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Joh JH. Novel Strategies for the Hostile Iliac Artery during Endovascular Aortic Aneurysm Repair. Vasc Specialist Int 2024; 40:8. [PMID: 38475895 DOI: 10.5758/vsi.230119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/29/2024] [Accepted: 02/09/2024] [Indexed: 03/14/2024] Open
Abstract
Successful endovascular aneurysm repair can be achieved with favorable aortic and iliac arterial anatomies. However, patients with challenging iliac anatomy, such as stenotic, calcified, tortuous arteries, or concomitant iliac artery aneurysms, are commonly encountered. Such a hostile iliac anatomy increases the risk of intraprocedural complications and worsens long-term outcomes. This review addresses various technical options for treating patients with a hostile iliac anatomy, including innovative endovascular solutions, physician-modified endografts, and hybrid procedures. These considerations demonstrate the wide scope of therapies that may be offered to patients with an unfavorable iliac anatomy.
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Affiliation(s)
- Jin Hyun Joh
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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Chinsakchai K, Ketklin N, Hongku K, Wongwanit C, Puangpunngam N, Hahtapornsawan S, Thongsai S, Prapassaro T, Sermsathanasawadi N, Ruangsetakit C, Mutirangura P. Navigating Challenges in the Endovascular Treatment of Asymptomatic Aortoiliac Aneurysms: A 10-Year Comparative Analysis. J Clin Med 2023; 12:7000. [PMID: 38002615 PMCID: PMC10672210 DOI: 10.3390/jcm12227000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Treating an abdominal aortoiliac aneurysm (AAIA) with endovascular methods can be challenging when the internal iliac artery (IIA) is involved. Embolizing the IIA and extending the limb to the external iliac artery (IIAE + EE) to prevent a type 2 endoleak may lead to pelvic ischemic complications. To avoid these complications, strategies that preserve the IIA, such as the bell-bottom technique (BBT) and the iliac branch device (IBD), have been proposed. This study aims to compare the outcomes of these three endovascular approaches for AAIA. METHODS Between January 2010 and December 2019, 174 patients with asymptomatic AAIA were enrolled in this retrospective analysis. They were divided into two groups: 81 patients underwent non-IIAE procedures, and 93 patients underwent IIAE procedures. The iliac limb study group consisted of 106 limbs treated with the BBT, 113 limbs treated with the IIAE + EE, and 32 limbs treated with the IBD. The primary outcomes included the 30-day mortality rate and intraoperative limb complications. The secondary outcomes included postoperative pelvic ischemia, freedom from reintervention, and the overall 10-year survival rate. RESULTS There was no significant difference in the perioperative mortality rate between the non-IIAE group (0%) and the IIAE group (2.1%), p = 0.500. The intraoperative limb complications did not differ significantly between the BBT limbs (7.5%), the IIAE + EE limbs (3.5%), and the IBD limbs (3.1%) groups, p = 0.349. The incidence of buttock claudication was significantly greater in the bilateral IIAE + EE group compared to the unilateral IIAE + EE and non-IIAE groups (25%, 11%, and 2.5%, p-value < 0.004), and was similar to the incidence of buttock rest pain with skin necrosis (15%, 0%, and 0%, p < 0.001). During the 10-year follow-up, the BBT limbs group had a significantly lower rate of iliac limb reintervention free time than the IIAE + EE limbs and the IBD limbs groups (88.7%, 98.2%, and 93.8%, p = 0.016). There was no significant difference in the overall 10-year survival rate between the non-IIAE and IIAE groups (51.4% vs. 55.9%, p = 0.703). CONCLUSIONS The early and late mortality rates were similar between the non-IIAE and IIAE groups. Preserving the IIA is recommended to avoid pelvic ischemic complications. Considering the higher rate of reintervention in the BBT group, the IBD strategy may be preferred for AAIA.
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Affiliation(s)
- Khamin Chinsakchai
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (N.K.); (K.H.); (C.W.); (N.P.); (S.H.); (T.P.); (N.S.); (C.R.); (P.M.)
| | - Natcha Ketklin
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (N.K.); (K.H.); (C.W.); (N.P.); (S.H.); (T.P.); (N.S.); (C.R.); (P.M.)
| | - Kiattisak Hongku
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (N.K.); (K.H.); (C.W.); (N.P.); (S.H.); (T.P.); (N.S.); (C.R.); (P.M.)
| | - Chumpol Wongwanit
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (N.K.); (K.H.); (C.W.); (N.P.); (S.H.); (T.P.); (N.S.); (C.R.); (P.M.)
| | - Nattawut Puangpunngam
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (N.K.); (K.H.); (C.W.); (N.P.); (S.H.); (T.P.); (N.S.); (C.R.); (P.M.)
| | - Suteekhanit Hahtapornsawan
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (N.K.); (K.H.); (C.W.); (N.P.); (S.H.); (T.P.); (N.S.); (C.R.); (P.M.)
| | - Sasima Thongsai
- Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
| | - Tossapol Prapassaro
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (N.K.); (K.H.); (C.W.); (N.P.); (S.H.); (T.P.); (N.S.); (C.R.); (P.M.)
| | - Nuttawut Sermsathanasawadi
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (N.K.); (K.H.); (C.W.); (N.P.); (S.H.); (T.P.); (N.S.); (C.R.); (P.M.)
| | - Chanean Ruangsetakit
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (N.K.); (K.H.); (C.W.); (N.P.); (S.H.); (T.P.); (N.S.); (C.R.); (P.M.)
| | - Pramook Mutirangura
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (N.K.); (K.H.); (C.W.); (N.P.); (S.H.); (T.P.); (N.S.); (C.R.); (P.M.)
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Endovascular repair of ruptured external iliac artery pseudoaneurysm and arteriovenous fistula using reversed bell-bottom technique. J Vasc Surg Cases Innov Tech 2022; 9:101087. [PMID: 36747599 PMCID: PMC9898736 DOI: 10.1016/j.jvscit.2022.101087] [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: 10/14/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Pseudoaneurysm and arteriovenous fistula can occur after iatrogenic trauma or penetrating injuries. Endovascular treatment is a minimally invasive method used to manage these complex vascular injuries. We have described the case of a 27-year-old male patient who had presented with progressively increasing pain and swelling of the left inguinal region after a gunshot injury 5 years earlier. The bell-bottom technique was used in a reversed fashion to exclude the pseudoaneurysm and treat the arteriovenous fistula, achieving symptom resolution without complications.
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Bonardelli S, Verzini F, Rivolta N, Pagliariccio G, Zanotti C, Boero M, Franchin M, Carbonari L, Baggi P, Gibello L, Parlani G, Cavi R, Piffaretti G. Long-term outcomes of endovascular aortic repair with flared iliac limb endografts in patients with abdominal aortic aneurysm and aneurysmal common iliac arteries. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:464-470. [PMID: 35238520 DOI: 10.23736/s0021-9509.22.12040-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the long-term outcomes of endovascular aneurysm repair with flared iliac limb grafts in patients with abdominal aortic aneurysm (AAA) and aneurysmal common iliac arteries (CIAs). METHODS This is a multicenter, retrospective, observational cohort study that involves four tertiary referral hospitals between May 1, 2005, and April 30, 2019. Primary outcomes were freedom from aneurysm-related mortality (ARM), and freedom from iliac-related reintervention. RESULTS We studied 995 aneurysmal iliac limbs in 795 (85.2%) patients who met the inclusion criteria. Median AAA diameter was 55mm (IQR: 51-60). Early mortality occurred in 3 (0.4%) patients. The median of follow-up time was 52 months (IQR: 26-88). Estimated freedom from ARM was 99±0.002% (95% CI: 99-99.9) at 1 year, and 99±0.004% (95% CI: 97.9-99.6) at 5-years. Chronic obstructive pulmonary disease (HR=6.4, 95% CI: 1.7-24.0, P=0.006), chronic kidney disease (HR=5.5, 95% CI: 1.4-21.9, P=0.016), and the presence of an aneurysmal left CIA (HR=5.3, 95% CI: 1.0.5-27.4, P=0.044) was associated with ARM. There were 42 (7.3%) late iliac-related events (limb occlusion, N.=5; iliac-related endoleaks, N.=37). Estimated freedom from iliac-related reintervention was 98±0.003% (95% CI: 97-99) at 1 year, and 95±0.01% (95% CI: 92.7-96.7) at 5-years, which was associated with an aneurysmal right CIA (HR=2.2, 95% CI: 1.3-3.9; P=0.005), and age ≥78 years (HR=1.9, 95% CI: 1.01-1.3; P=0.039). CONCLUSIONS EVAR flared iliac limb grafts showed a high rate of freedom from ARM and a low reintervention rate. Owing to these results, it can be a durable and stable alternative for patients aged >78 years.
