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Panthofer A, Bresler AM, Olson SL, Kuramochi Y, Eagleton M, Böckler D, Schneider DB, Lyden SP, Blackwelder WC, Meadows W, Pauli T, DeRoo E, Matsumura JS. Multicenter, CT image-based anatomic assessment of patients with aortoiliac aneurysm undergoing endovascular repair with iliac branch devices. Ann Vasc Surg 2024:S0890-5096(24)00404-7. [PMID: 39009130 DOI: 10.1016/j.avsg.2024.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/29/2024] [Accepted: 05/02/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVE The Global Iliac Branch Study (NCT05607277) is an international, multicenter, retrospective cohort study of anatomic predictors of adverse iliac events (AIE) in aortoiliac aneurysms treated with iliac branch devices (IBDs). METHODS Patients with pre- and post-IBD CT imaging were included. We measured arterial diameters, stenosis, calcification, bifurcation angles, and tortuosity indices using a standardized, validated protocol. A composite of ipsilateral AIE was defined, a priori, as occlusion, type I or III endoleak, device constriction, or clinical event requiring reintervention. Paired t-test compared tortuosity indices and splay angles pre- and post-treatment for all IBDs and by device material (stainless steel and nitinol). Two-sample t-test compared anatomical changes from pre- to post-treatment by device material. Logistic regression assessed associations between AIE and anatomic measurements. Analysis was performed by IBD. RESULTS We analyzed 297 patients (286 males, 11 females) with 331 IBDs (227 stainless steel, 104 nitinol). Median clinical follow-up was 3.8 years. Iliac anatomy was significantly straightened with all IBD treatment, though stainless steel IBDs had a greater reduction in total iliac artery tortuosity index and aortic splay angle compared to nitinol IBDs (absolute reduction -.20 [-.22 to -.18] versus -.09 [-.12 to -.06], P<.0001 and -19.6° [-22.4° to -16.9°] versus -11.2° [-15.3° to -7.0°], P=.001, respectively). There were 54 AIEs in 44 IBDs in 42 patients (AIE in 13.3% of IBD systems), requiring 35 reinterventions (median time to event 41 days; median time to reintervention 153 days). There were 18 endoleaks, 29 occlusions, and five device constrictions. There were no strong associations between anatomic measurements and AIE overall, though internal iliac diameter was inversely associated with AIE in nitinol devices (nAIE,nitinol=8). CONCLUSIONS Purpose-built iliac branch devices effectively treat aortoiliac disease, including that with tortuous anatomy, with a high patency rate (91.5%) and low reintervention rate (9.1%) at four years. Anatomic predictors of AIE are limited.
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Affiliation(s)
- Annalise Panthofer
- Department of Surgery, Division of Vascular Surgery, University of Wisconsin School of Medicine and Public Health.
| | | | - Sydney L Olson
- Department of Surgery, Division of Vascular Surgery, University of Wisconsin School of Medicine and Public Health
| | - Yuki Kuramochi
- Heart Vascular and Thoracic Institute, Department of Vascular Surgery, Cleveland Clinic
| | - Matthew Eagleton
- Department of Surgery, Division of Vascular and Endovascular Surgery, Massachusetts General Hospital
| | - Dittmar Böckler
- Department of Vascular Surgery, Heidelberg University Hospital
| | - Darren B Schneider
- Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania
| | - Sean P Lyden
- Heart Vascular and Thoracic Institute, Department of Vascular Surgery, Cleveland Clinic
| | - William C Blackwelder
- Department of Surgery, Division of Vascular Surgery, University of Wisconsin School of Medicine and Public Health; Department of Epidemiology & Public Health, University of Maryland
| | - Wendy Meadows
- Department of Surgery, Division of Vascular Surgery, University of Wisconsin School of Medicine and Public Health; Department of Surgery, Division of Vascular Surgery, University of Colorado School of Medicine
| | - Tom Pauli
- Department of Surgery, Division of Vascular Surgery, University of Wisconsin School of Medicine and Public Health; Department of Surgery, Division of Vascular Surgery, University of Colorado School of Medicine
| | - Elise DeRoo
- Department of Surgery, Division of Vascular Surgery, University of Wisconsin School of Medicine and Public Health
| | - Jon S Matsumura
- Department of Surgery, Division of Vascular Surgery, University of Wisconsin School of Medicine and Public Health; Department of Surgery, Division of Vascular Surgery, University of Colorado School of Medicine
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Lee H, Lee JM, Cho S, Hong J. The Use of an Iliac Branch Device: Single-Center Study of Endovascular Preservation of Internal Iliac Artery Flow. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:1339-1349. [PMID: 38107681 PMCID: PMC10721431 DOI: 10.3348/jksr.2023.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/17/2023] [Accepted: 06/30/2023] [Indexed: 12/19/2023]
Abstract
Purpose To determine the efficacy and safety of iliac branch device (IBD) implantation and to evaluate its limitations based on 7 years of experience in a single center. Materials and Methods This single-center study included patients with bilateral common iliac artery aneurysms (CIAAs). We investigated follow-up CT and reviewed the internal iliac artery (IIA) patency and complications related to IBD. A retrospective analysis was performed and the overall survival rate and freedom from reintervention rate were reported according to the Kaplan-Meier method. Results Of the 38 patients with CIAAs, only 10 (12 CIAAs) were suitable for IBD treatment. Five patients underwent unilateral IBD insertion with contralateral IIA embolization, and three (60%) showed claudication; however, symptoms resolved within 6 months. The 7-year freedom from IBD-related reintervention rate was 77.8%. No procedure-related deaths occurred. Conclusion IBD has good technical success and long-term patency rates; however, anatomical factors frequently limit its application, particularly in Asians. Additionally, unilateral IIA embolization showed relatively mild complications and a good prognosis; therefore, it can be performed safely for anatomically complex aortoiliac aneurysms.
