysms (AAAs) to the common iliac artery (CIA) presents a technical challenge to successful endovascular abdominal aortic aneurysm repair (EVAR). In the present study, we compared sac shrinkage and perioperative outcomes after the bell-bottom technique (BBT), internal iliac artery embolization and external iliac artery extension (EIE), and iliac branch endoprosthesis (IBE). METHODS Using the Vascular Quality Initiative database, a retrospective analysis was conducted for patients who had undergone EVAR from 2013 to 2019. The demographic, anatomic, and perioperative data were analyzed. All patients with a proximal aortic neck length <10 mm and aortic graft diameter >32 mm were excluded from the analysis. The patients were subdivided into four groups according to the distal limb strategy: group 1, control group with a bilateral common iliac artery limb <20 mm; group 2, BBT with either a unilateral or bilateral limb >20 mm; group 3, EIE technique; and group 4, IBE. The primary endpoint was the maximal change in the aortic diameter during follow-up. The secondary endpoints included postoperative complications and the rate of endoleak. RESULTS The records for 14,455 patients who had undergone EVAR were queried and 5788 met the anatomic criteria. The average age was 73 years, and 86.3% were men. The maximal change in the aortic diameter in the control, BBT, IBE, and EIE groups was -7.2 mm, -6.1 mm, -4.6 mm, and -6.8 mm, respectively (P = .06). The differences were not statistically significant on univariate analysis at an average follow-up of 405 days. However, on multivariable analysis (P = .01), compared with the control group, the BBT and IBE groups were 18.4% (odds ratio [OR], 0.816; 95% confidence interval [CI], 0.68-0.98) and 48.0% (OR, 0.52; 95% CI, 0.33-0.82) less likely to experience aneurysmal shrinkage, respectively. In contrast, the EIE group showed no significant difference in shrinkage compared with that in the control group. Multivariable analysis of the groups also revealed that compared directly with the BBT group, the EIE group was 69.5% more likely to have experienced shrinkage in the aortic aneurysmal diameter (OR, 1.70; 95% CI, 1.05-2.75). The BBT and IBE groups had a significantly higher rate of type II endoleaks (17.63% and 16.95%, respectively; P = .03). The EIE group had a higher rate of type Ib endoleaks (1.9%) compared with the BBT (1.1%), IBE (1.7%), and control (0.3%) groups (P = .01). No differences were found between the groups in terms of postoperative myocardial infarction (P = .47) or respiratory (P = .61) or intestinal (P = .71) complications. However, the rates of limb complications and reoperation were higher in the EIE group. CONCLUSIONS The present study revealed that the EIE technique was more likely to demonstrate shrinkage in the aortic aneurysmal diameter than were the BBT and IBE groups compared with the control group on multivariable analysis. The EIE technique was also more likely to result in aneurysmal sac shrinkage than was the BBT group, albeit with greater rates of limb-related complications.
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Affiliation(s)
- Donna Bahroloomi
- Department of General Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, New York, NY.
| | - Khalil Qato
- Department of General Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, New York, NY
| | - Nhan Nguyen
- Department of General Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, New York, NY
| | - Deanna Schreiber-Gregory
- Department of General Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, New York, NY
| | - Allan M Conway
- Department of General Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, New York, NY
| | - Gary Giangola
- Department of General Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, New York, NY
| | - Alfio Carroccio
- Department of General Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, New York, NY
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10
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Outcomes of Unilateral Versus Bilateral Use of the Iliac Branch Endoprosthesis for Elective Endovascular Treatment of Aorto-iliac Aneurysms. Cardiovasc Intervent Radiol 2022; 45:939-949. [DOI: 10.1007/s00270-022-03166-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/05/2022] [Indexed: 12/19/2022]
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11
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Akagi D, Murase K. Successful endovascular repair of iliac artery aneurysms with unsuitable anatomy by combining unibody bifurcated endograft and iliac branch systems to preserve hypogastric artery blood flow: a report of two cases. J Cardiothorac Surg 2022; 17:93. [PMID: 35505409 PMCID: PMC9066821 DOI: 10.1186/s13019-022-01855-1] [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: 11/14/2021] [Accepted: 04/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background To overcome the anatomical limitation of a narrow aorta and short length from the renal artery to the terminal aorta, unibody endograft AFX2 and iliac branch endoprosthesis (IBE) can be combined. Case presentation Case 1: The first patient was an 89-year-old woman who had a right saccular common iliac artery (CIA) aneurysm (38 mm); the abdominal aorta was not aneurysmal (diameter, 19 mm). The right CIA’s origin was 10 mm in diameter. A bifurcated AFX2 was placed in an ordinary manner. Then, IBE was inserted in the right leg of the AFX2. Case 2: The second patient was an 87-year-old man diagnosed with an abdominal aortic aneurysm (55 mm), right dissecting CIA aneurysm (20 mm), and right hypogastric artery aneurysm (22 mm) extending to the bifurcation of the superior and inferior gluteal arteries. The length between the renal artery and terminal aorta was 107 mm. The beginning of the right CIA was segmentally stenotic (13 mm). A bifurcated AFX2 was placed in the infrarenal aorta; IBE was advanced to the origin of the right limb of the AFX2. To control the type 1b endoleak, the right superior gluteal artery was embolized with coils and internal iliac components were deployed toward the inferior gluteal artery. Satisfactory results were obtained in both cases. Conclusion The AFX2 main body and IBE could be combined to preserve hypogastric blood flow and overcome anatomical limitations.
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Affiliation(s)
- Daisuke Akagi
- Department of Vascular Surgery, Tokyo Metropolitan Geriatric Medical Center, Tokyo, Japan. .,Department of Cardiovascular Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki-city, Okayama, Japan.
| | - Kai Murase
- Department of Surgery, Tokyo Metropolitan Geriatric Medical Center, Tokyo, Japan
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12
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Gouveia e Melo R, Fenelli C, Prendes CF, Öz T, Stavroulakis K, Rantner B, Stana J, Tsilimparis N. A Cross Sectional Study on the Anatomic Feasibility of Iliac Side Branch Grafts in a Real-World Setting. J Vasc Surg 2022; 76:724-732. [DOI: 10.1016/j.jvs.2022.02.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/10/2022] [Indexed: 12/31/2022]
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13
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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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14
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Wang L, Shu C, Li Q, Li M, He H, Li X, Shi Y, Qiu J, Wang T, Yang C, Wang M, Li J, Wang H, Sun L. Application of a Novel Common-Iliac-Artery Skirt Technology (CST) in Treating Challenge Aorto-Iliac or Isolated Iliac Artery Aneurysms. Front Cardiovasc Med 2021; 8:745250. [PMID: 34733894 PMCID: PMC8558348 DOI: 10.3389/fcvm.2021.745250] [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: 07/21/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To report a novel common-iliac-artery skirt technology (CST) in treating challenge iliac artery aneurysms. Methods: When required healthy landing zone of common iliac artery (CIA) is not available, CST is a strategy to exclude the internal iliac artery (IIA) and prevent IIA reflux without need of embolization. Patients who received endovascular aneurysm repair (EVAR) in our center from 2014 to 2020 were retrospectively screened, and patients treated with CST or with IIA embolization (IIAE) were enrolled. Results: After retrospective screen of 524 EVAR patients, 39 CST patients, 26 IIAE patients, and 7 CST + IIAE patients were enrolled in this study. CST group suggested to have more aged, hyperlipemia, and smoking patients than IIAE group. Two groups had comparable maximal diameter of abdominal aorta (AA), CIA, EIA, but larger diameter of IIA (CST 19.82 ± 2.281 vs. IIAE 27.82 ± 3.401, p = 0.048), and CIA bifurcation (CST 25.01 ± 1.316 vs. IIAE 29.76 ± 2.775, p = 0.087) was found in IIAE group. Anatomy of 79.5% of CST patients and 92.3% of IIAE patients (p = 0.293) was not suitable for potential use of iliac branch device. CST group had significant shorter surgery time (CST 97.42 ± 3.891 vs. IIAE 141.0 ± 8.010, p < 0.001), shorter hospital stay (CST 15.35 ± 0.873 vs. IIAE 19.32 ± 1.067, p = 0.009), lower in-hospital [CST 0% (0/39) vs. IIAE 11.5% (3/26), p = 0.059] and 1-year follow-up stent related MAEs [CST 6.7% (2/30) vs. IIAE 28.6% (6/21), p = 0.052], but comparable mortality and stent related MAEs for all-cohort follow-up analysis comparing to IIAE group. In our study, a lower in-hospital buttock claudication (BC) rate for CST (CST 20.5% vs. IIAE 46.2%, p = 0.053) and a comparable erectile dysfunction (ED) rate (CST 10.3% vs. IIAE 23.1%, p = 0.352) were found between CST and IIAE groups. After 1 year, both groups had about one third relief of BC symptoms [CST 33.3% (4/12) vs. IIAE 30.7% (4/13), p = 1.000]. Subgroup analysis of 14 patents concomitant with IIA aneurysm in CST group and the 7 CST + IIAE patients were carried out, and no difference was found in mortality, stent MAEs, sac dilation, or reintervention rate. Last, illustration of seven typical CST cases was presented. Conclusion: In selected cases, the CST is a safe, feasible-and-effective choose in treating challenge iliac artery aneurysms and preventing IIA endoleak.