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Affiliation(s)
- Stefano Bonardelli
- Unit of Vascular Surgery, Department of Surgical and Clinical Sciences, ASST Spedali Civili di Brescia, University of Brescia School of Medicine, Brescia, Italy
| | - Fabio Verzini
- Unit of Vascular Surgery, Department of Surgical Sciences, University of Turin School of Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Nicola Rivolta
- Unit of Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | | | - Camilla Zanotti
- Unit of Vascular Surgery, Department of Surgical and Clinical Sciences, ASST Spedali Civili di Brescia, University of Brescia School of Medicine, Brescia, Italy
| | - Michele Boero
- Unit of Vascular Surgery, Department of Surgical Sciences, University of Turin School of Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Marco Franchin
- Unit of Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | | | - Paolo Baggi
- Unit of Vascular Surgery, Department of Surgical and Clinical Sciences, ASST Spedali Civili di Brescia, University of Brescia School of Medicine, Brescia, Italy
| | - Lorenzo Gibello
- Unit of Vascular Surgery, Department of Surgical Sciences, University of Turin School of Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Gianbattista Parlani
- Unit of Vascular and Endovascular Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Raffaella Cavi
- Unit of Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
- ASST Settelaghi, Varese, Italy
| | - Gabriele Piffaretti
- Unit of Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy -
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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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Liang S, Jia H, Zhang X, Guo W, Zhou G, Li S, Yuan P, Xiong J, Chen D. In-vitro and In-silico Haemodynamic Analyses of a Novel Embedded Iliac Branch Device. Front Cardiovasc Med 2022; 9:828910. [PMID: 35449876 PMCID: PMC9016111 DOI: 10.3389/fcvm.2022.828910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Iliac branch devices (IBDs) are valid tools for internal iliac artery preservation during endovascular abdominal aortic aneurysm and iliac aneurysm repair. The purpose of this study was to evaluate the effectiveness of a novel IBD with an embedded branch configuration. Method A typical iliac artery model was reconstructed, and two models were manufactured using three-dimensional printing technology. The novel IBD was deployed into one iliac artery model by an experienced vascular surgeon. A mock circulation loop (MCL) and a computational fluid dynamics (CFD) simulation were used to investigate the haemodynamic parameters of the iliac models without (Model A) and with (Model B) the IBD. A morphological analysis was conducted using computed tomography angiography and medical endoscopy. The flow distribution rate (FDR) and energy loss (EL) were used to quantify IBD performance. Results The FDR of the right internal iliac artery in the MCL of Model A and Model B was 18.88 ± 0.12% and 16.26 ± 0.09%, respectively (P = 0.0013). The FDR of the right internal iliac artery in the CFD simulation of Model A and Model B was 17.52 and 14.49%, respectively. The EL of Model A was greater than Model B in both the MCL and the CFD simulation. Compared with Model A, Model B had a larger region (8.46 vs. 3.64%) with a relative residence time of >20 Pa−1 at peak systole. Meanwhile, the area where the oscillatory flow index was >0.4 was significantly smaller in Model B than in Model A (0.46 vs. 0.043%). The region with an average wall shear stress of >4 Pa was greater in Model B than in Model A (0 vs. 0.22%). Conclusion The MCL and CFD simulation showed that the novel IBD had little impact on the FDR and EL of the iliac artery models. However, the IBD might be an effective tool for the treatment of abdominal aortic/iliac aneurysms that extend into branches. Further investigations are warranted to confirm whether this IBD could be useful in the clinic.
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Affiliation(s)
- Shichao Liang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Heyue Jia
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Xuehuan Zhang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Wei Guo
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Guojing Zhou
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Shilong Li
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Panpan Yuan
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Jiang Xiong
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
- Jiang Xiong
| | - Duanduan Chen
- School of Life Science, Beijing Institute of Technology, Beijing, China
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
- Wenzhou Safety (Emergency) Institute of Tianjin University, Tianjin, China
- *Correspondence: Duanduan Chen
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Endovascular treatment with iliac branch devices: multicenter study. ANGIOLOGIA 2021. [DOI: 10.20960/angiologia.00187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Pagliariccio G, Gatta E, Schiavon S, Grilli Cicilioni C, Lattanzi S, Dimitri E, Carbonari L. Bell-bottom technique in iliac branch era: mid-term single stent graft performance. CVIR Endovasc 2020; 3:57. [PMID: 32886266 PMCID: PMC7474032 DOI: 10.1186/s42155-020-00147-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/03/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Endovascular abdominal aortic aneurysm repair (EVAR) is considered the primary option for abdominal aortic aneurysm but the management of concomitant wide or aneurysmal iliac arteries (CIAs) is still controversial. METHODS We retrospectively evaluated mid-term results of patients receiving standard EVAR combined with bell-bottom technique (BBT) using Medtronic Endurant endograft between January 2009 and December 2018. Patients were followed up by CT scan performed 1 month after the procedure and by duplex ultrasound annually (with or without contrast medium) followed by CT scan in case of evolution. RESULTS Seventy-one patients (67 males; mean age of 77,1 years) with abdominal aortic aneurysm and wide or aneurysmal common iliac artery (distal landing zone diameter up to 25 mm and length more than 20 mm) were treated with standard EVAR and BBT (107 limbs) using Endurant stent graft. The median aortic diameter was 56,1 mm (31.0-85.0). Technical success was obtained in 100%. Mean procedural time was of 100.1 min. No 30 days' mortality, renal failure or limb ischaemia occurred. The median follow-up was of 36.56 months (1-136). 5-year aneurysm related mortality was not found. At 5 years, the number of all-cause deaths was seven. The freedom from secondary intervention was 91.6% at 5 years. Three patients (4.4%) were treated for iliac related complications at 5 years: internal iliac artery aneurysm, iliac obstruction, type 1b endoleak, all successfully treated by endovascular technique. CONCLUSIONS According with this study BBT using Endurant stent graft is effective and safe with good mid-term results, with low rate of iliac related complications and no aneurysm related mortality.
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Affiliation(s)
- Gabriele Pagliariccio
- Department of Vascular Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti Ancona, Via Conca, 71, 60126, Ancona, Italy.