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Karelis A, Sonesson B, Gallitto E, Tsilimparis N, Forsell C, Leone N, Silingardi R, Mesnard T, Sobocinski J, Isernia G, Resch T, Gargiulo M, Dias NV. Iliac Branch Devices in the Repair of Ruptured Aorto-iliac Aneurysms: A Multicenter Study. J Endovasc Ther 2023:15266028221149922. [PMID: 36683380 DOI: 10.1177/15266028221149922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE To evaluate the outcomes of preserving the internal iliac artery (IIA) with iliac branched devices (IBDs) during acute endovascular repair of ruptured aortoiliac aneurysms. MATERIAL AND METHODS This is a multicenter retrospective review of all consecutive patients undergoing acute endovascular repair of ruptured aortoiliac aneurysm with an IBD at 8 aortic centers between December 2012 and June 2020. A control group was used where the IIA was intentionally occluded from the same study period. The main outcome measures were 30-day mortality, major adverse events, technical success, and clinical success. Secondary outcomes were buttock claudication, primary patency, primary-assisted and secondary patency of the IBD, occurrence of endoleak types I/III, and reintervention. Values are presented as numbers and percentages or interquartile range in parenthesis. RESULTS Forty-eight patients were included in the study: 24 with IBD and 24 with IIA occlusion. There was no difference in demographics, cardiovascular risk factors, and aneurysm extent. Twenty (83%) of them were hemodynamically stable during the procedure as opposed to 14 (58%, p=.23) with the IIA occlusion. Technical success was achieved in all cases with a procedure time of 180 (133-254) minutes, 45 (23-65) of which were from IBD. There were 2 (8%) deaths during the first 30 days and 2 (8%) major complications unrelated to the IBD, whereas in the IIA occlusion, the figures were 10 (42%) and 7 (29%), respectively. No patient in the IBD group developed buttock claudication compared to 8 (57%, p<.0001) in the IIA occlusion group; 1 (4%) patient developed bowel ischemia on both groups, with 1 in the IIA occlusion group needing resection. The median follow-up duration was 17 months (interquartile range 2-39) for the IBD group, with a primary patency of 60±14% at 3 years that went up to 92±8% with reinterventions (8 reinterventions in 6 patients). When the first 90 days were disregarded, there were no differences in survival between the groups. CONCLUSION IBD is a valid alternative for maintaining the pelvic circulation for endovascular aortic aneurysm repair of ruptured aortoiliac aneurysms. The technical success and midterm outcomes are very satisfactory but require patient selection particularly regarding hemodynamic stability. The reintervention rate is considerable, mandating continuous follow-up. CLINICAL IMPACT This multicenter study demonstrates that ruptured aortoiliac aneurysms do not necessarily require mandatory occlusion of hypogastric arteries. Iliac branch devices are shown to be a valid alternative in highly selected cases, with good midterm results, even if reinterventions are required in a significant proportion of patients.
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Affiliation(s)
- Angelos Karelis
- Vascular Center, Department of Thoracic Surgery and Vascular Diseases, Skåne University Hospital, Malmö, Sweden
| | - Björn Sonesson
- Vascular Center, Department of Thoracic Surgery and Vascular Diseases, Skåne University Hospital, Malmö, Sweden
| | - Enrico Gallitto
- Division of Vascular Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Nikolaos Tsilimparis
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Claes Forsell
- Department of Cardiothoracic Surgery and Cardiothoracic Anesthesia, Linköping University Hospital, Linköping, Sweden
| | - Nicola Leone
- Department of Vascular Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto Silingardi
- Department of Vascular Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Thomas Mesnard
- Department of Vascular Surgery, Aortic Centre, CHU Lille, Lille, France
- Inserm, CHU Lille, Université de Lille, Lille, France
| | | | - Giacomo Isernia
- Unit of Vascular and Endovascular Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Timothy Resch
- Department of Vascular Surgery, Faculty of Health and Medical Sciences, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mauro Gargiulo
- Division of Vascular Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Nuno V Dias
- Vascular Center, Department of Thoracic Surgery and Vascular Diseases, Skåne University Hospital, Malmö, Sweden
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Suzuki S, Akamatsu D, Goto H, Kakihana T, Sugawara H, Tsuchida K, Yoshida Y, Umetsu M, Kamei T, Unno M. Prospective clinical study for claudication after endovascular aneurysm repair involving hypogastric artery embolization. Surg Today 2022; 52:1645-1652. [PMID: 35532782 PMCID: PMC9592672 DOI: 10.1007/s00595-022-02502-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/28/2022] [Indexed: 11/28/2022]
Abstract
Purpose This prospective study aimed to assess the prognosis of claudication after endovascular aneurysm repair (EVAR) involving hypogastric artery (HGA) embolization. Methods Patients who were scheduled to undergo EVAR involving bilateral or unilateral HGA embolization (BHE or UHE, respectively) between May 2017 and January 2019 were included in this study. Patients underwent the walk test preoperatively, one week postoperatively, and monthly thereafter for six months. The presence of claudication and the maximum walking distance (MWD) were recorded. A near-infrared spectroscopy monitor was placed on the buttocks, and the recovery time (RT) was determined. A walking impairment questionnaire (WIQ) was completed to determine subjective symptoms. Results Of the 13 patients who completed the protocol, 12 experienced claudication in the 6-min walk test. The MWD was significantly lower at one week postoperatively than preoperatively. The claudication prevalence was significantly higher at five and six months postoperatively after BHE than after UHE. BHE was associated with longer RTs and lower WIQ scores than UHE. Conclusions We noted a trend in adverse effects on the gluteal circulation and subjective symptoms ameliorating within six months postoperatively, with more effects being associated with BHE than with UHE. These findings should be used to make decisions concerning management strategies for HGA reconstruction. Supplementary Information The online version contains supplementary material available at 10.1007/s00595-022-02502-x.