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Affiliation(s)
- Lunchang Wang
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
| | - Chang Shu
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China.,Department of Vascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Quanming Li
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
| | - Ming Li
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
| | - Hao He
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
| | - Xin Li
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
| | - Yin Shi
- Department of Vascular Surgery, Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Jian Qiu
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
| | - Tun Wang
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
| | - Chenzi Yang
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
| | - Mo Wang
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
| | - Jiehua Li
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
| | - Hui Wang
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
| | - Likun Sun
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
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15
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Simonte G, Isernia G, Fino G, Centonza E, Parlani G, Lenti M, Cieri E. The Effect of Manufacturer's Instructions for Use Compliance on Cook ZBIS Iliac-Branched Endograft Long-Term Outcomes. Ann Vasc Surg 2020; 72:454-463. [PMID: 33160059 DOI: 10.1016/j.avsg.2020.09.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Current guidelines indicate iliac-branched endografts (IBDs) as the ideal means to preserve pelvic perfusion during endovascular aortic repair. Because patient vascular anatomy represents the main limitation to extensive use of these devices, off-label application may be considered to expand the number of patients being treated. The aim of this study is to evaluate long-term outcomes obtained using the Cook ZBIS endograft in the treatment of aortoiliac aneurysms as per or outside manufacturer's instruction for use (IFU). METHODS Data from all patients who underwent IBD implant in a single center were reviewed. Study population was divided into two subgroups: Group I treated as per manufacturer's IFU and group II treated outside IFU. RESULTS During the study period (2008-2018), 119 patients were treated with 130 IBDs. Eighty-six patients were treated as per IFU (group I) and 44 outside IFU (group II). Overall technical success was 99.2%. Mean follow-up was of 63.5 ± 38.3 months for group I and 58.3 ± 35.9 months for group II (P = 0.45). Freedom from reintervention at ten years was 79.8% in group I and 69.6% in group II (P = 0.29). Freedom from IBD-related reintervention rate was 98.7% and 95.3% in groups I and II, respectively (P = 0.240). Iliac-branched module thrombosis occurred significantly more in patients treated outside IFU with 4 cases in group I (4.7%) and 10 cases in group II (22.7%), (P = 0.005). Cox regression analysis identified hypogastric artery aneurysm as the only independent predictor for both IBD thrombosis and hypogastric artery occlusion during follow-up. CONCLUSIONS When used by an experienced team, Cook IBDs are safe and effective in the treatment of aortoiliac aneurysms both inside and outside IFU. Anyway a lower target hypogastric patency rate should be expected when treating patients with hypogastric aneurysms.
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Affiliation(s)
- Gioele Simonte
- Vascular Surgery Unit, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
| | - Giacomo Isernia
- Vascular Surgery Unit, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Gianluigi Fino
- Vascular Surgery Unit, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | | | - Gianbattista Parlani
- Vascular Surgery Unit, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Massimo Lenti
- Vascular Surgery Unit, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Enrico Cieri
- Vascular Surgery Unit, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
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16
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Chisci E, Pigozzi C, Alberti A, Masciello F, Troisi N, Turini F, Michelagnoli S. Staged in situ aorto-iliac hybrid technique: an original technique to treat complex juxtarenal and iliac aneurysms. INT ANGIOL 2020; 39:517-524. [PMID: 33140625 DOI: 10.23736/s0392-9590.20.04457-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To report a novel staged hybrid technique to treat complex juxtarenal abdominal aortic aneurysm (JAAA) associated with at least one iliac artery aneurysm (IA) with no adequate distal fixation zone. METHODS The novel technique herein described has two main "staged" steps. The first step consists in creating an adequate distal fixation zone by endovascular means; after hypogastric embolization an iliac stent-graft has placed from 5 mm above the aortic bifurcation to the external iliac artery. The second step is the surgical resection of the JAAA and graft placement sutured distally to the stent-graft which was always performed the day after. RESULTS The five cases included (mean age 74 years), were rejected for fenestrated or branched endovascular aortic repair or iliac branch devices. Four tube grafts and one aorto-bi-iliac graft were sutured to one stent-graft (N.=3), two stent-grafts in iliac kissing configuration (N.=1) and to a main body of a bifurcated stent-graft (N.=1). Mean follow-up duration was 14 (4-27) months with no mortality. Technical success was obtained in all cases (2 suprarenal clamping). Postoperative complications included two pleural effusions, two transient gluteal intermittent claudications, and one renal failure. CONCLUSIONS The technique herein described seems to be a feasible and cost-effective alternative treatment for selected concomitant complex JAAAs and IAs unsuitable for totally endovascular treatment.
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Affiliation(s)
- Emiliano Chisci
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Giovanni di Dio Hospital, Florence, Italy -
| | - Clara Pigozzi
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Giovanni di Dio Hospital, Florence, Italy
| | - Aldo Alberti
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Giovanni di Dio Hospital, Florence, Italy
| | - Fabrizio Masciello
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Giovanni di Dio Hospital, Florence, Italy
| | - Nicola Troisi
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Giovanni di Dio Hospital, Florence, Italy
| | - Filippo Turini
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Giovanni di Dio Hospital, Florence, Italy
| | - Stefano Michelagnoli
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Giovanni di Dio Hospital, Florence, Italy
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17
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Mylonas SN, Ioannides G, Ahmad W, Brunkwall JS. Comparison of Two Iliac Branch Devices and Their Midterm Performance in Maintaining Blood Flow to the Internal Iliac Artery. J Endovasc Ther 2020; 27:818-825. [PMID: 32580623 DOI: 10.1177/1526602820934762] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To compare and contrast the midterm outcomes of the E-liac and Zenith (ZBIS) iliac branch devices (IBDs) for the preservation of the internal iliac artery (IIA) in aneurysms involving the iliac bifurcation. Materials and Methods: Between January 2014 and December 2018, 84 consecutive patients (median age 74 years; 76 men) were electively treated with the E-liac (n=44) or ZBIS (n=40) IBDs and were retrospectively analyzed to evaluate the technical success, patency, need for reintervention, and mortality associated with these devices. Results: Technical success was achieved in 95 of 99 implantations (95.9%) without any statistically significant difference between the groups (93.7% vs 98.0%, p=0.114). During the first 30 days, 3 occlusions in the ZBIS group and 1 in the E-liac group were identified. There was 1 perioperative death in the ZBIS group. The median follow-up was 37 months for the ZBIS group and 28 months for the E-liac group (p=0.657). Six patients from the ZBIS group and 7 from the E-liac group were lost to follow-up. Among the remaining, there were 2 further deaths recorded, 1 in each group. Four further reinterventions in the E-liac group and 2 in the ZBIS group were performed during follow-up. The Kaplan-Meier estimates of freedom from reintervention were 87.2% (95% CI 82.6% to 90.2%) for the ZBIS group and at 86.0% (95% CI 83.7% to 89.1%) for the E-liac group (p=0.563); the freedom from occlusion estimates were 89.7% (95% CI 85.8% to 94.5%) and 95.3% (95% CI 92% to 98.7%; p=0.317), respectively. Conclusion: The E-liac and the ZBIS IBDs showed equally high technical success, midterm patency, and low reintervention rates.