| | - Emanuele Gatta
- Department of Vascular Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti Ancona, Via Conca, 71, 60126, Ancona, Italy
| | - Sara Schiavon
- Department of Vascular Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti Ancona, Via Conca, 71, 60126, Ancona, Italy
| | - Carlo Grilli Cicilioni
- Department of Vascular Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti Ancona, Via Conca, 71, 60126, Ancona, Italy
| | - Simona Lattanzi
- Department of Experimental and Clinical Medicine, Clinic of Neurology, Marche Polytechnic University, Ancona, Italy
| | - Elisa Dimitri
- Department of Vascular Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti Ancona, Via Conca, 71, 60126, Ancona, Italy
| | - Luciano Carbonari
- Department of Vascular Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti Ancona, Via Conca, 71, 60126, Ancona, Italy
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Giosdekos A, Antonopoulos CN, Sfyroeras GS, Moulakakis KG, Tsilimparis N, Kakisis JD, Lazaris A, Chatziioannou A, Geroulakos G. The use of iliac branch devices for preservation of flow in internal iliac artery during endovascular aortic aneurysm repair. J Vasc Surg 2020; 71:2133-2144. [DOI: 10.1016/j.jvs.2019.10.087] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/19/2019] [Indexed: 01/24/2023]
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Impact of Compliance with Anatomical Guidelines of "Bell-Bottom" Iliac Stent Grafts for Ectatic or Aneurysmal Iliac Arteries. Cardiovasc Intervent Radiol 2020; 43:1143-1147. [PMID: 32409997 DOI: 10.1007/s00270-020-02489-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the impact of compliance with anatomical guidelines on outcomes of endovascular aortic aneurysm repair using "bell-bottom" stent grafts (BBSGs). METHODS This is a retrospective review from January 1999 to May 2012 of patients who underwent endovascular infrarenal abdominal aneurysm repair and whose iliac limbs were greater than 18 mm in diameter. Computed tomography angiography was utilized for compliance with anatomical guidelines as stated in manufacturer's instructions for use (IFU). The primary outcome observed was iliac limb events. The secondary outcome observed was the need for re-intervention due to BBSG failure. RESULTS Of the 376 BBSGs, 55 (15%) in 27 patients met IFU. Aneurysm exclusion was achieved in all patients. The mean follow-up was 44 ± 30 months. Twenty-eight patients (11%) had 29 iliac limb events (12 type 1b endoleaks, 4 aneurysm sac growth, 4 stenosis/kink, 4 retrograde migrations, 2 component separations, 2 ruptures and 1 limb occlusion); all among patients treated outside of IFU (p < 0.04). The rate of aneurysm sac enlargement was similar between both groups, at 56%, respectively, between those treated within and those treated outside of IFU. On multivariate regression analysis, larger common iliac artery (CIA) (HR 1.088, 95% CI 1.016-1.166, p = 0.016), greater CIA tortuosity (HR 2.352, 95% CI 1.004-5.509, p = 0.048) and limbs with more than two characteristics that did not meet IFU criteria (HR 3.84, 95% CI 1.15-12.83, p = 0.03) were associated with higher rates of BBSG events and re-interventions. CONCLUSIONS BBSGs effectively seal ectatic CIAs. But rates of iliac limb events and re-interventions are higher among patients who do not meet IFU criteria. The larger CIA diameter, the greater CIA tortuosity and more than two criteria not met by IFU were associated with BBSG failure and re-intervention.
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Shintani T, Mitsuoka H, Hasegawa Y, Hayashi M, Natsume K, Ookura K, Sato Y, Obara H. Importance of Distal Sealing during Endovascular Aneurysm Repair Using Aneurysmal Common Iliac Artery as Landing Zone. Ann Vasc Surg 2020; 66:120-131. [PMID: 31953142 DOI: 10.1016/j.avsg.2020.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 01/02/2020] [Accepted: 01/02/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although the use of aneurysmal common iliac artery (CIA) as the landing zone during endovascular aortic aneurysm repair EVAR remains an essential procedure, this procedure may increase the risk of late complications such as ongoing CIA dilatation and type Ib endoleak (CIA-related complications). We hypothesized that incomplete sealing of the aneurysmal CIA segment during EVAR could increase the incidence of CIA-related complications. In this study, we evaluated the midterm results of EVAR with aneurysmal CIA used as the landing zone and assessed the importance of distal sealing in this procedure. METHODS We retrospectively reviewed all cases of endovascular aneurysm repair using CIA as landing zone between 2007 and 2015 that had at least 3 years' follow-up. We defined aneurysmal CIA as maximum diameter ≥18 mm. The main outcome was the incidence of CIA-related complications. We compared midterm results between normal CIA and aneurysmal CIA. Next, we analyzed risk factors for CIA-related complications in aneurysmal CIA. RESULTS Four complications occurred in normal CIA (mean follow-up, 66.5 ± 22.1 months); 21 occurred in aneurysmal CIA (mean follow-up, 62.2 ± 20.5 months). The 5-year portion of freedom from CIA-related complications was 97.3% in normal CIA and 69.4% in aneurysmal CIA (P < 0.001). Multivariable analysis in aneurysmal CIA showed that unsealed CIA segment length was only risk factor for CIA-related complications. Given the receiver operating characteristic curve results, we defined the unsealed CIA segment ≥10 mm as incomplete sealing. The hazard ratio for incomplete sealing associated with CIA-related complications was 3.92 (95% confidence interval 1.62-9.46, P = 0.02). CONCLUSIONS Use of aneurysmal CIA as landing zone increases the risk of CIA-related complications. However, maximum sealing of the aneurysmal CIA segment could prevent these complications.
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Affiliation(s)
- Tsunehiro Shintani
- Department of Vascular Surgery, Shizuoka Red Cross Hospital, Shizuoka, Japan.
| | - Hiroshi Mitsuoka
- Department of Cardiovascular Surgery, Shizuoka Hospital, Shizuoka, Japan
| | - Yuto Hasegawa
- Department of Cardiac Surgery, Shizuoka Red Cross Hospital, Shizuoka, Japan
| | - Masanori Hayashi
- Department of Vascular Surgery, Shizuoka Red Cross Hospital, Shizuoka, Japan
| | - Kayoko Natsume
- Department of Vascular Surgery, Shizuoka Red Cross Hospital, Shizuoka, Japan
| | - Kazuhiro Ookura
- Department of Cardiac Surgery, Shizuoka Red Cross Hospital, Shizuoka, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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12
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Pfabe FP. [The Treatment of Aneurysms of the Extremities Arteries - a Systematic Overview - New Therapies for Isolated Iliac Artery Aneurysm Employing a New Classification]. Zentralbl Chir 2020; 145:456-466. [PMID: 31931546 DOI: 10.1055/a-1027-7164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aneurysms of arteries in the extremities have a low incidence and are often manifest through complications. The most serious complications are rupture and extremity-threatening ischemia. Both usually lead to the diagnosis. Absolute indications for therapy are symptomatic aneurysms and asymptomatic aneurysms of 2 cm diameter or more. The extrailiacal gold standard is interponat or bypass with venous graft material. Endovascular methods are reserved for inoperable patients and clinical decisions on special cases. In contrast, complex endovascular techniques have been established in isolated iliac aneurysms and have significantly improved treatment options. Their implementation is bound to the existence of a suitable landing zone. This is the basis for a new classification of isolated iliac artery aneurysm. With the help of morphological subtypes, this classification permits standardised procedure planning for perfusion preservation of the internal iliac artery. The present article gives an overview of the current treatment strategy for aneurysms of extremities arteries. Similarities and regional differences in therapy are discussed.