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Affiliation(s)
- Shunya Suzuki
- Department of Surgery, Division of Vascular Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
| | - Daijirou Akamatsu
- Department of Surgery, Division of Vascular Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Hitoshi Goto
- Department of Surgery, Division of Vascular Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Takaaki Kakihana
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hirofumi Sugawara
- Department of Surgery, Division of Vascular Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Ken Tsuchida
- Department of Surgery, Division of Vascular Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Yoshitaro Yoshida
- Department of Surgery, Division of Vascular Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Michihisa Umetsu
- Department of Surgery, Division of Vascular Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Takashi Kamei
- Department of Surgery, Division of Vascular Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Michiaki Unno
- Department of Surgery, Division of Vascular Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
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Mrad IB, Mrad MB, Mleyhi S, Miri R, Zairi I, Khaddar Y, Hammamia MB, Denguir R. Endovascular management of an isolated common iliac artery aneurysm: a case report. Pan Afr Med J 2021; 40:69. [PMID: 34804337 PMCID: PMC8590276 DOI: 10.11604/pamj.2021.40.69.30814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/01/2021] [Indexed: 11/13/2022] Open
Abstract
Isolated iliac artery aneurysms are rare, and treatment by conventional surgery gives good results. Endovascular repair of such aneurysms has recently become the preferred form of treatment, provided the appropriate anatomy for endovascular repair exists. We report the case of a 60-year-old man admitted in our department for an aneurysm of the left primitive iliac artery revealed by intermittent claudication and treated by a covered stent after embolization of the hypogastric artery by an Amplatzer Vascular Plug with a good result. This case highlights the importance of preservation of the collaterals of the hypogastric artery when you treat such entity; in order to avoid transient gluteal claudication and sexual dysfunction.
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Affiliation(s)
| | - Melek Ben Mrad
- Cardiovascular Surgery Department, Rabta Hospital, Tunis, Tunisia
| | - Sobhi Mleyhi
- Cardiovascular Surgery Department, Rabta Hospital, Tunis, Tunisia
| | - Rim Miri
- Cardiovascular Surgery Department, Rabta Hospital, Tunis, Tunisia
| | - Ihsen Zairi
- Cardiology Department, Habib Thameur Hospital, Tunis, Tunisia
| | - Yassine Khaddar
- Cardiovascular Surgery Department, Rabta Hospital, Tunis, Tunisia
| | | | - Raouf Denguir
- Cardiovascular Surgery Department, Rabta Hospital, Tunis, Tunisia
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Abugov SA, Polyakov RS, Puretsky MV, Mardanyan GV, Pirkova AA, Kraynikov DA, Vartanyan EL, Charchyan ER. [Endovascular treatment of common iliac artery aneurisms]. Khirurgiia (Mosk) 2021:52-58. [PMID: 34032789 DOI: 10.17116/hirurgia202106252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To demonstrate endovascular management of common iliac artery aneurysms with iliac branch devices and to discuss some technical aspects of these interventions including bilateral procedures. MATERIAL AND METHODS Endovascular abdominal aortic aneurysm repair with concomitant implantation of iliac branch devices was performed in 9 patients at the Petrovsky National Research Center of Surgery for the period from January 2019 to December 2020. Mean age of patients was 64.8± years (min 52; max 72 years). Preoperative planning and morphometric analysis were based on CT data with a slice thickness of 1 mm. Angiographic reconstruction was made using Osirix 3D software (OsiriX Foundation, Geneva, Switzerland). Abdominal aortic aneurysm was combined with common iliac artery aneurysm in 7 patients (77.7%). Three (33.3%) patients had isolated common iliac artery aneurysm without significant abdominal aorta enlargement (Reber type I). Bilateral common iliac artery aneurysms were detected in 1 (11.1%) patient. All patients had iliac artery aneurysms over 4 cm. Iliac branch device implantation was accompanied by endovascular abdominal aneurysm repair in all patients. RESULTS Technical success rate was 100%. Six-month results were followed-up in 5 patients (55.5%), annual outcomes - in 2 patients (22.2%). Control examination consisted of a telephone interview, ultrasound of abdominal aorta, pelvic and lower limb arteries and computed tomography. All patients had no endoleaks, stent-graft thrombosis, as well as signs of ischemia of pelvic organs and lower extremities. Incidence of iliac artery aneurysm combined with abdominal aortic aneurysms is about 20%. Until recently, treatment of these patients was performed exclusively with covering of internal iliac artery. Improvement of technologies and development of iliac branch devices made it possible to preserve blood flow in internal iliac artery after endovascular management. This approach allowed avoiding of ischemic complications associated with embolization of internal iliac arteries.