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Affiliation(s)
- Spyridon N Mylonas
- Department of Vascular and Endovascular Surgery, University of Cologne, Germany
| | - Giorgos Ioannides
- Department of Vascular and Endovascular Surgery, University of Cologne, Germany
| | - Wael Ahmad
- Department of Vascular and Endovascular Surgery, University of Cologne, Germany
| | - Jan S Brunkwall
- Department of Vascular and Endovascular Surgery, University of Cologne, Germany
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18
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't Mannetje YW, Broos PPHL, Teijink JAW, Stokmans RA, Cuypers PWM, van Sambeek MRHM. Midterm Results After Abandoning Routine Preemptive Coil Embolization of the Internal Iliac Artery During Endovascular Aneurysm Repair. J Endovasc Ther 2020; 26:238-244. [PMID: 30898067 DOI: 10.1177/1526602819833068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To analyze the results of endovascular repair of common iliac artery (CIA) aneurysms without preemptive coil embolization of the internal iliac artery (IIA). MATERIALS AND METHODS Between January 2010 and July 2016, 79 patients (mean age 74.3±8.4 years; 76 men) underwent endovascular repair extending into the external iliac artery owing to a CIA aneurysm. The procedure was performed for a ruptured aneurysm in 22 (28%) patients. Eighty-one IIAs were intentionally covered. The median CIA diameter was 37 mm (range 20-90). The primary outcomes were the occurrence of type II endoleaks and the incidence of buttock claudication. RESULTS Five (6%) patients died within 30 days (4 with ruptured aneurysms and 1 elective case). Two type II endoleaks originating from a covered IIA were recorded; one required an endovascular intervention because of aneurysm growth. The other patient died of a rupture based on an additional type III endoleak. Mean follow-up was 37.6±26.3 months. Nineteen (26%) patients required a secondary intervention. Buttock claudication was reported in 21 (28%) of 74 patients and persisted after 1 year in 7. No severe ischemic complications as a result of IIA coverage were recorded, and no revascularization was required during follow-up. CONCLUSION Treatment of CIA aneurysms by overstenting the IIA without preemptive coil embolization is safe and has a low risk of type II endoleak and aneurysm growth. Persisting buttock claudication is rare.
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Affiliation(s)
- Yannick W 't Mannetje
- 1 Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands.,2 Department of Epidemiology, CAPHRI Research School, Maastricht University, Maastricht, the Netherlands
| | - Pieter P H L Broos
- 1 Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands.,2 Department of Epidemiology, CAPHRI Research School, Maastricht University, Maastricht, the Netherlands
| | - Joep A W Teijink
- 1 Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands.,2 Department of Epidemiology, CAPHRI Research School, Maastricht University, Maastricht, the Netherlands
| | - Rutger A Stokmans
- 1 Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands.,2 Department of Epidemiology, CAPHRI Research School, Maastricht University, Maastricht, the Netherlands
| | - Philippe W M Cuypers
- 1 Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Marc R H M van Sambeek
- 1 Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands.,3 Department of CardioVascular Biomechanics, Eindhoven University of Technology, Eindhoven, the Netherlands
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19
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The Use of Iliac Branched Devices in the Acute Endovascular Repair of Ruptured Aortoiliac Aneurysms. Ann Vasc Surg 2020; 67:171-177. [PMID: 32205247 DOI: 10.1016/j.avsg.2020.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/03/2020] [Accepted: 02/16/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the feasibility and midterm outcomes of iliac branch devices (IBDs) to preserve the internal iliac artery perfusion in emergent endovascular repair of ruptured aorto-iliac aneurysms. METHODS Between December 2012 and July 2017, a total of 8 IBDs were implanted in 6 patients (the median age 65 years; all men) in a single tertiary referral center. The indication for IBD implantation was a ruptured abdominal aortic aneurysm with a concomitant common iliac artery aneurysm (n = 4) or isolated CIA aneurysms (n = 2). The main outcome measures were technical and clinical success. The secondary outcomes were primary and primary assisted patency, the occurrence of type I/III endoleaks, and reinterventions. RESULTS All patients were hemodynamically stable during the procedures, which were performed under local anesthesia. Technical success was achieved in all cases (the median total procedure time of 188 min and the median IBD procedure time of 28 min). The median follow-up was 34 months (interquartile range 19-78). There were no deaths during the follow-up and no major complications unrelated to the IBD. Two (25%) secondary interventions were performed for IBD occlusion in patients with bilateral IBDs. The other reintervention was a type II endoleak embolization in 1 of these 2 patients. The freedom from reintervention estimate was 75% through 2 years. The overall primary assisted patency was 100% through 3 years. CONCLUSIONS The use of IBDs in the acute setting is feasible to exclude ruptured aortoiliac aneurysms while maintaining pelvic circulation. The secondary intervention rate is considerable; however, the midterm assisted primary patency rates are promising. Further studies are needed to guide patient selection and to evaluate longer term outcomes.