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Affiliation(s)
- Frank-Peter Pfabe
- Klinik für Gefäßmedizin, Asklepios Klinikum Uckermark GmbH, Schwedt, Deutschland
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13
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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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14
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Volume Change after Endovascular Treatment of Common Iliac Arteries ≥ 17 mm Diameter: Assessment of Type 1b Endoleak Risk Factors. Eur J Vasc Endovasc Surg 2020; 59:51-58. [DOI: 10.1016/j.ejvs.2019.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 05/24/2019] [Accepted: 06/11/2019] [Indexed: 11/24/2022]
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15
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Pini R, Faggioli G, Indelicato G, Gallitto E, Mascoli C, Abualhin M, Stella A, Gargiulo M. Anatomical Predictors of Flared Limb Complications in Endovascular Aneurysm Repair. J Endovasc Ther 2019; 26:550-555. [DOI: 10.1177/1526602819851251] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To evaluate possible predictors of complications with flared iliac stent-graft limbs for ectatic common iliac arteries (CIAs) associated with abdominal aortic aneurysms treated with endovascular aneurysm repair (EVAR). Materials and Methods: A retrospective comparative analysis was conducted of 533 EVAR patients (mean age 75 years; 442 men) treated between 2012 and 2017 who had complications associated with the stent-graft limbs (n=1066). Complications, including type Ib endoleak, type IIIa endoleak, and limb occlusion, were compared between patients with nondilated (<16 mm) CIAs treated with standard iliac limbs (SLs, n=808) vs patients with ectatic CIAs treated with flared limbs (FLs, n=258). Follow-up included a duplex scan at 3, 6, and 12 months and yearly thereafter; computed tomography angiography was performed in case of iliac complications. Risk factors for iliac complications in FLs were investigated using Cox regression and Kaplan-Meier analyses; results of the regression analysis are presented as the hazard ratio (HR) and 95% confidence interval (CI). Results: Overall, no iliac complications occurred at 30 days, but over a mean follow-up of 38±8 months, there were 10 (1%) events (4 limb occlusions, 6 type Ib endoleaks): 7 (3%) in FLs and 3 (0.4%) in SLs (p=0.20). Kaplan-Meier analysis found no differences at 5 years in SLs vs FLs for freedom from limb occlusion (99%±1% vs 98%±1%, respectively; p=0.30) or type Ib endoleak (96%±3% vs 97%±1%, respectively; p=0.44). Similarly, the overall 5-year iliac complication rates were similar in SLs vs FLs (96%±3% vs 95%±2%, p=0.21). Regression analysis found CIA length ≤30 mm (HR 4.7, 95% CI 1.02 to 21.6, p=0.04) and a diameter ≥20 mm (HR 7.8, 95% CI 1.05 to 64.8, p=0.03) to be independent predictors of iliac complications in FLs. Kaplan-Meier estimates of iliac complication–free survival in FLs were significantly worse when the CIA length was ≤30 mm (79%±9% vs 98%±1%, p=0.003) or the diameter was ≥20 mm (85%±7% vs 99%±1%, p=0.02). The combination of both risk factors produced significantly poorer iliac complication–free survival compared with cases in which there was one or no risk factor (67%±19% vs 96%±2% vs 99%±1%, respectively; p<0.001). Conclusion: Iliac limb complications are infrequent in EVAR, regardless of the type of iliac limb chosen; however, CIAs ≤30 mm in length or ≥20 mm in diameter significantly increased the risk of late iliac complications in FLs. If both characteristics were present, this risk was further elevated.
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Affiliation(s)
- Rodolfo Pini
- Vascular Surgery, University of Bologna “Alma Mater Studiorum,” Bologna, Italy
| | - Gianluca Faggioli
- Vascular Surgery, University of Bologna “Alma Mater Studiorum,” Bologna, Italy
| | - Giuseppe Indelicato
- Vascular Surgery, University of Bologna “Alma Mater Studiorum,” Bologna, Italy
| | - Enrico Gallitto
- Vascular Surgery, University of Bologna “Alma Mater Studiorum,” Bologna, Italy
| | - Chiara Mascoli
- Vascular Surgery, University of Bologna “Alma Mater Studiorum,” Bologna, Italy
| | - Mohammad Abualhin
- Vascular Surgery, University of Bologna “Alma Mater Studiorum,” Bologna, Italy
| | - Andrea Stella
- Vascular Surgery, University of Bologna “Alma Mater Studiorum,” Bologna, Italy
| | - Mauro Gargiulo
- Vascular Surgery, University of Bologna “Alma Mater Studiorum,” Bologna, Italy
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Early and Late Outcome of Common Iliac Aneurysms Treated by Flared Limbs or Iliac Branch Devices during Endovascular Aortic Repair. J Vasc Interv Radiol 2019; 30:503-510. [DOI: 10.1016/j.jvir.2018.10.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/18/2018] [Accepted: 10/22/2018] [Indexed: 11/17/2022] Open
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17
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Duvnjak S, Balezantis T. Endovascular Treatment of Aorta-Iliac Aneurysms with a Flared Iliac Limb. Int J Angiol 2019; 28:57-63. [PMID: 30880895 DOI: 10.1055/s-0039-1683411] [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: 10/27/2022] Open
Abstract
Endovascular abdominal aneurysm repair (EVAR) relies on the quality of the proximal and distal landing zone. Reinterventions are higher in patients with suboptimal landing zone. The study aimed to evaluate reintervention rate after endovascular treatment of an aorta-iliac aneurysm using the flared iliac limbs. The retrospective study included 179 patients treated with EVAR at a single university hospital institution from January 2011 to January 2014 of which 75 patients (42%) were treated with flared iliac limb stent graft and 104 patients (58%) were treated with a nonflared iliac limb stent graft. There were 165 male patients (92%), mean age was 75.8 ± 6.6 years. Thirty-six patients underwent secondary treatment accounting for overall reintervention rate of 20%. Endoleak type 1b occurred in 13 patients (7%), followed by endoleak type 1a in six patients (3%). Endoleak type 2 occurred in seven patients (4%) requiring the treatment due to abdominal aortic aneurysm (AAA) enlargement, endoleak type 3 in three patients (2%), and leg stent graft thrombosis in seven patients (4%). In 143 patients (80%), there were no secondary interventions during the follow-up period. Reintervention due to endoleak type 1b was statistically significantly higher in a flared iliac limb group ( p < 0.02) with the rate of 7.2% compared with 1.9% rate in nonflared iliac limb group. The mean follow-up was 44.3 ± 20.4. Overall mortality was 33%. Flared iliac limb with a distal diameter of ≥ 20 mm, show a higher rate of iliac limb reintervention in a follow-up period due to endoleak type 1b.
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Affiliation(s)
- Stevo Duvnjak
- Department of Radiology, Odense University Hospital, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, Denmark
| | - Tomas Balezantis
- Department of Thoracic, Vascular and Cardiac Surgery, Odense University Hospital, Odense C, Denmark
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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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19
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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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20
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Riambau V, Yugueros X, Blanco C, Mestres G. Endovascular solutions for iliac aneurysms. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2018. [DOI: 10.23736/s1824-4777.18.01357-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Robalo C, Sousa J, Mansilha A. Internal iliac artery preservation strategies in the endovascular treatment of aortoiliac aneurysms. INT ANGIOL 2018; 37:346-355. [DOI: 10.23736/s0392-9590.18.04004-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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22
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Wu ZY, Chen ZG, Diao YP, Sun R, Liu CW, Chen YX, Zheng YH, Liu B, Li YJ. Endovascular Repair of Complex Aortoiliac Aneurysm with the Sandwich Technique in Sixteen Patients. Ann Vasc Surg 2018; 54:233-239. [PMID: 30053551 DOI: 10.1016/j.avsg.2018.05.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 04/10/2018] [Accepted: 05/04/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND This study aimed to evaluate the safety and efficiency of the sandwich technique in endovascular repair of complex aortoiliac aneurysm. METHODS Sixteen patients (mean age 69.6 years, ranging from 58 to 78 years) with complex aortoiliac aneurysm were studied retrospectively from October 2013 to September 2017 in two vascular centers of teaching hospitals. Computed tomography angiography (CTA) was performed to make individual therapy. They were all performed endovascular repair with sandwich technique, including one with the sandwich, chimney, and fenestrated techniques during the same procedure. All patients were followed up at 1 month, 3 months, 6 months, 12 months, and yearly thereafter with X-ray, ultrasound, and/or CTA. RESULTS The initial technical success was 81.25%, and the assisted technical success was 100%. At final angiography, little flow of a type I and a type III endoleak was found in two patients with observation. Two type II endoleaks were also detected. During the perioperative period, two patients suffered myocardial infarction. One pulmonary infection and one urinary infection happened. No death or cerebrovascular events occurred. During the follow-up (mean 18 months, ranging from 2 to 45 months), three stent occlusions were detected. One case got reintervened for his external iliac artery stent thrombosis in the first month postoperatively. The other two were under observation. A readmission happened to one man for his right brachial artery pseudoaneurysm in the third month postoperatively. One patient died of nonaneurysmal related reason in the eighth month. No aneurysmal related death, rupture, or new endoleak was found. No paralysis, claudication, or bowel ischemia was complained of. The primary patency of the preserved branches were 94.7%, 92.0%, 92.0%, 92.0%, 92.0% separately in first, sixth, 12th, 24th, and 36th month. CONCLUSIONS For patients who are not candidates for open surgery or conventional endovascular repair with complex aortoiliac aneurysm, the sandwich technique is a feasible alternative to management.