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Affiliation(s)
- S A Abugov
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| | - R S Polyakov
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| | - M V Puretsky
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| | - G V Mardanyan
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| | - A A Pirkova
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| | - D A Kraynikov
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| | - E L Vartanyan
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| | - E R Charchyan
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
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Jensen R, Lane JS, Owens E, Bandyk D, Malas M, Covarrubias A, Levine M, Barleben A. Common Iliac Artery Aneurysm Repair with Hypogastric Preservation via Balloon-Expandable Covered Stents Using the Eyelet Technique-Iliac Branched Devices Still Inappropriate in Many Patients. Ann Vasc Surg 2020; 71:513-522. [PMID: 32950623 DOI: 10.1016/j.avsg.2020.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/06/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Common iliac artery aneurysms (CIAAs) are seen in 20-40% of patients with abdominal aortic aneurysms. Historically treated with sacrifice of the hypogastric artery, which can result in significant morbidity related to pelvic ischemia, new devices have made hypogastric artery preservation more feasible but are only applicable to a small subset of aneurysm anatomy. We sought to assess the safety and efficacy or a novel technique for hypogastric artery preservation applicable to a wider variety of patients with CIAAs. METHODS We conducted a retrospective review of a prospectively maintained database of all patients with CIAAs treated with a novel endovascular technique at the UC San Diego Sulpizio Cardiovascular Center or the San Diego Veterans Affairs Hospital between March 2016 and December 2017. The endovascular technique involved stent placement in both the internal and external iliac arteries, with balloon expansion to minimize gutters between the endografts. Primary end points included technical success, limb patency, and presence of endoleaks (ELs). RESULTS A total of 14 limbs (12 patients) were treated for CIAAs with 100% technical success and limb patency at an average of 6.8 months of follow-up. No patients experienced type I or type III ELs or evidence of pelvic ischemia. Two patients required reintervention, and one patient died of causes unrelated to the procedure. CONCLUSIONS This technique was performed with excellent short- and mid-term safety in patients with varying aneurysm anatomy. The high rates of technical success and low rate pelvic ischemia represent improvement over conventional techniques that sacrifice the hypogastric artery and warrant further testing in a larger patient series with longer term follow-up.
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Affiliation(s)
- Rachel Jensen
- University of California San Diego Sulpizio Cardiovascular Center, La Jolla, CA
| | - John S Lane
- University of California San Diego Sulpizio Cardiovascular Center, La Jolla, CA
| | - Erik Owens
- University of California San Diego Sulpizio Cardiovascular Center, La Jolla, CA
| | - Dennis Bandyk
- University of California San Diego Sulpizio Cardiovascular Center, La Jolla, CA
| | - Mahmoud Malas
- University of California San Diego Sulpizio Cardiovascular Center, La Jolla, CA
| | | | - Michael Levine
- University of California San Diego Sulpizio Cardiovascular Center, La Jolla, CA
| | - Andrew Barleben
- University of California San Diego Sulpizio Cardiovascular Center, La Jolla, CA.
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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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9
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Kang J, Chung BH, Hyun DH, Park YJ, Kim DI. Clinical outcomes after internal iliac artery embolization prior to endovascular aortic aneurysm repair. INT ANGIOL 2020; 39:323-329. [PMID: 32214071 DOI: 10.23736/s0392-9590.20.04328-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Aortic anatomy is important in determining the success or failure of endovascular aortic aneurysm repair (EVAR). Endoleak is another issue which should be addressed for a long-term durability of the procedure. Internal iliac artery (IIA) embolization is required to prevent type II endoleak when the iliac landing zone is not sufficient such that the iliac limb should be extended down to the external iliac artery (EIA). Pelvic ischemia is an important complication of IIA embolization, but its incidence and severity is not exactly known. Our experience suggests this to be common but not severe. In this study we reviewed the clinical outcomes of patients who underwent IIA embolization to facilitate EVAR at one of the major tertiary medical centers in South Korea. METHODS We performed a retrospective review of the patients who underwent IIA embolization prior to EVAR between November 2005 and June 2018 at a single tertiary medical center in South Korea. Patients were interviewed via telephone to determine the severity of buttock claudication according to a previously defined pain scale. RESULTS The majority of 139 patients in both the unilateral and bilateral IIA embolization groups experienced no (N.=83, 60.0%) or mild (N.=51, 36.7%) buttock claudication. Only three patients in the unilateral IIA embolization group reported that their symptoms affected daily life, but without need for any measures for pain relief. Symptom duration was longer in the bilateral embolization group (12.6 months) compared to the unilateral group (6.6 months) without statistical significance (P=0.559). There were no critical complications such as buttock necrosis, spinal cord ischemia, or ischemic colitis. CONCLUSIONS Based on our experience, IIA embolization does cause buttock claudication of a certain degree. However, the most of them experienced mild discomfort rather than such symptoms severely affect their quality of life. Considering the risks of general anesthesia and complications of surgical procedures, IIA reconstruction along with EVAR may not be necessary.
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Affiliation(s)
- Jihee Kang
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byeoung-Hoon Chung
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dong-Ho Hyun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea -
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Endovascular Repair of Aortoiliac or Common Iliac Artery Aneurysm Using the Lifetech Iliac Bifurcation Stent Graft System: A Prospective Multicenter Clinical Study. Ann Vasc Surg 2019; 63:136-144. [PMID: 31563658 DOI: 10.1016/j.avsg.2019.06.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 06/25/2019] [Accepted: 06/30/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sacrifice of the internal iliac artery (IIA) may result in ischemic manifestations after aortoiliac aneurysm (AIA) or common iliac artery aneurysm (CIAA) endovascular repair. This study sought to evaluate the safety and efficacy of a new Iliac Bifurcation Stent Graft (IBSG; Lifetech Scientific, Shenzhen, China) system for revascularization of the IIA. METHODS Patients who underwent implantation of the IBSG at 8 centers in China from September 2015 to June 2018 were enrolled. Clinical and computed tomography angiography follow-up assessments were conducted at 30 and 180 days postoperatively. The primary end point was the IIA patency rate of the IBSG device at 180 days postoperatively. Secondary end points comprised the postoperative technical success rate and clinical success rate at 30 and 180 days. Descriptive statistics and the Clopper-Pearson exact method were used to analyze the data. RESULTS Seventy-three patients (mean age, 69.6 years; 91.8% men) were eligible for this trial, and 59 patients were eligible for primary effectiveness end-point analysis. AIA was present in 55 patients (75.34%) and CIAA in 18 patients (24.66%). The iliac artery aneurysms were unilateral in 69 patients (94.52%) and bilateral in 4 patients (5.48%). Overall technical success was 89.04% (65 of 73 patients). IIA patency at 180 days was 96.61% (57 of 59 patients). Sexual dysfunction occurred in 1 patient (1.69%), and 2 patients (3.39%) experienced buttock claudication. There was no mortality, type III endoleak, stent migration, kinking, or fracture during the procedure and follow-up. CONCLUSIONS The IBSG implantation system is a safe and effective technique for IIA preservation during AIA or CIAA endovascular repair. The high technical success rate, IIA patency rate, and low complication rate are promising. Follow-up will be continued for 5 years to confirm the durability of the device.