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20
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D'Oria M, Mendes BC, Bews K, Hanson K, Johnstone J, Shuja F, Kalra M, Bower T, Oderich GS, DeMartino RR. Perioperative Outcomes After Use of Iliac Branch Devices Compared With Hypogastric Occlusion or Open Surgery for Elective Treatment of Aortoiliac Aneurysms in the NSQIP Database. Ann Vasc Surg 2020; 62:35-44. [DOI: 10.1016/j.avsg.2019.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 04/09/2019] [Accepted: 04/13/2019] [Indexed: 12/20/2022]
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Extension of Iliac Branch Device Repair Into the Superior Gluteal Artery Is a Safe and Effective Maneuver. Ann Vasc Surg 2020; 62:195-205. [DOI: 10.1016/j.avsg.2019.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/22/2019] [Accepted: 06/04/2019] [Indexed: 11/18/2022]
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Brunkwall JS, Vaquero-Puerta C, Heckenkamp J, Egaña Barrenechea JM, Szopinski P, Mertikian G, Seifert S, Rümenapf G, Buz S, Assadian A, Majd P, Mylonas S, Calavia AR, Theis T, de Blas Bravo M, Pleban E, Schupp J, Esche M, Kocaer C, Hirsch K, Oberhuber A, Schäfer JP. Prospective Study of the Iliac Branch Device E-liac in Patients with Common Iliac Artery Aneurysms: 12 Month Results. Eur J Vasc Endovasc Surg 2019; 58:831-838. [DOI: 10.1016/j.ejvs.2019.06.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 06/12/2019] [Accepted: 06/17/2019] [Indexed: 11/17/2022]
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Lu JJ, Glousman B, Macsata RA, Zettervall SL, Lee KB, Amdur RL, Sidawy AN, Nguyen BN. Preservation of pelvic perfusion with iliac branch devices does not decrease ischemic colitis compared with hypogastric embolization in endovascular abdominal aortic aneurysm repair. J Vasc Surg 2019; 71:815-823. [PMID: 31471238 DOI: 10.1016/j.jvs.2019.05.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Ischemic colitis is a rare but devastating complication of endovascular repair of infrarenal abdominal aortic aneurysms. Although it is rare (0.9%) in standard endovascular aneurysm repair (EVAR), the incidence increases to 2% to 3% in EVAR with hypogastric artery embolization (HAE). This study investigated whether preservation of pelvic perfusion with iliac branch devices (IBDs) decreases the incidence of ischemic colitis. METHODS We used the targeted EVAR module in the American College of Surgeons National Surgical Quality Improvement Program database to identify patients undergoing EVAR of infrarenal abdominal aortic aneurysm from 2012 to 2017. The cohort was further stratified into average-risk and high-risk groups. Average-risk patients were those who underwent elective repair for sizes of the aneurysms, whereas high-risk patients were repaired emergently for indications other than asymptomatic aneurysms. Within these groups, we examined the 30-day outcomes of standard EVARs, EVAR with HAE, and EVAR with IBDs. The primary outcome was the incidence of ischemic colitis. Secondary outcomes included mortality, major organ dysfunction, thromboembolism, length of stay, and return to the operating room. The χ2 test, Fisher exact test, Kruskal-Wallis test, and multivariate regression models were used for data analysis. RESULTS There were 11,137 patients who had infrarenal EVAR identified. We designated this the all-risk cohort, which included 9263 EVAR, 531 EVAR-HAE, and 1343 EVAR-IBD procedures. These were further stratified into 9016 cases with average-risk patients and 2121 cases with high-risk patients. In the average-risk group, 7482 had EVAR, 411 had EVAR-HAE, and 1123 had EVAR-IBD. In the high-risk group, 1781 had EVAR, 120 had EVAR-HAE, and 220 had EVAR-IBD. There was no significant difference in 30-day outcomes (including ischemic colitis) between EVAR, EVAR-HAE, and EVAR-IBD in the all-risk and high-risk groups. In the average-risk cohort, EVAR-HAE was associated with a higher mortality rate than EVAR (2.2% vs 1.0%; adjusted odds ratio, 2.58; P = .01). Although EVAR-IBD was not superior to EVAR-HAE in 30-day mortality, major organ dysfunction, or ischemic colitis in this average-risk cohort, EVAR-IBD exhibited a trend toward lower mortality compared with EVAR-HAE in this cohort, but it was not statistically significant (1.0% vs 2.2%; adjusted odds ratio, 0.42; P = .07). CONCLUSIONS Ischemic colitis is a rare complication of EVAR. HAE does not appear to increase the risk of ischemic colitis, and preservation of pelvic perfusion with IBDs does not decrease its incidence. Although HAE is associated with significantly higher mortality than standard EVAR in average-risk patients, the preservation of pelvic perfusion with IBDs does not appear to improve mortality over HAE.
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Affiliation(s)
- Jinny J Lu
- Department of Surgery, George Washington University, Washington, D.C..
| | - Brandon Glousman
- Department of Surgery, George Washington University, Washington, D.C
| | - Robyn A Macsata
- Department of Surgery, George Washington University, Washington, D.C
| | - Sara L Zettervall
- Department of Surgery, George Washington University, Washington, D.C
| | - K Benjamin Lee
- Department of Surgery, George Washington University, Washington, D.C
| | - Richard L Amdur
- Department of Surgery, George Washington University, Washington, D.C
| | - Anton N Sidawy
- Department of Surgery, George Washington University, Washington, D.C
| | - Bao-Ngoc Nguyen
- Department of Surgery, George Washington University, Washington, D.C
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The JOTEC iliac branch device for exclusion of hypogastric artery aneurysms: ABRAHAM study. J Vasc Surg 2019; 70:748-755. [DOI: 10.1016/j.jvs.2018.10.124] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 10/28/2018] [Indexed: 11/21/2022]
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Chen PL, Hsu HL, Chen IM, Kuo TT, Chen YY, Shih CC. Tailor-made iliac branched device for preserving the internal iliac artery in patients with common iliac artery aneurysm. J Chin Med Assoc 2019; 82:710-713. [PMID: 31335630 DOI: 10.1097/jcma.0000000000000156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Endovascular repair with stent-graft is a treatment option for patient with common iliac artery aneurysm (CIAA). However, the preservation of the internal iliac artery (IIA) is a concern. The commercially available iliac branched device (IBD) requires a common iliac length of at least 5 cm, which is usually too long for Asian people. Here, we report our medium-term results of using tailor-made IBD for patients with short common iliac artery (CIA) with and without abdominal aortic aneurysm (AAA). METHODS A selected iliac limb of the AAA stent-graft was unloaded from the delivery system. A 6-mm fenestration hole was made at the length of the CIA from the proximal end. The edge of the hole was reinforced with the soft and radiopaque tip of a 0.014´´ wire. Then, the iliac limb was reloaded into the introduced sheath as the tailor-made IBD. It was inserted from the selected side of the femoral artery and deployed. The ipsilateral IIA was cannulated through the fenestration hole. Then, a balloon-expandable or self-expandable covered stent with an appropriate size was deployed as the bridging stent-graft. RESULTS Between March 2013 and March 2017, a total of 10 patients received the tailor-made IBDs. One patient died of systemic thromboembolism 2 days after the operation. The bridging stent-grafts remained patent in all patients, except one occluded at 1 year after operation. CONCLUSION A tailor-made IBD is an easy-to-apply, alternative option for preserving the IIA perfusion in short CIAA patients with and without AAA.
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Affiliation(s)
- Po-Lin Chen
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Hung-Lung Hsu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Cardiovascular Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - I-Ming Chen
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Tzu-Ting Kuo
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yin-Yin Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chun-Che Shih
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
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Technical Tips for the Implantation of the Gore® Excluder® Abdominal Aortic Aneurysm and Iliac Branch Endoprosthesis in Short Aortoiliac Anatomies. Ann Vasc Surg 2019; 61:461-465. [PMID: 31382006 DOI: 10.1016/j.avsg.2019.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/16/2019] [Indexed: 11/23/2022]
Abstract
The purpose of this article is to describe the techniques used to deploy a Gore® Excluder® abdominal aortic aneurysm (AAA) and iliac branch endoprosthesis (IBE) in a short aortoiliac anatomy, expanding treatment options of a patient otherwise unfit for endovascular repair. Four strategies were used to shorten the total length of the components, achieving a reduction of over 3 cm during deployment: a pull-pull technique on a through-and-through guidewire to accommodate the IBE onto the iliac bifurcation, deployment in a "cross-limb" configuration, foreshortening of the iliac bridging component during release, and final proximal shortening of the AAA main body thanks to the C3 repositionable delivery system.
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Fereydooni A, Deyholos C, Botta R, Nezami N, Dardik A, Nassiri N. Bifurcated unibody aortic endografts can overcome unfavorable aortoiliac anatomy for deployment of bilateral iliac branch endoprostheses. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:174-178. [PMID: 31193591 PMCID: PMC6536773 DOI: 10.1016/j.jvscit.2019.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 01/27/2019] [Indexed: 11/25/2022]
Abstract
In conjunction with traditional modular bifurcated aortic endografts, bilateral iliac branch endoprostheses have been safely and effectively used for treatment of bilateral iliac artery aneurysms. However, anatomic constraints, such as inadequate renal artery to iliac bifurcation lengths and unfavorable aortic anatomy, can preclude deployment in certain configurations and limit use in many patients. We present an innovative technique to overcome such anatomic constraints and to extend the reach of iliac branch endoprosthesis technology in patients with iliac artery aneurysms.