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Affiliation(s)
- Zhi-Yuan Wu
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China; Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zuo-Guan Chen
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China; Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yong-Peng Diao
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China; Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Rui Sun
- Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Chang-Wei Liu
- Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yue-Xin Chen
- Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yue-Hong Zheng
- Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Bao Liu
- Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yong-Jun Li
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China; Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
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Morphology-Related Limitations of Endovascular Aneurysm Repair Applicability in the Treatment of Abdominal Aortic Aneurysm in West-Central Poland. Ann Vasc Surg 2018; 52:49-56. [PMID: 29772324 DOI: 10.1016/j.avsg.2018.02.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/12/2018] [Accepted: 02/28/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Morphology is one of the most important factors influencing the long-term durability of endovascular repair of an infrarenal abdominal aortic aneurysm (AAA). The knowledge of morphological characteristics of AAA that may differ in various populations seems to be important for further development of a technology of endovascular repair as well as for planning of treatment strategies. To analyze the current applicability of endovascular aneurysm repair (EVAR) in patients with an infrarenal AAA with an indication for elective treatment in west-central Poland. METHODS Computed tomography angiograms of 100 consecutive patients with infrarenal AAA deemed to require treatment were analyzed with an OsiriX DICOM viewer in 3D-multiplanar reconstruction mode. Proximal neck diameter, length, angulation, shape, the presence of thrombus and calcification, distal neck diameter, and morphology of the iliac arteries were determined. Three sets of morphological criteria were established. The optimal criteria consisted of a nonconical proximal neck without moderate or severe calcification or thrombus, with a diameter of 18-28 mm, length of ≥15 mm, and β angulation of <60%; a distal neck with a diameter of ≥20 mm; a landing zone in the common iliac arteries (CIAs) with a length of ≥10 mm and diameter of ≤20 mm; and external iliac arteries with diameters of ≥7 mm. The suboptimal criteria included proximal neck diameters of 18-32 mm, neck lengths ≥10 mm, infrarenal neck angulations of up to 75°, and CIA diameters of up to 25 mm. Finally, the extended suboptimal criteria included proximal neck diameters of 16-34 mm and infrarenal neck angulations ≤90°, without limits in the maximal diameter of the CIAs. RESULTS The median maximum aneurysm diameter was 61 mm. The optimal, suboptimal, and extended suboptimal criteria were met by 23%, 32%, and 53% of patients, respectively. The most common deviations were wide, conical, and angulated proximal necks and aneurysmal iliac arteries. CONCLUSIONS The majority of patients with AAA deemed to be candidates for elective repair do not meet the most favorable criteria for EVAR. Availability of better endovascular solutions for conical, angulated, and wide necks and aneurysmal iliac arteries would likely expand EVAR applicability. Open repair remains a valid option.
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24
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Wang L, Liang S, Xu X, Chen B, Jiang J, Shi Z, Tang X, Zhou X, Zhou M, Guo D, Fu W. A Comparative Study of the Efficacy by using Different Stent Grafts in Bell-Bottom Technique for the Treatment of Abdominal Aortic Aneurysm Concomitant with Iliac Artery Aneurysm. Ann Vasc Surg 2018; 52:41-48. [PMID: 29885433 DOI: 10.1016/j.avsg.2018.05.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/20/2018] [Accepted: 05/19/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Bell-bottom technique (BBT) is one method to preserve the internal iliac artery during endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) that extends to iliac artery. The data on the efficacy of this technique are still limited. We sought to evaluate the midterm efficacy of BBT by using different stent grafts in the treatment of AAA combined with iliac artery aneurysm (IAA). METHODS From January 2011 to December 2016, AAA patients with IAA using BBT to preserve the internal iliac artery were retrospectively analyzed in our institution. Patients were followed up at 3, 6, and then every 12 months after surgery. The outcomes among 3 types of stent grafts (Zenith, Excluder, and Endurant) were compared. BBT-related end points including type Ib endoleak, IAA sac expansion, distal neck expansion, and rupture during follow-up were compared. Other events including perioperative death, any other types of endoleak, and corresponding management were also documented. RESULTS A total of 125 patients with 141 IAAs were identified. Ninety-eight patients (78.4%) with 113 lesions (80.4%) received a median follow-up time of 38 months. The incidence of type Ib endoleak was 22.9%, 8.3%, 11.9%, and 14.2% (P = 0.19) in Zenith, Excluder, Endurant group, and total patients, respectively. The incidence of IAA sac enlargement was 17.1%, 5.6%, 7.1%, and 9.7% (P = 0.20). The incidence of IAA rupture was 8.6%, 0.0%, 0.0%, and 2.7% (P = 0.03). The incidence of IAA neck enlargement was 34.3%, 13.9%, 16.7%, and 21.2% (P = 0.07). Totally, 14 cases (10.7%) received further treatment for BBT-related issues. CONCLUSIONS Although BBT remains a safe and effective treatment option to preserve internal iliac artery during standard EVAR with acceptable complication rates in Asians, different IAA rupture rates were found among 3 different stent grafts. Our data for the first time revealed that the type of stent grafts has influence on the final clinical outcome. Based on that, iliac extension should be selected appropriately while treating AAA-IAA.
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Affiliation(s)
- Lixin Wang
- Vascular Surgery Department of Zhongshan Hospital, Fudan University, Shanghai, China; Vascular Surgery Institute of Fudan University, Shanghai, China; Vascular Surgery Department of Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
| | - Shuangchao Liang
- Department of Vascular Surgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Xin Xu
- Vascular Surgery Department of Zhongshan Hospital, Fudan University, Shanghai, China; Vascular Surgery Institute of Fudan University, Shanghai, China
| | - Bin Chen
- Vascular Surgery Department of Zhongshan Hospital, Fudan University, Shanghai, China; Vascular Surgery Institute of Fudan University, Shanghai, China
| | - Junhao Jiang
- Vascular Surgery Department of Zhongshan Hospital, Fudan University, Shanghai, China; Vascular Surgery Institute of Fudan University, Shanghai, China
| | - Zhenyu Shi
- Vascular Surgery Department of Zhongshan Hospital, Fudan University, Shanghai, China; Vascular Surgery Institute of Fudan University, Shanghai, China
| | - Xiao Tang
- Vascular Surgery Department of Zhongshan Hospital, Fudan University, Shanghai, China; Vascular Surgery Institute of Fudan University, Shanghai, China
| | - Xiushi Zhou
- Vascular Surgery Department of Zhongshan Hospital, Fudan University, Shanghai, China; Vascular Surgery Institute of Fudan University, Shanghai, China
| | - Min Zhou
- Vascular Surgery Department of Zhongshan Hospital, Fudan University, Shanghai, China; Vascular Surgery Institute of Fudan University, Shanghai, China
| | - Daqiao Guo
- Vascular Surgery Department of Zhongshan Hospital, Fudan University, Shanghai, China; Vascular Surgery Institute of Fudan University, Shanghai, China.
| | - Weiguo Fu
- Vascular Surgery Department of Zhongshan Hospital, Fudan University, Shanghai, China; Vascular Surgery Institute of Fudan University, Shanghai, China; Vascular Surgery Department of Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China.
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Hallett RL, Ullery BW, Fleischmann D. Abdominal aortic aneurysms: pre- and post-procedural imaging. Abdom Radiol (NY) 2018; 43:1044-1066. [PMID: 29460048 DOI: 10.1007/s00261-018-1520-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Abdominal aortic aneurysm (AAA) is a relatively common, potentially life-threatening disorder. Rupture of AAA is potentially catastrophic with high mortality. Intervention for AAA is indicated when the aneurysm reaches 5.0-5.5 cm or more, when symptomatic, or when increasing in size > 10 mm/year. AAA can be accurately assessed by cross-sectional imaging including computed tomography angiography and magnetic resonance angiography. Current options for intervention in AAA patients include open surgery and endovascular aneurysm repair (EVAR), with EVAR becoming more prevalent over time. Cross-sectional imaging plays a crucial role in AAA surveillance, pre-procedural assessment, and post-EVAR management. This paper will discuss the current role of imaging in the assessment of AAA patients prior to intervention, in evaluation of procedural complications, and in long-term follow-up of EVAR patients.