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Mitsuoka H, Miyano Y, Terai Y, Goto S, Kawaguchi S, Nakai M, Yamazaki F. One Technique to Modulate a Device Implantation Path in a Short Treatment Length Using the Gore IBE Device. Ann Vasc Dis 2019; 12:408-411. [PMID: 31636758 PMCID: PMC6766775 DOI: 10.3400/avd.hdi.19-00028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The GORE EXCLUDER Iliac Branch Endoprosthesis (IBE; W. L. Gore and Associates, Flagstaff, AZ, USA) applicability is limited by the aorto-iliac length (AOL). The shortage may be a major exclusion criterion. An 85-year-old male presented with an abdominal aortic and left common iliac arterial aneurysm. The left-side AOL was 146-mm, which was deemed 19-mm too short for IBE usage. To increase implantation length, the contra-lateral connection stent graft was deployed along the implantation line, wound half-circumferentially around the ipsilateral limb. Any form of endoleak, limb occlusion, and device migration has not been observed for twelve months.
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Affiliation(s)
- Hiroshi Mitsuoka
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Shizuoka, Japan
| | - Yuta Miyano
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Shizuoka, Japan
| | - Yasuhiko Terai
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Shizuoka, Japan
| | - Shinnosuke Goto
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Shizuoka, Japan
| | - Shinji Kawaguchi
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Shizuoka, Japan
| | - Masanao Nakai
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Shizuoka, Japan
| | - Fumio Yamazaki
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Shizuoka, Japan
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Lu JJ, Glousman B, Macsata RA, Zettervall SL, Lee KB, Amdur RL, Sidawy AN, Nguyen BN. Preservation of pelvic perfusion with iliac branch devices does not decrease ischemic colitis compared with hypogastric embolization in endovascular abdominal aortic aneurysm repair. J Vasc Surg 2019; 71:815-823. [PMID: 31471238 DOI: 10.1016/j.jvs.2019.05.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Ischemic colitis is a rare but devastating complication of endovascular repair of infrarenal abdominal aortic aneurysms. Although it is rare (0.9%) in standard endovascular aneurysm repair (EVAR), the incidence increases to 2% to 3% in EVAR with hypogastric artery embolization (HAE). This study investigated whether preservation of pelvic perfusion with iliac branch devices (IBDs) decreases the incidence of ischemic colitis. METHODS We used the targeted EVAR module in the American College of Surgeons National Surgical Quality Improvement Program database to identify patients undergoing EVAR of infrarenal abdominal aortic aneurysm from 2012 to 2017. The cohort was further stratified into average-risk and high-risk groups. Average-risk patients were those who underwent elective repair for sizes of the aneurysms, whereas high-risk patients were repaired emergently for indications other than asymptomatic aneurysms. Within these groups, we examined the 30-day outcomes of standard EVARs, EVAR with HAE, and EVAR with IBDs. The primary outcome was the incidence of ischemic colitis. Secondary outcomes included mortality, major organ dysfunction, thromboembolism, length of stay, and return to the operating room. The χ2 test, Fisher exact test, Kruskal-Wallis test, and multivariate regression models were used for data analysis. RESULTS There were 11,137 patients who had infrarenal EVAR identified. We designated this the all-risk cohort, which included 9263 EVAR, 531 EVAR-HAE, and 1343 EVAR-IBD procedures. These were further stratified into 9016 cases with average-risk patients and 2121 cases with high-risk patients. In the average-risk group, 7482 had EVAR, 411 had EVAR-HAE, and 1123 had EVAR-IBD. In the high-risk group, 1781 had EVAR, 120 had EVAR-HAE, and 220 had EVAR-IBD. There was no significant difference in 30-day outcomes (including ischemic colitis) between EVAR, EVAR-HAE, and EVAR-IBD in the all-risk and high-risk groups. In the average-risk cohort, EVAR-HAE was associated with a higher mortality rate than EVAR (2.2% vs 1.0%; adjusted odds ratio, 2.58; P = .01). Although EVAR-IBD was not superior to EVAR-HAE in 30-day mortality, major organ dysfunction, or ischemic colitis in this average-risk cohort, EVAR-IBD exhibited a trend toward lower mortality compared with EVAR-HAE in this cohort, but it was not statistically significant (1.0% vs 2.2%; adjusted odds ratio, 0.42; P = .07). CONCLUSIONS Ischemic colitis is a rare complication of EVAR. HAE does not appear to increase the risk of ischemic colitis, and preservation of pelvic perfusion with IBDs does not decrease its incidence. Although HAE is associated with significantly higher mortality than standard EVAR in average-risk patients, the preservation of pelvic perfusion with IBDs does not appear to improve mortality over HAE.