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Affiliation(s)
| | - Christine Deyholos
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Robert Botta
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Nariman Nezami
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn
| | - Alan Dardik
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn.,VA Connecticut Healthcare System, West Haven, Conn
| | - Naiem Nassiri
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn.,VA Connecticut Healthcare System, West Haven, Conn
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Iliac Aneurysms Treated with Endovascular Iliac Branch Device: A Systematic Review and Meta-analysis. Ann Vasc Surg 2019; 56:303-316. [DOI: 10.1016/j.avsg.2018.07.058] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 07/16/2018] [Accepted: 07/19/2018] [Indexed: 11/22/2022]
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Current Status of Endovascular Preservation of the Internal Iliac Artery with Iliac Branch Devices (IBD). Cardiovasc Intervent Radiol 2019; 42:935-948. [DOI: 10.1007/s00270-019-02199-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/06/2019] [Indexed: 02/06/2023]
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Wanhainen A, Verzini F, Van Herzeele I, Allaire E, Bown M, Cohnert T, Dick F, van Herwaarden J, Karkos C, Koelemay M, Kölbel T, Loftus I, Mani K, Melissano G, Powell J, Szeberin Z, ESVS Guidelines Committee, de Borst GJ, Chakfe N, Debus S, Hinchliffe R, Kakkos S, Koncar I, Kolh P, Lindholt JS, de Vega M, Vermassen F, Document reviewers, Björck M, Cheng S, Dalman R, Davidovic L, Donas K, Earnshaw J, Eckstein HH, Golledge J, Haulon S, Mastracci T, Naylor R, Ricco JB, Verhagen H. Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2019; 57:8-93. [DOI: 10.1016/j.ejvs.2018.09.020] [Citation(s) in RCA: 873] [Impact Index Per Article: 174.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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31
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Surgical internal iliac artery preservation associated with endovascular repair of infrarenal aortoiliac aneurysms to avoid buttock claudication and distal type I endoleaks. J Vasc Surg 2018; 68:1736-1743. [DOI: 10.1016/j.jvs.2018.03.416] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 03/05/2018] [Indexed: 11/21/2022]
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Matteo J, Hood P, Hulsberg PC, Eadie E, Soule E, Shabandi M, Harmon TS. Larger Sizes Matter More! Applying the Matteo Mathematics Method for Endovascular Aortic Bifurcation Reconstruction to Large Venous Vascular Repair. Cureus 2018; 10:e3537. [PMID: 30648070 PMCID: PMC6318114 DOI: 10.7759/cureus.3537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 11/02/2018] [Indexed: 11/05/2022] Open
Abstract
Endovascular aortobifemoral bypass repair with aortic bifurcation reconstruction is a well-established option with mortality benefits compared to conventional surgical management. The same theory, formulas, and techniques can be applied to the central venous system as long as there are commercially available devices. Using mathematically derived criteria for optimal stent size selection, endovascular aortic bifurcation reconstruction with kissing stents was extrapolated to the inferior vena cava (IVC). This report describes a traumatic case of IVC injury that was successfully repaired using the standard aortic grafts while adhering to the guidelines for proper stent size selection.
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Affiliation(s)
- Jerry Matteo
- Interventional Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Preston Hood
- Interventional Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Paul C Hulsberg
- Interventional Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Erik Eadie
- Interventional Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Erik Soule
- Interventional Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Michael Shabandi
- Interventional Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Taylor S Harmon
- Interventional Radiology, The University of Texas Medical Branch, Galveston, USA
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Brunkwall J, Vaquero Puerta C, Heckenkamp J, Egaña Barrenechea JM, Szopinski P, Mertikian G, Seifert S, Rümenapf G, Buz S, Assadian A, Majd P, Mylonas S, Revilla Calavia A, Theis T, de Blas Bravo M, Pleban E, Schupp J, Esche M, Kocaer C, Hirsch K, Oberhuber A, Schäfer JP. Prospective study of the E-liac Stent Graft System in patients with common iliac artery aneurysms: 30-Day results. Vascular 2018; 26:647-656. [PMID: 30037302 DOI: 10.1177/1708538118789510] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To study the safety and feasibility of the E-liac Stent Graft System® in patients with aorto/iliac aneurysms. METHODS A prospective multicentric European registry of patients receiving the E-liac Stent Graft System® was conducted. Endpoints of the study included the technical success as well as periprocedural events and 30-day endoleaks, reinterventions, internal and external iliac artery patency and mortality. RESULTS Between July 2014 and June 2016, a total of 45 patients (93% men, mean age 72 years, range 53-90 years) were enrolled at 11 sites in four European countries. Five patients received an isolated iliac treatment. Thirty-seven patients were treated with a combination of an abdominal stent graft and a unilateral E-liac and three in combination with bilateral E-liac. All E-liac Stent Grafts (48) were implanted in the intended position and the internal iliac arteries were successfully bridged. Two patients did not receive clinical success, due to endoleak type Ia of the aortic stent graft. At 30-day follow-up, clinical success rate was 96%. Three successful endovascular reinterventions were performed within the 30-day follow-up: one due to a type Ia endoleak in the common iliac artery, one due to type Ia endoleak of the aortic stent graft, and one due to bilateral lower limb claudication provoked by stent graft limb stenosis. At 30-day, a 100% survival rate and complete absence of pelvic or buttock ischemia/claudication were reported. Primary patency at 30 days was 100% for the internal iliac artery and 98% for the external iliac artery with an assisted patency of 100% in the latter. CONCLUSIONS The high clinical success rate, low rates of device-related reinterventions (2%), and excellent patency rate demonstrate the safety and feasibility of the E-liac Stent Graft System. Long-term results are awaited to state efficacy and durability. Clinical Trials.gov. Identifier no. NCT02209194.
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Affiliation(s)
- Jan Brunkwall
- 1 Clinic of Vascular and Endovascular Surgery, University Clinic of Cologne, Cologne, Germany
| | | | - Joerg Heckenkamp
- 3 Department of Vascular and Endovascular Surgery, Marienhospital, Osnabrück, Germany
| | | | - Piotr Szopinski
- 5 Clinic of Vascular Surgery, Institute of Haematology and Transfusion Medicine, Warsaw, Poland
| | - Gerard Mertikian
- 6 Department of Interventional Radiology, Hietzing Hospital, Vienna, Austria
| | - Sven Seifert
- 7 Klinik für Thorax-, Gefäß- und endovaskuläre Chirurgie, Klinikum Chemnitz gGmbH, Germany
| | - Gerhard Rümenapf
- 8 Department of Vascular Surgery, Diakonissen Speyer-Mannheim Hospital, Speyer, Germany
| | - Semih Buz
- 9 Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - Payman Majd
- 1 Clinic of Vascular and Endovascular Surgery, University Clinic of Cologne, Cologne, Germany
| | - Spyridon Mylonas
- 1 Clinic of Vascular and Endovascular Surgery, University Clinic of Cologne, Cologne, Germany
| | | | - Thorsten Theis
- 3 Department of Vascular and Endovascular Surgery, Marienhospital, Osnabrück, Germany
| | - Mariano de Blas Bravo
- 4 Department of Vascular Surgery, Donostia University Hospital, San Sebastián, Spain
| | - Eliza Pleban
- 5 Clinic of Vascular Surgery, Institute of Haematology and Transfusion Medicine, Warsaw, Poland
| | - Jasper Schupp
- 11 Department of Radiology, University of Kiel, Kiel, Germany
| | - Mirko Esche
- 7 Klinik für Thorax-, Gefäß- und endovaskuläre Chirurgie, Klinikum Chemnitz gGmbH, Germany
| | - Cetin Kocaer
- 8 Department of Vascular Surgery, Diakonissen Speyer-Mannheim Hospital, Speyer, Germany
| | | | - Alexander Oberhuber
- 12 Department of Vascular and Endovascular Surgery, University of Düsseldorf, Germany
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Endoprótesis GORE ® EXCLUDER ® con rama iliaca para el tratamiento de aneurismas aortoiliacos. Experiencia multicéntrica. Resultados a un año. ANGIOLOGIA 2018. [DOI: 10.1016/j.angio.2017.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Giaquinta A, Ardita V, Ferrer C, Beggs CB, Veroux M, Barbante M, Orrico M, Cao P, Veroux P. Isolated Common Iliac Artery Aneurysms Treated Solely With Iliac Branch Stent-Grafts: Midterm Results of a Multicenter Registry. J Endovasc Ther 2018; 25:169-177. [PMID: 30141378 DOI: 10.1177/1526602818754862] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess early and midterm outcomes of iliac branch device (IBD) implantation without an aortic stent-graft for the treatment of isolated common iliac artery aneurysm (CIAA). METHODS From December 2006 to June 2016, 49 isolated CIAAs in 46 patients were treated solely with an IBD at 7 vascular centers. Five patients were lost to follow-up, leaving 41 male patients (mean age 72.5±7.8 years) for analysis. Mean CIAA diameter was 39.1±10.5 mm (range 25-65). Thirty-two patients (2 with bilateral CIAAs) were treated with a Cook Zenith iliac branch device; 9 patients (1 bilateral) received a Gore Excluder iliac branch endoprosthesis. Primary endpoints were technical success, survival, aneurysm exclusion, device patency, and freedom from reintervention at 1 and 5 years. Freedom from major adverse events and aneurysm shrinkage at 1 year were also assessed. RESULTS Thirty-day mortality and the IBD occlusion rate were 2.4% and 2.3%, respectively. At a mean follow-up of 40.2±33.9 months, no patient presented buttock claudication, erectile dysfunction, or bowel or spinal cord ischemia. Three patients died within 6 months after the procedure. Estimates of cumulative survival, device patency, and freedom from reintervention were 90.2%, 95.2%, and 95.7%, respectively, at 1 and 5 years. At 1 year, CIAA shrinkage ≥5 mm was recorded in 21 of 38 survivors. No evidence of endoleak, device migration, or disconnection was found on imaging follow-up. CONCLUSION The use of IBDs without an aortic stent-graft for isolated CIAAs resulted in excellent patency, with low morbidity and mortality. This, in conjunction with no endoleak or migration and a low reintervention rate, supports the use of isolated IBDs as a stable and durable means of endovascular reconstruction in cases with suitable anatomy. Longer follow-up and a larger cohort are needed to validate these results.