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Affiliation(s)
- Richard L Hallett
- Department of Radiology, Cardiovascular Imaging Section, Stanford University Hospital and Clinics, 300 Pasteur Drive, Grant Building, S-072, Stanford, CA, 94305, USA.
- St. Vincent Heart Center of Indiana, Indianapolis, IN, USA.
- Northwest Radiology Network, Indianapolis, IN, USA.
| | - Brant W Ullery
- Department of Cardiovascular Surgery, Providence Heart and Vascular Institute, Portland, OR, USA
| | - Dominik Fleischmann
- Department of Radiology, Cardiovascular Imaging Section, Stanford University Hospital and Clinics, 300 Pasteur Drive, Grant Building, S-072, Stanford, CA, 94305, USA
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Schiro BJ, Gandhi RT, Peña CS, Geronemus AR, Powell A, Benenati JF. Endovascular management of iliac aneurysmal disease with hypogastric artery preservation. Cardiovasc Diagn Ther 2018; 8:S168-S174. [PMID: 29850428 DOI: 10.21037/cdt.2017.09.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Common iliac artery aneurysms (CIAAs) pose a challenge in endovascular aneurysm repair. Aneurysm repair of CIAA traditionally requires embolization of the ipsilateral hypogastric artery (HA). Symptoms of buttock claudication and more feared complications of pelvic ischemia make HA preservation an appealing addition to aneurysm repair. In this review, we discuss various methods of CIAA repair with devices specifically designed for aneurysm repair and other custom techniques of HA preservation.
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Affiliation(s)
- Brian J Schiro
- Miami Cardiac & Vascular Institute, Baptist Hospital of Miami, Miami, FL, USA
| | - Ripal T Gandhi
- Miami Cardiac & Vascular Institute, Baptist Hospital of Miami, Miami, FL, USA
| | - Constantino S Peña
- Miami Cardiac & Vascular Institute, Baptist Hospital of Miami, Miami, FL, USA
| | - Adam R Geronemus
- Miami Cardiac & Vascular Institute, Baptist Hospital of Miami, Miami, FL, USA
| | - Alex Powell
- Miami Cardiac & Vascular Institute, Baptist Hospital of Miami, Miami, FL, USA
| | - James F Benenati
- Miami Cardiac & Vascular Institute, Baptist Hospital of Miami, Miami, FL, USA
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Kim JY, Kim DH, Quan C, Suh YJ, Ann HY, Kim JI, Moon IS, Lee T. Treatment options for isolated iliac artery aneurysms and their impact on aortic diameter after treatment. Ann Surg Treat Res 2018; 96:146-151. [PMID: 30838187 PMCID: PMC6393409 DOI: 10.4174/astr.2019.96.3.146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/19/2018] [Accepted: 11/06/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose Isolated iliac artery aneurysm (IIAA) is uncommon. It is frequently treated by endovascular aneurysm repair (EVAR). This study was to evaluate treatment results of IIAA and survey aortic diameter after EVAR. Methods Patients treated for IIAA in Seoul St. Mary's Hospital and Bundang Seoul National University from 2005 to April 2016 were retrospectively enrolled. The inclusion criteria of IIAA was >30 mm of iliac artery aneurysm without abdominal aortic aneurysm, which was treated by open surgical repair (OSR) or EVAR. Patients' clinical characteristics, treatment results, and mortality were obtained from electronic medical records. Diameters of aorta and iliac arteries were measured periodically with scheduled interval based on CT scans. Results Forty-nine patients (40 males; mean age, 71.9 ± 11.1 years) were enrolled. Five ruptured IIAAs were treated with EVAR (n = 1) or hybrid methods (n = 4). The diameter of ruptured IIAAs was 65 ± 31.4 mm, which was not significantly different from that of elective (44.3 ± 17.0 mm). Forty-four elective IIAA underwent 9 OSR, 31 EVARs, and 3 hybrid treatments (15 bifurcated and 12 straight stent-grafts). Treatment success rate was 93.8% without hospital mortality. There were 4 type I endoleak, 1 type II endoleak, and 1 type III endoleak without aneurysm-related mortality during follow-up. However, the aortic diameter was increased over time though there was no change or decrease in common iliac artery's diameter. Conclusion Treatment of IIAA included various endovascular modalities as well as open surgery. Regular surveillance is still needed due to aortic dilatation after its treatment.
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Affiliation(s)
- Jang Yong Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dae Hwan Kim
- Divison of Vascular Surgery, Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Cheng Quan
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Ju Suh
- Department of Biostatistics, School of Medicine, Inha University, Incheon, Korea
| | - Hyun Young Ann
- Department of Biostatistics, Graduate School of Korea University, Seoul, Korea
| | - Ji Il Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Sung Moon
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Taeseung Lee
- Divison of Vascular Surgery, Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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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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Bannazadeh M, Jenkins C, Forsyth A, Kramer J, Aggarwal A, Somerset AE, Bove PG, Long GW. Outcomes for concomitant common iliac artery aneurysms after endovascular abdominal aortic aneurysm repair. J Vasc Surg 2017; 66:1390-1397. [DOI: 10.1016/j.jvs.2017.02.058] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 02/23/2017] [Indexed: 12/11/2022]
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Prospective, multicenter study of endovascular repair of aortoiliac and iliac aneurysms using the Gore Iliac Branch Endoprosthesis. J Vasc Surg 2017; 66:775-785. [DOI: 10.1016/j.jvs.2017.02.041] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/10/2017] [Indexed: 11/23/2022]
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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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33
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Bosanquet D, Wilcox C, Whitehurst L, Cox A, Williams I, Twine C, Bell R, Bicknell C, Coughlin P, Hayes P, Jenkins M, Vallabhaneni S. Systematic Review and Meta-analysis of the Effect of Internal Iliac Artery Exclusion for Patients Undergoing EVAR. Eur J Vasc Endovasc Surg 2017; 53:534-548. [DOI: 10.1016/j.ejvs.2017.01.009] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 01/15/2017] [Indexed: 12/13/2022]
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Massière B, VON-Ristow A, Vescovi A, Leal D, Fonseca LMB. Endovascular therapeutic options for the treatment of aortoiliac aneurysms. Rev Col Bras Cir 2017; 43:480-485. [PMID: 28273223 DOI: 10.1590/0100-69912016006008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 09/26/2016] [Indexed: 11/21/2022] Open
Abstract
About 20% of patients with abdominal aortic aneurysms have associated iliac aneurysms. Distal sealing during the endovascular treatment of aortic-iliac aneurysms is a challenge that has led to the emergence of several technical options to achieve this goal over the years. Internal iliac artery embolization is associated with the risk of ischemic complications, such as gluteal necrosis, lower limb neurological deficit, colonic ischemia, impotence and gluteal claudication. This article summarizes the technical options for endovascular treatment of aortoiliac aneurysms with different approaches to preserving the patency of internal iliac arteries.