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Affiliation(s)
- Jinny J Lu
- Department of Surgery, George Washington University, Washington, D.C..
| | - Brandon Glousman
- Department of Surgery, George Washington University, Washington, D.C
| | - Robyn A Macsata
- Department of Surgery, George Washington University, Washington, D.C
| | - Sara L Zettervall
- Department of Surgery, George Washington University, Washington, D.C
| | - K Benjamin Lee
- Department of Surgery, George Washington University, Washington, D.C
| | - Richard L Amdur
- Department of Surgery, George Washington University, Washington, D.C
| | - Anton N Sidawy
- Department of Surgery, George Washington University, Washington, D.C
| | - Bao-Ngoc Nguyen
- Department of Surgery, George Washington University, Washington, D.C
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Chen PL, Hsu HL, Chen IM, Kuo TT, Chen YY, Shih CC. Tailor-made iliac branched device for preserving the internal iliac artery in patients with common iliac artery aneurysm. J Chin Med Assoc 2019; 82:710-713. [PMID: 31335630 DOI: 10.1097/jcma.0000000000000156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Endovascular repair with stent-graft is a treatment option for patient with common iliac artery aneurysm (CIAA). However, the preservation of the internal iliac artery (IIA) is a concern. The commercially available iliac branched device (IBD) requires a common iliac length of at least 5 cm, which is usually too long for Asian people. Here, we report our medium-term results of using tailor-made IBD for patients with short common iliac artery (CIA) with and without abdominal aortic aneurysm (AAA). METHODS A selected iliac limb of the AAA stent-graft was unloaded from the delivery system. A 6-mm fenestration hole was made at the length of the CIA from the proximal end. The edge of the hole was reinforced with the soft and radiopaque tip of a 0.014´´ wire. Then, the iliac limb was reloaded into the introduced sheath as the tailor-made IBD. It was inserted from the selected side of the femoral artery and deployed. The ipsilateral IIA was cannulated through the fenestration hole. Then, a balloon-expandable or self-expandable covered stent with an appropriate size was deployed as the bridging stent-graft. RESULTS Between March 2013 and March 2017, a total of 10 patients received the tailor-made IBDs. One patient died of systemic thromboembolism 2 days after the operation. The bridging stent-grafts remained patent in all patients, except one occluded at 1 year after operation. CONCLUSION A tailor-made IBD is an easy-to-apply, alternative option for preserving the IIA perfusion in short CIAA patients with and without AAA.
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Affiliation(s)
- Po-Lin Chen
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Hung-Lung Hsu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Cardiovascular Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - I-Ming Chen
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Tzu-Ting Kuo
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yin-Yin Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chun-Che Shih
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
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Mehmutjan M, ZHOU M. [Risk factors of pelvic ischemic symptoms after iliac artery occlusion during endovascular aneurysm repair]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2019; 48:546-551. [PMID: 31901030 PMCID: PMC8800759 DOI: 10.3785/j.issn.1008-9292.2019.10.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/25/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To analyze risk factors of pelvic ischemia after occlusion of the internal iliac artery during endovascular aneurysm repair (EVAR) surgery. METHODS The clinical data, preoperative CT angiography (CTA) findings and follow-up results of 82 patients with unilateral embolization of internal iliac artery undergoing EVAR were analyzed retrospectively. Among 82 patients, pelvic ischemic symptoms were developed in 20 patients (ischemia group) and the remaining patients served as control group. The risk factors for pelvic ischemia after occlusion of internal iliac artery during EVAR surgery were explored using univariate and multivariate analysis, and the clinical value was evaluated using ROC curves. RESULTS The univariate analysis showed that the numbers of the contralateral internal iliac artery and the ipsilateral deep femoral artery stenosis in the pelvic ischemia group were less than those in the control group (both P<0.05). Multivariate Logistic regression analysis showed that the decreased number of internal iliac artery branches (OR=8.383, 95%CI:1.469-47.841, P<0.05) was an independent risk of pelvic ischemia. The ROC curve analysis showed that AUC of the decreased number of contralateral internal iliac artery branches for predicting the incidence of pelvic ischemia was 0.816; when the number of 3.5 was taken as cut-off value, the corresponding sensitivity was 0.861 and the specificity was 0.167. CONCLUSIONS The decrease in number of the contralateral internal iliac artery branches on preoperative CTA is an independent risk factor for pelvic ischemia after occlusion of the internal iliac artery during EVAR surgery, but it does not show enough clinical value.
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Affiliation(s)
| | - Min ZHOU
- 周敏(1979-), 男, 博士研究生, 副教授, 主任医师, 主要从事血管外科研究; E-mail:
;
https://orcid.org/0000-0003-3707-1542
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Schneider DB, Milner R, Heyligers JM, Chakfé N, Matsumura J. Outcomes of the GORE Iliac Branch Endoprosthesis in clinical trial and real-world registry settings. J Vasc Surg 2019; 69:367-377.e1. [DOI: 10.1016/j.jvs.2018.05.200] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 05/01/2018] [Indexed: 12/11/2022]
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16
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Hypogastric Preservation Using Retrograde Endovascular Bypass. Ann Vasc Surg 2018; 52:67-71. [DOI: 10.1016/j.avsg.2018.04.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/10/2018] [Accepted: 04/15/2018] [Indexed: 11/24/2022]
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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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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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Cheng WM, Huang YH, Chiu AW, Shih CC, Chang YH, Lin AT, Chen KK. Urinary retention after endovascular treatment for aortic aneurysm: A single hospital experience. UROLOGICAL SCIENCE 2017. [DOI: 10.1016/j.urols.2016.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Naji F, Srivatsav V, Qadura M, Harlock J, Andrinopoulos T, Iyer V, Rapanos T. Evaluating the Effectiveness of Internal Iliac Artery Branched Endovascular Stent Grafts. Ann Vasc Surg 2017; 45:247-252. [PMID: 28689946 DOI: 10.1016/j.avsg.2017.06.126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/14/2017] [Accepted: 06/16/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of this study is to describe our institutional experience using iliac branch grafts (IBGs) in aortoiliac aneurysm repair. METHODS From October 2009 to April 2016, 41 consecutive patients (all men), mean age 71.7 years (range 55-87), underwent IBG implantation. Abdominal aortic aneurysm with common iliac artery involvement (n = 21) or bilateral common iliac artery aneurysms (n = 20) were indications. Computed tomography was used to evaluate patency and postoperative endoleaks within 1 month of implantation and after 1 year. RESULTS A total of 42 IBGs were deployed in 41 patients successfully. One hundred percent of grafts implanted were patent at 1 month and at annual follow-up. There was 1 mortality at 30 days, due to acute renal failure. Sixteen type II and 1 type Ib endoleaks were found, for which 3 reinterventions were performed and the remainder treated conservatively. Five patients had complications which required reintervention. CONCLUSIONS IBG placement has excellent short-term outcomes and potential to limit buttock claudication in the treatment of abdominal aortic aneurysms involving the iliac arteries.