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Affiliation(s)
- Alessia Giaquinta
- 1 Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Italy
| | - Vincenzo Ardita
- 1 Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Italy
| | - Ciro Ferrer
- 2 Department of Surgery "Pietro Valdoni," "Sapienza" University, Rome, Italy
| | - Clive B Beggs
- 3 Research Institute for Sport, Physical Activity and Leisure, Carnegie Faculty, Leeds Beckett University, Leeds, UK
| | - Massimiliano Veroux
- 1 Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Italy
| | - Matteo Barbante
- 4 Vascular Surgery Unit, Department of Biomedicine and Prevention, University of Rome "Tor Vergata," Rome, Italy
| | - Matteo Orrico
- 5 Department of Vascular Surgery, San Filippo Neri Hospital, Rome, Italy
| | - Piergiorgio Cao
- 6 Division of Vascular Surgery, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Piefrancesco Veroux
- 1 Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Italy
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Gray D, Shahverdyan R, Reifferscheid V, Gawenda M, Brunkwall J. EVAR with Flared Iliac Limbs has a High Risk of Late Type 1b Endoleak. Eur J Vasc Endovasc Surg 2017; 54:170-176. [DOI: 10.1016/j.ejvs.2017.05.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 05/10/2017] [Indexed: 11/16/2022]
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Delay C, Deglise S, Lejay A, Georg Y, Roussin M, Schaeffer M, Saucy F, Thaveau F, Corpataux JM, Chakfe N. Zenith Bifurcated Iliac Side Branch Device: Mid-term Results and Assessment of Risk Factors for Intraoperative Thrombosis. Ann Vasc Surg 2017; 41:141-150. [PMID: 28238918 DOI: 10.1016/j.avsg.2016.08.048] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/03/2016] [Accepted: 08/23/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study is to evaluate the short- and mid-term results of the Zenith bifurcated iliac side branch device (ZBIS) in the treatment of common iliac artery (CIA) aneurysms, and to assess risk factors for intraoperative internal iliac artery (IIA) thrombosis. METHODS All patients who underwent endovascular treatment of either an isolated CIA aneurysm or an aortoiliac aneurysm using the ZBIS device in the departments of vascular surgery of Strasbourg (France) and Lausanne (Switzerland) between January 2010 and December 2014 were retrospectively collected. RESULTS Thirty-one implantations were performed: 30 patients underwent 31 endovascular CIA aneurysm treatments with the ZBIS device. Mean operative time was 188 min. Technical success was obtained in 26 implantations (84%). In 5 implantations (16%), the final angiogram revealed an IIA thrombosis. Thirty-day mortality was 3.2%. Thirty-day morbidity was 13.3%. Mean follow-up was 15 months. Overall survival was 96% at 1 year and 89% at 2 years. In intention-to-treat analysis, primary patency of the internal iliac side branch was 84% at 1 year and 76% at 2 years (5 peroperative IIA occlusions and 1 late occlusion). Freedom from reintervention was 89% at 1 and 2 years. One case of type III endoleak and 2 cases of type II endoleaks were identified. Only type III endoleak required an additional intervention with a covered stent. Aneurysm diameter decreased in 15 implantations (48%) and remained stable in 16 implantations (52%). Clinical, radiological, and peroperative parameters were analyzed to identify risk factor for intraoperative thrombosis of the internal iliac side branch. Notion of intraoperative difficulties (any additional procedure that was not initially planned and increasing the operating time) appeared as a risk factor in multivariate analysis (P < 0.01, standard deviation 1.27, odds ratio 30.6). CONCLUSIONS The main findings of our study is that the procedure can be difficult to perform in particular conditions and can lead to peroperative failure in these cases, highlighting the need for adequate patients screening. When technical success is obtained, outcomes can be considered as satisfactory.
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Affiliation(s)
- Charline Delay
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Sébastien Deglise
- Department of Vascular Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Yannick Georg
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Mathieu Roussin
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Mickaël Schaeffer
- Department of Methodology and Biostatistics, University Hospital of Strasbourg, Strasbourg, France
| | - François Saucy
- Department of Vascular Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Fabien Thaveau
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Jean-Marc Corpataux
- Department of Vascular Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Nabil Chakfe
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.
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Itoga NK, Fujimura N, Hayashi K, Obara H, Shimizu H, Lee JT. Outcomes of Endovascular Repair of Aortoiliac Aneurysms and Analyses of Anatomic Suitability for Internal Iliac Artery Preserving Devices in Japanese Patients. Circ J 2017; 81:682-688. [PMID: 28154297 DOI: 10.1253/circj.cj-16-1109] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Understanding that the common iliac arteries (CIA) are shorter in Asian patients, we investigated whether this anatomic difference affects the clinical outcomes of internal iliac artery (IIA) exclusion during endovascular aneurysm repair (EVAR) of aortoiliac aneurysm and thus limits the use of IIA-preserving devices in Japanese patients.Methods and Results:From 2008 to 2014, 69 Japanese patients underwent EVAR of aortoiliac aneurysms with 53 unilateral and 16 bilateral IIA exclusions. One patient had persistent buttock claudication during follow-up; however, colonic or spinal cord ischemia was not observed. Anatomic suitability was investigated for the iliac branch device (IBD) by Cook Medical and the iliac branch endoprosthesis (IBE) by WL Gore: 87 aortoiliac segments were analyzed, of which 17% met the criteria for the IBD, 25% met the criteria for the IBE and 40% met the criteria for either. Main exclusions for the IBD were IIA diameter >9 mm or <6 mm (47%) and CIA length <50 mm (39%). Main exclusions for the IBE were proximal CIA diameter <17 mm (44%) and aortoiliac length <165 mm (24%). CONCLUSIONS EVAR with IIA exclusions in Japanese patients showed low incidence of persistent buttock claudication and no major pelvic complications. Aorto-iliac morphology demonstrated smaller proximal CIA diameters and shorter CIA lengths, limiting the use of IIA-preserving devices.