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Affiliation(s)
- Bernardo Massière
- Department of Vascular Surgery, CENTERVASC, Pontifical University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Arno VON-Ristow
- Department of Vascular Surgery, CENTERVASC, Pontifical University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alberto Vescovi
- Department of Vascular Surgery, CENTERVASC, Pontifical University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Daniel Leal
- Department of Vascular Surgery, CENTERVASC, Pontifical University of Rio de Janeiro, Rio de Janeiro, Brazil
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Shutze RA, Oglesby W, Lee A, Shutze WP. Results of repair of iliac artery aneurysms with the sandwich technique. Proc (Bayl Univ Med Cent) 2017; 30:7-10. [PMID: 28127120 DOI: 10.1080/08998280.2017.11929512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Patients undergoing endovascular repair (EVAR) of aortoiliac or iliac artery aneurysm may require sacrifice of one or both internal iliac arteries (IIAs). Until Food and Drug Administration-approved commercial grafts became available, endovascular IIA preservation was accomplished using the "sandwich" technique, but limited information is available regarding the results of this method. After obtaining institutional review board approval, we identified patients undergoing IIA preservation with the sandwich technique during EVAR at our institution. The patients have been followed prospectively since being identified to record patency rates and vascular symptoms or events. Twenty-four procedures were performed from 2011 through 2015 to treat iliac artery aneurysms. Fourteen of these procedures were done with concomitant EVAR using different endografts (Gore Excluder 11, Endologix AFX 2, Cook Zenith 1). Five were done to extend a previous EVAR that had developed a type Ib endoleak, 2 for an isolated external iliac artery aneurysm, 3 for an anastomotic aneurysm from a previous aortobiiliac graft, and 2 for isolated iliac aneurysm repair. There were 25 sandwich grafts (unilateral in 19, bilateral in 6). Contralateral embolization was performed in 5 cases. Immediate success rates were high, and patency rates were excellent at intermediate follow-up. Intraoperative type 3 endoleaks were not uncommon but usually resolved postoperatively. Endovascular IIA preservation is feasible with currently available devices using this technique. This procedure is recommended for preservation of the IIA during endovascular treatment of aortoiliac and iliac artery aneurysms when anatomy requires IIA preservation.
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Affiliation(s)
- Ryan A Shutze
- Texas Vascular Associates, Dallas, Texas (R. A. Shutze, W. P. Shutze); Soltero Center for Cardiovascular Research, Baylor Heart and Vascular Hospital, Dallas, Texas (Oglesby); The Surgical Clinic, St. Thomas Health and Centennial Medical Center, Nashville, Tennessee (Lee); and The Heart Hospital Baylor Plano, Plano, Texas (W. P. Shutze)
| | - Wes Oglesby
- Texas Vascular Associates, Dallas, Texas (R. A. Shutze, W. P. Shutze); Soltero Center for Cardiovascular Research, Baylor Heart and Vascular Hospital, Dallas, Texas (Oglesby); The Surgical Clinic, St. Thomas Health and Centennial Medical Center, Nashville, Tennessee (Lee); and The Heart Hospital Baylor Plano, Plano, Texas (W. P. Shutze)
| | - Allen Lee
- Texas Vascular Associates, Dallas, Texas (R. A. Shutze, W. P. Shutze); Soltero Center for Cardiovascular Research, Baylor Heart and Vascular Hospital, Dallas, Texas (Oglesby); The Surgical Clinic, St. Thomas Health and Centennial Medical Center, Nashville, Tennessee (Lee); and The Heart Hospital Baylor Plano, Plano, Texas (W. P. Shutze)
| | - William P Shutze
- Texas Vascular Associates, Dallas, Texas (R. A. Shutze, W. P. Shutze); Soltero Center for Cardiovascular Research, Baylor Heart and Vascular Hospital, Dallas, Texas (Oglesby); The Surgical Clinic, St. Thomas Health and Centennial Medical Center, Nashville, Tennessee (Lee); and The Heart Hospital Baylor Plano, Plano, Texas (W. P. Shutze)
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36
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Massière B, von Ristow A, Vescovi A, Leal D, Barbosa da Fonseca LM. Ten-Year Experience with Management of Aortoiliac Aneurysms Using Retrograde Endovascular Internal Iliac Artery Preservation. Ann Vasc Surg 2016; 35:163-7. [DOI: 10.1016/j.avsg.2016.01.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 12/08/2015] [Accepted: 01/09/2016] [Indexed: 11/26/2022]
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37
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Heim F, Chakfé N. Commentary on 'Displacement Forces in Stent Grafts. Influence of Diameter Variation and Curvature Asymmetry'. Eur J Vasc Endovasc Surg 2016; 52:157. [PMID: 27298189 DOI: 10.1016/j.ejvs.2016.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 04/18/2016] [Indexed: 11/29/2022]
Affiliation(s)
- F Heim
- Laboratoire de Physique et Mécanique Textile, Université de Haute-Alsace, Mulhouse, France
| | - N Chakfé
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, France.
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38
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Zha B, Zhu H, Liu B, Ye Y, Li J. Preservation of Internal Iliac Artery after Endovascular Repair of Common Iliac Artery Dissection Using Modified Fenestrated Stent Graft. Korean Circ J 2016; 46:412-6. [PMID: 27275179 PMCID: PMC4891607 DOI: 10.4070/kcj.2016.46.3.412] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/04/2015] [Accepted: 08/19/2015] [Indexed: 11/13/2022] Open
Abstract
Standard endovascular repair of iliac/aortoiliac pathologies can lead to complications, such as buttock claudication, colon ischemia and erectile dysfunction. Branch grafts have been developed but require at least 6 weeks for customization and are not currently available in China; they are also quite expensive. To our knowledge, modified fenestrated stent grafts (MFSGs) are a safe and effective alternative for treating patients with juxtarenal aneurysms. Most MFSGs are used for the preservation of renal and left subclavian arteries. Few cases of MFSGs have been reported in the treatment of iliac pathologies. The use of an MFSG is decided on a case-by-case basis. This report presents our first clinical use of an MFSG for preservation of the internal iliac artery.
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Affiliation(s)
- Binshan Zha
- Department of Vascular Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Huagang Zhu
- Department of Vascular Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Bin Liu
- Department of Vascular Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yusheng Ye
- Department of Vascular Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jun Li
- Department of Vascular Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China
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39
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Taudorf M, Grønvall J, Schroeder TV, Lönn L. Endovascular Aneurysm Repair Treatment of Aortoiliac Aneurysms: Can Iliac Branched Devices Prevent Gluteal Claudication? J Vasc Interv Radiol 2016; 27:174-80. [DOI: 10.1016/j.jvir.2015.11.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 10/30/2015] [Accepted: 11/07/2015] [Indexed: 11/16/2022] Open
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40
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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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Treatment of iliac artery bifurcation aneurysms with the second-generation straight iliac bifurcated device. J Vasc Surg 2015; 62:1168-75. [DOI: 10.1016/j.jvs.2015.06.135] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 06/03/2015] [Indexed: 11/24/2022]
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42
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Griffin CL, Scali ST, Feezor RJ, Chang CK, Giles KA, Fatima J, Huber TS, Beck AW. Fate of Aneurysmal Common Iliac Artery Landing Zones Used for Endovascular Aneurysm Repair. J Endovasc Ther 2015; 22:748-59. [PMID: 26290584 DOI: 10.1177/1526602815602121] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine outcomes of aneurysmal common iliac arteries (aCIA) used for landing zones (LZs) during endovascular aneurysm repair (EVAR). METHODS This single-center study retrospectively compared 57 EVAR patients (mean age 72±8 years; 56 men) with 70 aCIAs (diameter ≥20 mm) to 25 control EVAR subjects (mean age 73±7 years; 20 men) with 50 normal (≤15-mm) CIA LZs treated consecutively during the same time interval. The CIA LZ measurements were analyzed using random effects linear mixed models to determine diameter change over time. Life tables were used to estimate freedom from endoleak, reintervention, and all-cause mortality. RESULTS The mean maximum preoperative CIA diameter in the aCIA LZ group was 24.8±4.5 mm (range 20.0-47.3, median 23.9) vs 13.6±1.5 mm (range 9.2-15.0, median 13.9; p<0.001) in the controls. Nineteen aCIA LZs were treated outside the instructions for use of the device. Median follow-up in the aCIAs LZ cohort was 39.2 months [interquartile range (IQR) 15, 61] vs 49.3 months (IQR 36, 61) in the controls (p=0.06). The rate of aCIA LZ change (0.09 mm/mo, 95% CI 0.07 to 0.1) was significantly greater than controls (0.03 mm/mo, 95% CI -0.009 to 0.07; p<0.0001). No type Ib endoleaks developed in either group; however, aCIA LZ patients had 6 (11%) iliac limb-related reinterventions. There were significantly more endograft-related reinterventions in the aCIA LZ patients (n=10, 14%) compared with controls (n=2, 4%; p=0.06). There was no difference in mortality or freedom from any post-hospital discharge endoleak. CONCLUSION Aneurysmal CIA LZs used during EVAR experience greater dilatation compared with normal LZs, but no significant difference in outcome was noted in midterm follow-up. However, an increased incidence of graft limb complications or endograft-related reintervention may be encountered. Use of aCIA LZs appears to be safe; however, greater patient numbers and longer follow-up are needed to understand the clinical implications of morphologic changes in these vessels when used during EVAR.