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Affiliation(s)
- Faysal Naji
- Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
| | - Varun Srivatsav
- Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Mohammed Qadura
- Division of Vascular Surgery, Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - John Harlock
- Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Tara Andrinopoulos
- Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Vikram Iyer
- Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Theodore Rapanos
- Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
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Bargay Juan P, Plaza Martínez A, Pepén Moquete L, Ramírez Montoya M, Molina Nacher V, Gómez Palonés F. Sellado distal en ilíaca externa: ramificación ilíaca frente a la exclusión de la arteria hipogástrica. ANGIOLOGIA 2017. [DOI: 10.1016/j.angio.2017.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Simonte G, Parlani G, Farchioni L, Isernia G, Cieri E, Lenti M, Cao P, Verzini F. Lesson Learned with the Use of Iliac Branch Devices: Single Centre 10 Year Experience in 157 Consecutive Procedures. Eur J Vasc Endovasc Surg 2017; 54:95-103. [DOI: 10.1016/j.ejvs.2017.03.026] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 03/31/2017] [Indexed: 01/29/2023]
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Saengprakai W, van Herwaarden JA, Georgiadis GS, Slisatkorn W, Moll FL. Clinical outcomes of hypogastric artery occlusion for endovascular aortic aneurysm repair. MINIM INVASIV THER 2017; 26:362-371. [DOI: 10.1080/13645706.2017.1326385] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Wuttichai Saengprakai
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | | | - George S. Georgiadis
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Vascular Surgery, ‘Democritus’ University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Worawong Slisatkorn
- Division of Cardio-thoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Frans L. Moll
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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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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Dierks A, Sauer A, Wolfschmidt F, Hassold N, Kellersmann R, Bley TA, Kickuth R. Proximal occlusion of unaffected internal iliac artery versus distal occlusion of aneurysmatic internal iliac artery prior to EVAR: a comparative evaluation of efficacy and clinical outcome. Br J Radiol 2017; 90:20160527. [PMID: 28256907 DOI: 10.1259/bjr.20160527] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Occlusion of the internal iliac artery (IIA) may be necessary prior to endovascular aneurysm repair (EVAR) to prevent endoleak Type II. We compared efficacy and clinical outcome after proximal occlusion of an unaffected IIA (ProxEmbx) using an Amplatzer vascular plug (AVP) I vs distal occlusion of aneurysmatic IIA with coils and plugs (DistEmbx). METHODS Between 2009 and 2012, 22 patients underwent EVAR. In 9 patients with unaffected IIA, occlusion was performed by a single AVP. In 13 patients with aneurysmatic IIA, more distal embolization (DistEmbX) was conducted by using several coils and additional AVPs. Retrospectively, technical success, clinical outcome and complications were evaluated. RESULTS Embolization of the IIA was successful in all patients. Three patients with more DistEmbX of aneurysmatic IIAs suffered from new onset of sexual dysfunction after occlusion without statistically significant difference (p > 0.05). Transient buttock claudication was observed in three patients in each group. Bowel ischaemia did not occur. The procedure time (p = 0.013) and fluoroscopy time (p = 0.038) was significantly lower in the ProxEmbx group than in the DistEmbx group. CONCLUSION Proximal occlusion of an unaffected IIA and more distal occlusion of an aneurysmatic IIA prior to EVAR had the same technical and clinical outcome. However, proximal plug embolization of an unaffected IIA prior to EVAR was associated with shorter procedure and fluoroscopy time in comparison with more DistEmbX of aneurysmatic IIAs. Advances in knowledge: Proximal embolization of unaffected IIA and DistEmbX of aneurysmatic IIA before EVAR are both effective in preventing Type II endoleaks and have the same technical and clinical outcome.