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Affiliation(s)
- Nathan K Itoga
- Division of Vascular Surgery, Stanford University Medical Center
| | - Naoki Fujimura
- Department of Surgery, Keio University School of Medicine
| | - Keita Hayashi
- Department of Surgery, Keio University School of Medicine
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University School of Medicine
| | - Jason T Lee
- Division of Vascular Surgery, Stanford University Medical Center
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Ardita V, Giaquinta A, Veroux M, Sanfiorenzo A, Virgilio C, D’Arrigo G, Veroux P. Endovascular repair of bilateral common iliac artery aneurysms using GORE Excluder iliac branch endoprosthesis without aortobi-iliac stent graft conjunction: A case report. Medicine (Baltimore) 2017; 96:e5977. [PMID: 28207510 PMCID: PMC5319499 DOI: 10.1097/md.0000000000005977] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Bilateral common iliac artery (CIA) aneurysm (CIAA) is a rare entity. In the past decade, different endovascular approaches have been adopted for patients with several comorbidities or unfit for open repair (OR). Recently, the use of iliac branch stent graft has been proposed, resulting in satisfactory patency rates and decrease in morbidity. Currently, according to instruction for use, the iliac branch stent graft is to be used with aortobi-iliac stent graft conjunction. We describe a case of a successful endovascular repair of bilateral CIAAs using the GORE Excluder iliac branch endoprosthesis (IBEs) without aortobi-iliac stent graft conjunction. CASE PRESENTATION An 83-year-old man was admitted with abdominal pain and presence of pulsatile mass in the right and left iliac fossa. Computed tomographic (CT) angiography showed the presence of large bilateral CIAAs (right CIA = 66 mm; left CIA = 38 mm), without concomitant thoracic or abdominal aorta aneurysm. Moreover, CT scan demonstrated the presence of bilateral lower accessory renal artery close to the aortic bifurcation. Due to the high operative risk, the patient was scheduled for endovascular repair with bilateral IBEs, without the aortobi-iliac stent graft conjunction to avoid the renal ischemia as a consequence of renal arteries covering. The procedure was completed without complications and duplex ultrasound demonstrated the complete exclusion of both aneurysms without any type of endoleaks at 1 month of follow-up. CONCLUSIONS GORE IBEs without aortobi-iliac stent graft conjunction seem to be a feasible and effective procedure for the treatment of isolated CIAAs in patients with highly selected anatomical conditions.
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Affiliation(s)
- Vincenzo Ardita
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Via Santa Sofia, Catania
- Vascular Surgery Unit, Guzzardi Hospital of Vittoria, Via Papa Giovanni XXIII, Vittoria
| | - Alessia Giaquinta
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Via Santa Sofia, Catania
| | - Massimiliano Veroux
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Via Santa Sofia, Catania
- Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Via Santa Sofia, Catania
| | - Angelo Sanfiorenzo
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Via Santa Sofia, Catania
| | - Carla Virgilio
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Via Santa Sofia, Catania
| | - Giuseppe D’Arrigo
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Via Santa Sofia, Catania
| | - Pierfrancesco Veroux
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Via Santa Sofia, Catania
- Department of Surgical Specialties, University Hospital of Catania, Via Santa Sofia, Catania, Italy
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Mylonas SN, Rümenapf G, Schelzig H, Heckenkamp J, Youssef M, Schäfer JP, Ahmad W, Brunkwall JS, Mylonas SN, Rümenapf G, Oberhuber A, Schelzig H, Heckenkamp J, Theis T, Youssef M, Schäfer JP, Ahmad W, Brunkwall JS. A multicenter 12-month experience with a new iliac side-branched device for revascularization of hypogastric arteries. J Vasc Surg 2016; 64:1652-1659.e1. [DOI: 10.1016/j.jvs.2016.04.065] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
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41
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Kontopodis N, Tavlas E, Papadopoulos G, Galanakis N, Tsetis D, Ioannou CV. Embolization or Simple Coverage to Exclude the Internal Iliac Artery During Endovascular Repair of Aortoiliac Aneurysms? Systematic Review and Meta-analysis of Comparative Studies. J Endovasc Ther 2016; 24:47-56. [DOI: 10.1177/1526602816677962] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To compare results of simple coverage vs preemptive embolization to exclude the internal iliac artery (IIA) during endovascular repair of aortoiliac aneurysms. Methods: A systematic review of the literature was conducted by searching MEDLINE, CENTRAL, and OpenGray databases until March 2016. Primary outcome measures were safety and efficacy of the 2 strategies. Safety was determined by 30-day mortality and the minor and major complication rates. Efficacy was determined by absence of endoleak from the target IIA. Secondary outcomes of any endoleak, reintervention, operative time, fluoroscopy time, blood loss, contrast volume, and length of hospitalization were also examined. The random effects model was used to calculate combined overall effect sizes of pooled data. Data are presented as the odds ratio (OR) or mean difference (MD) with 95% confidence interval (CI). Forest plots and inconsistency ( I2) statistics were used to evaluate the heterogeneity of the included studies. Results: Eight observational studies were included in the analysis. Overall, 284 and 255 subjects underwent IIA coverage or embolization, respectively. IIA coverage resulted in a significantly lower major complication rate (6% vs 29%; OR 2.97, 95% CI 1.46 to 6.04, p=0.003; I2=0%) and shorter hospitalization (MD 0.48 days, 95% CI 0.08 to 0.89, p=0.02; I2=0%), while differences in all other outcomes were not statistically significant. Conclusion: In the presence of limited data, available evidence suggests that simple coverage of the IIA may result in significantly fewer major complications compared to preemptive embolization; at the same time, the rates of endoleaks and/or reinterventions are similar between groups.
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Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Emmanouil Tavlas
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
| | - George Papadopoulos
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Nikolaos Galanakis
- Interventional Radiology Unit, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Christos V. Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
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Jongsma H, Bekken JA, Bekkers WJJ, Zeebregts CJ, van Herwaarden J, Hoksbergen A, Cuypers P, de Vries JPPM, Verhagen HJ, Fioole B. Endovascular Treatment of Common Iliac Artery Aneurysms With an Iliac Branch Device. J Endovasc Ther 2016; 24:239-245. [DOI: 10.1177/1526602816679132] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To evaluate the efficacy, feasibility, and long-term outcomes of the Zenith ZBIS iliac branch device (IBD) to preserve internal iliac artery (IIA) perfusion in a large Dutch multicenter cohort. Methods: Between September 2004 and August 2015, 140 patients (mean age 70.9±7.4 years; 130 men) with 162 IBD implantations were identified in 7 vascular centers. The indication for IBD implantation was an abdominal aortic aneurysm >55 mm with a concomitant common iliac artery (CIA) aneurysm >20 mm (n=40), a CIA aneurysm with a diameter >30 mm (n=89), or revision of a type Ib endoleak after endovascular aneurysm repair (n=11). Results: Technical success (aneurysm exclusion, no type I or III endoleak, and a patent IIA) was obtained in 157 (96.9%) of 162 IBD implantations. Six (4.3%) patients developed major complications; 2 (1.4%) died. Mean follow-up was 26.6±24.1 months, during which 17 (12.1%) IBD-associated secondary interventions were performed. Including technical failures and intentional IIA embolizations, 15 (9.3%) IIA branch occlusions were identified; buttock claudication developed in 6 of these patients. The freedom from secondary intervention estimate was 75.9% (95% confidence interval 59.7 to 86.3) at 5 years. Conclusion: CIA aneurysms can be treated safely and effectively by IBDs with preservation of antegrade flow to the IIA. Secondary interventions are indicated in >10% of patients during follow-up but can be performed endovascularly in most.