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Affiliation(s)
| | - Salvatore T Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, USA
| | - Robert J Feezor
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, USA
| | - Catherine K Chang
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, USA
| | - Kristina A Giles
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, USA
| | - Javairiah Fatima
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, USA
| | - Thomas S Huber
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, USA
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, USA
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Yun WS, Park K. Iliac anatomy and the incidence of adjunctive maneuvers during endovascular abdominal aortic aneurysm repair. Ann Surg Treat Res 2015; 88:334-40. [PMID: 26029679 PMCID: PMC4443265 DOI: 10.4174/astr.2015.88.6.334] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 12/29/2014] [Accepted: 12/30/2014] [Indexed: 11/30/2022] Open
Abstract
Purpose Challenging iliac anatomy remains an important issue during endovascular aneurysm repair (EVAR), and it is known that the length of the common iliac artery (CIA) is shorter in Asians than in Western groups. We analyzed both the iliac anatomy and the incidence of adjunctive maneuvers to overcome iliac artery-related difficulties during EVAR. Methods Seventy-four EVARs were performed for abdominal aortic aneurysm between January 2010 and March 2013. Patient demographic data, iliac anatomical characteristics (presence of iliac artery aneurysm, iliac artery diameter and length, and iliac tortuosity), and adjunctive iliac artery maneuvers were reviewed retrospectively. Results Mean CIA length was 52.8 mm (range, 6.6-98.0 mm) on the right and 56.3 mm (range, 0-94.8 mm) on the left. CIA length was ≥20 mm, except in one patient with bilateral short CIAs. Forty patients (54%) had a CIA aneurysm, and 18 had aneurysms on both sides. Iliac adjunctive procedures were performed in 38 patients (51%) as follows: 23 internal iliac artery (IIA) embolizations or ligations, seven IIA revascularizations, 16 external iliac artery (EIA) balloon angioplasties or stenting, one EIA patch angioplasty, one EIA interposition, two femoral endarterectomies with patch angioplasty, and nine femoro-femoral bypasses after EVAR with an aorto-uni-iliac device. Technical success for the adjunctive iliac procedures was achieved in all patients. Conclusion Short CIA length was uncommon. Although many patients had access-related difficulties, most were overcome by an endovascular or hybrid technique. Liberal use of iliac adjunctive procedures can facilitate EVAR.
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Affiliation(s)
- Woo-Sung Yun
- Division of Transplantation and Vascular Surgery, Department of Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Kihyuk Park
- Division of Vascular/Endovascular Surgery, Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
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Karkos CD, Kapetanios DM, Anastasiadis PT, Grigoropoulou FS, Kalogirou TE, Giagtzidis IT, Papazoglou KO. Endovascular Repair of Abdominal Aortic Aneurysms with the Anaconda™ Stent Graft: Mid-term Results from a Single Center. Cardiovasc Intervent Radiol 2015; 38:1416-24. [DOI: 10.1007/s00270-015-1081-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/08/2015] [Indexed: 11/24/2022]
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45
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Endovascular Hypogastric Artery Preservation During Endovascular Aneurysm Repair: A Review of Current Techniques and Devices. Ann Vasc Surg 2015; 29:367-76. [DOI: 10.1016/j.avsg.2014.10.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 10/21/2014] [Accepted: 10/25/2014] [Indexed: 11/23/2022]
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46
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Essentials of Endovascular Abdominal Aortic Aneurysm Repair Imaging: Preprocedural Assessment. AJR Am J Roentgenol 2014; 203:W347-57. [DOI: 10.2214/ajr.13.11735] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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47
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Midterm outcomes of endovascular repair for abdominal aortic aneurysms with the on-label use compared with the off-label use of an endoprosthesis. Surg Today 2014; 45:880-5. [DOI: 10.1007/s00595-014-0978-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 06/02/2014] [Indexed: 11/25/2022]
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48
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From the “Bell-Bottom” to a Migrated “Running Stent” and Then a Successful Conversion to Hypogastric Branched Endograft. Ann Vasc Surg 2013; 27:671.e7-10. [DOI: 10.1016/j.avsg.2012.06.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 05/14/2012] [Accepted: 06/14/2012] [Indexed: 11/21/2022]
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49
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Endovascular repair of bilateral common iliac artery aneurysms following open abdominal aortic aneurysm repair with preservation of both hypogastric arteries using commercially available stent grafts. J Vasc Surg 2013; 59:516-9. [PMID: 23642920 DOI: 10.1016/j.jvs.2013.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 03/05/2013] [Accepted: 03/06/2013] [Indexed: 11/22/2022]
Abstract
Endovascular treatment of aneurysmal disease has become the predominant form of repair for all aneurysms. Some areas continue to pose specific challenges to stay within the general tenets of successful repair, mainly achieving adequate seal without sacrificing other arterial pathways. Following aortic aneurysm repair, the common iliac arteries can continue to have aneurysmal degeneration. We present a case of bilateral common iliac artery aneurysms that presented 9 years after open repair of an infrarenal abdominal aortic aneurysm in conjunction with an extensive aortic dissection. These were repaired using endovascular techniques with preservation of both hypogastric arteries.
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Alvarez Marcos F, Garcia de la Torre A, Alonso Perez M, Llaneza Coto JM, Camblor Santervas LA, Zanabili Al Sibbai AA, Garcia-Cosio Mir JM, Vega Garcia F, Rodriguez Menendez JE. Use of aortic extension cuffs for preserving hypogastric blood flow in endovascular aneurysm repair with aneurysmal involvement of common iliac arteries. Ann Vasc Surg 2012; 27:139-45. [PMID: 22841756 DOI: 10.1016/j.avsg.2012.02.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 01/22/2012] [Accepted: 02/14/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intentional hypogastric artery covering during endovascular repair of abdominal aortic aneurysms (EVAR) can carry a non-negligible rate of complications; to preserve pelvic blood flow, several approaches are in use, such as sandwich techniques, branched iliac devices, or the use of aortic extender cuffs in a bell-bottom configuration. We assess the performance of the latter for treatment of common iliac artery aneurysms during EVAR. METHODS Prospective gathering of data in 21 dilated common iliac arteries (18-25 mm) with coexisting abdominal aorta aneurysm, which were treated from 2005 to 2010 and received a GORE(®) Excluder endograft and one (n = 14) or several aortic extenders in a bell-bottom configuration. Control group consisted of 136 EVARs performed with the same device in the same time frame. Median follow-up was of 47 months, with contrast-enhanced computed tomography assessment 1 month after the procedure and yearly thereafter. RESULTS Age and comorbidities were homogeneously distributed among groups, although the aortic aneurysm diameter was lower in the bell-bottom group (50 mm vs. 58.2 mm, P < 0.001). There was no 30-day mortality registered in this group, and only one patient died during follow-up (5.3%), without relation with the aneurysmal disease. No significant differences were found in reintervention (15.8% vs. 14.7%, P = 0.707) or endoleak rates (36.8% vs. 38.9%, Fisher P = 1). There were no type I and four type II endoleaks, two of which precised treatment for sac growth. Endoleak-free survival (P = 0.994) and reintervention-free survival (P = 0.563) did not show differences either. CONCLUSION Bell-bottom technique is a feasible and safe alternative for preserving hypogastric blood flow, and does not imply a higher risk of reintervention or endoleak at 3-year follow-up.
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Affiliation(s)
- Francisco Alvarez Marcos
- Department of Angiology and Vascular Surgery, Asturias University Central Hospital, Oviedo, Spain.
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