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Affiliation(s)
- Hidde Jongsma
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - Joost A. Bekken
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Clark J. Zeebregts
- Department of Vascular Surgery, University Medical Center, Groningen, the Netherlands
| | - Joost van Herwaarden
- Department of Vascular Surgery, University Medical Center, Utrecht, the Netherlands
| | - Arjan Hoksbergen
- Department of Vascular Surgery, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Philip Cuypers
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Hence J. Verhagen
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Bram Fioole
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands
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Krievins DK, Savlovskis J, Holden AH, Kisis K, Hill AA, Gedins M, Ezite N, Zarins CK. Preservation of hypogastric flow and control of iliac aneurysm size in the treatment of aortoiliac aneurysms using the Nellix EndoVascular Aneurysm Sealing endograft. J Vasc Surg 2016; 64:1262-1269. [PMID: 27776696 DOI: 10.1016/j.jvs.2016.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/11/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the long-term effectiveness of endovascular aneurysm sealing (EVAS) in the treatment of complex aortoiliac aneurysms with preservation of hypogastric artery flow. METHODS We reviewed all patients with abdominal aortic aneurysms (AAAs) and common iliac aneurysms (CIAs) enrolled and treated in prospective studies of EVAS using the Nellix endograft (Endologix, Irvine, Calif) at two centers from 2008 to 2014. Patients with 1 year or more of computed tomography follow-up underwent quantitative morphometric assessment by two independent vascular radiologists blinded to clinical outcome results. Hypogastric patency and CIA diameter changes over time were assessed and compared in three treatment groups: totally excluded CIA, partially excluded CIA, and untreated CIA. RESULTS Among 125 patients with EVAS, 68 patients (mean age, 75 ± 8 years; 79% men) had both AAA (mean diameter, 55.8 ± 2.0 mm) and CIA (median diameter, 23.4; interquartile range, 21.3-27.0 mm), with bilateral CIAs in 33 patients. Treatment of 101 CIAs included complete CIA exclusion in 40 (39.6%), partial CIA exclusion in 33 (32.7%), and no CIA treatment in 28 (27.7%), with successful AAA exclusion in all patients. Internal iliac flow was preserved in all 122 hypogastric arteries that were patent before treatment (14 hypogastric arteries were occluded at baseline). During the 5-year follow-up period (median follow-up, 24.7 months; range, 11.5-61.7 months), three patients required secondary treatment with hypogastric occlusion and graft extension to the external iliac. Thus, internal iliac flow was maintained in 98% of at-risk hypogastric arteries. There were no aneurysm-related clinical events, except for the three secondary treatments. Totally excluded iliac aneurysms did not change in diameter over time (P = .85), whereas untreated CIAs enlarged at a rate of 0.16 mm/y (95% confidence interval, 0.09-0.23; P < .0001). Partially excluded CIAs enlarged at a higher rate of 0.59 mm/y (95% confidence interval, 0.47-0.71; P < .0001). Enlargement ≥3 mm occurred only in partially treated CIAs larger than 3 cm. CONCLUSIONS EVAS was effective in treating aortoiliac aneurysms with preservation of internal iliac patency in most cases. Complete CIA exclusion prevented aneurysm enlargement over time, whereas partial exclusion did not prevent continued CIA enlargement, particularly in larger aneurysms.
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Affiliation(s)
- Dainis K Krievins
- Department of Vascular Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia.
| | - Janis Savlovskis
- Department of Radiology, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Andrew H Holden
- Department of Interventional Radiology, Auckland City Hospital, Auckland, New Zealand
| | - Kaspars Kisis
- Department of Vascular Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Andrew A Hill
- Department of Vascular Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Marcis Gedins
- Department of Vascular Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Natalija Ezite
- Department of Radiology, Pauls Stradins Clinical University Hospital, Riga, Latvia
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Conformability of GORE Excluder Iliac Branch Endoprosthesis and COOK Zenith Bifurcated Iliac Side Branched Iliac Stent Grafts. Ann Vasc Surg 2016; 36:139-144. [DOI: 10.1016/j.avsg.2016.02.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 02/19/2016] [Accepted: 02/23/2016] [Indexed: 11/18/2022]
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Kouvelos GN, Katsargyris A, Antoniou GA, Oikonomou K, Verhoeven ELG. Outcome after Interruption or Preservation of Internal Iliac Artery Flow During Endovascular Repair of Abdominal Aorto-iliac Aneurysms. Eur J Vasc Endovasc Surg 2016; 52:621-634. [PMID: 27600731 DOI: 10.1016/j.ejvs.2016.07.081] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 07/19/2016] [Indexed: 11/25/2022]
Abstract
AIM The aim was to conduct a systematic review of the literature investigating outcomes after interruption or preservation of the internal iliac artery (IIA) during endovascular aneurysm repair (EVAR). METHODS A systematic review was undertaken using the MEDLINE and EMBASE databases to identify studies reporting IIA management during EVAR. The search identified 57 articles: 30 reported on IIA interruption (1468 patients) and 27 on IIA preservation (816 patients). RESULTS The pooled 30 day buttock claudication (BC) rate was 29.2% (95% CI 24.2-34.7). Patients undergoing bilateral IIA interruption had a higher incidence of BC than patients with unilateral IIA interruption (36.5% vs. 27.2%, OR 1.7, 95% CI 1.11-2.6, p = .01). During a median follow up of 17 months, the pooled rate of persistent BC was 20.5% (95% CI 15.7-26.2). Of the patients, 93.9% underwent an endovascular revascularization procedure for IIA preservation. Most patients (87.6%) had an iliac branched device, and technical success was 96.2%. Within 30 days of EVAR, 4.3% of internal iliac branches occluded. During a median follow up of 15 months, the pooled occlusion rate at the site of IIA revascularization was 8.8% (95% CI 6.8-11.3). In patients treated with an iliac-branched device, 5.2% of internal iliac branches and 1.7% of external iliac arteries occluded. The pooled BC rate on the side of the IIA revascularization during follow up was 4.1% (95% CI 2.9-5.9). Pooled rates of late device related endoleak type I or III and secondary procedures on the side of the previous IIA revascularization were 4.6% (95% CI 3.2-6.5) and 7.8% (95% CI 5.7-10.7) respectively. CONCLUSION Unilateral or bilateral IIA occlusion during EVAR seems to carry a substantial risk of significant ischemic complications in nearly one quarter of patients. Bilateral IIA occlusion was related to a significantly higher rate of BC. IIA preservation techniques represent a significant improvement in the treatment of aorto-iliac aneurysms and have been associated with high technical success and low morbidity.
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Affiliation(s)
- G N Kouvelos
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Germany.
| | - A Katsargyris
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Germany
| | - G A Antoniou
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - K Oikonomou
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Germany
| | - E L G Verhoeven
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Germany
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Amplatzer Plug to Occlude the Internal Iliac Artery During Endovascular Aortic Aneurysm Repair: A Large Multicenter Study. Eur J Vasc Endovasc Surg 2016; 51:641-6. [DOI: 10.1016/j.ejvs.2015.12.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 12/12/2015] [Indexed: 11/18/2022]
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Millon A, Della Schiava N, Arsicot M, De Lambert A, Feugier P, Magne JL, Lermusiaux P. Preliminary Experience with the GORE® EXCLUDER® Iliac Branch Endoprosthesis for Common Iliac Aneurysm Endovascular Treatment. Ann Vasc Surg 2016; 33:11-7. [DOI: 10.1016/j.avsg.2015.12.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/10/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
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48
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Modified Sandwich-graft Technique Employing Aorfix and Viabahn Stent-grafts to Preserve Hypogastric Flow in Cases of Complex Aortoiliac and Isolated Common Iliac Artery Aneurysms Including the Internal Iliac Artery Ostium. Eur J Vasc Endovasc Surg 2016; 51:364-70. [DOI: 10.1016/j.ejvs.2015.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 10/13/2015] [Indexed: 11/20/2022]
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Borges L, Machado R, Pereira C, Matos A, Almeida R. Técnica híbrida de exclusão endovascular de aneurisma ilíaco comum e revascularização cirúrgica da artéria ilíaca interna. ANGIOLOGIA E CIRURGIA VASCULAR 2015. [DOI: 10.1016/j.ancv.2015.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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