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Affiliation(s)
- Alexander Dierks
- 1 Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg, Germany
| | - Alexander Sauer
- 1 Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg, Germany
| | - Franziska Wolfschmidt
- 1 Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg, Germany
| | - Nicole Hassold
- 1 Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg, Germany
| | - Richard Kellersmann
- 2 Department of General, Visceral, Vascular and Paediatric Surgery, University of Wuerzburg, Würzburg, Germany
| | - Thorsten A Bley
- 1 Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg, Germany
| | - Ralph Kickuth
- 1 Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg, Germany
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Itoga NK, Fujimura N, Hayashi K, Obara H, Shimizu H, Lee JT. Outcomes of Endovascular Repair of Aortoiliac Aneurysms and Analyses of Anatomic Suitability for Internal Iliac Artery Preserving Devices in Japanese Patients. Circ J 2017; 81:682-688. [PMID: 28154297 DOI: 10.1253/circj.cj-16-1109] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Understanding that the common iliac arteries (CIA) are shorter in Asian patients, we investigated whether this anatomic difference affects the clinical outcomes of internal iliac artery (IIA) exclusion during endovascular aneurysm repair (EVAR) of aortoiliac aneurysm and thus limits the use of IIA-preserving devices in Japanese patients.Methods and Results:From 2008 to 2014, 69 Japanese patients underwent EVAR of aortoiliac aneurysms with 53 unilateral and 16 bilateral IIA exclusions. One patient had persistent buttock claudication during follow-up; however, colonic or spinal cord ischemia was not observed. Anatomic suitability was investigated for the iliac branch device (IBD) by Cook Medical and the iliac branch endoprosthesis (IBE) by WL Gore: 87 aortoiliac segments were analyzed, of which 17% met the criteria for the IBD, 25% met the criteria for the IBE and 40% met the criteria for either. Main exclusions for the IBD were IIA diameter >9 mm or <6 mm (47%) and CIA length <50 mm (39%). Main exclusions for the IBE were proximal CIA diameter <17 mm (44%) and aortoiliac length <165 mm (24%). CONCLUSIONS EVAR with IIA exclusions in Japanese patients showed low incidence of persistent buttock claudication and no major pelvic complications. Aorto-iliac morphology demonstrated smaller proximal CIA diameters and shorter CIA lengths, limiting the use of IIA-preserving devices.
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Affiliation(s)
- Nathan K Itoga
- Division of Vascular Surgery, Stanford University Medical Center
| | - Naoki Fujimura
- Department of Surgery, Keio University School of Medicine
| | - Keita Hayashi
- Department of Surgery, Keio University School of Medicine
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University School of Medicine
| | - Jason T Lee
- Division of Vascular Surgery, Stanford University Medical Center
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Fujioka S, Hosaka S, Morimura H, Chen K, Wang ZC, Toguchi K, Fukuda S, Takizawa K, Osawa H. Outcomes of Extended Endovascular Aortic Repair for Aorto-Iliac Aneurysm with Internal Iliac Artery Occlusion. Ann Vasc Dis 2017. [PMID: 29515696 PMCID: PMC5835440 DOI: 10.3400/avd.oa.17-00089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Patients of aorto-iliac aneurysms who undergo endovascular aortic repair (EVAR) require internal iliac artery (IIA) occlusion with coil embolization and its coverage with the stent graft to prevent type II endoleak after extending the endograft into the external iliac artery. However, it has become well recognized that IIA occlusion cause buttock claudication and other various sequelae due to pelvic ischemia. We retrospectively analyzed IIA occlusion outcomes. Methods: From October 2008 to February 2015, 71 patients with aorto-iliac aneurysms underwent IIA occlusion prior to EVAR. The relationship between pelvic circulation and symptom of pelvic ischemia was studied. Results: Buttock claudication occurred in 17 patients (22.9%) of all. Eight patients (14.8%) in unilateral IIA occlusion group (54 patients) and nine patients (52.9%) in bilateral IIA group (17 patients) had sequelae of claudication. The sacrifice of the communication of superior gluteal artery (SGA) and inferior gluteal artery (IGA) led to buttock claudication in 18 (64.3%) of 28 limbs. Instead, only 4 of 60 limbs had buttock claudication, when we preserved the communication between SGA and IGA. In all patients, staged treatment of aorto-iliac aneurysms with IIA occlusion and EVAR were done successfully without pelvic ischemic complications except for buttock claudication, and postoperative CT scanning showed no endoleakage. Conclusion: IIA occlusion prior to EVAR is recognized as a safe and reasonable strategy. It is emphasized that preservation of the communication of SGA and IGA is important to prevent buttock claudication. (This is a translation of Jpn J Vasc Surg 2016; 25: 240–245.)
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Affiliation(s)
- Shunichiro Fujioka
- Department of Cardiovascular Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shigeru Hosaka
- Department of Cardiovascular Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hayato Morimura
- Department of Cardiovascular Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ken Chen
- Department of Cardiovascular Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Zhi Chao Wang
- Department of Cardiovascular Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Koji Toguchi
- Department of Cardiovascular Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shoji Fukuda
- Department of Cardiovascular Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Koki Takizawa
- Department of Cardiovascular Surgery, Shimada General Hospital, Choshi, Chiba, Japan
| | - Hiroshi Osawa
- Department of Cardiovascular Surgery, Shimada General Hospital, Choshi, Chiba, Japan
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Krievins DK, Savlovskis J, Holden AH, Kisis K, Hill AA, Gedins M, Ezite N, Zarins CK. Preservation of hypogastric flow and control of iliac aneurysm size in the treatment of aortoiliac aneurysms using the Nellix EndoVascular Aneurysm Sealing endograft. J Vasc Surg 2016; 64:1262-1269. [PMID: 27776696 DOI: 10.1016/j.jvs.2016.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/11/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the long-term effectiveness of endovascular aneurysm sealing (EVAS) in the treatment of complex aortoiliac aneurysms with preservation of hypogastric artery flow. METHODS We reviewed all patients with abdominal aortic aneurysms (AAAs) and common iliac aneurysms (CIAs) enrolled and treated in prospective studies of EVAS using the Nellix endograft (Endologix, Irvine, Calif) at two centers from 2008 to 2014. Patients with 1 year or more of computed tomography follow-up underwent quantitative morphometric assessment by two independent vascular radiologists blinded to clinical outcome results. Hypogastric patency and CIA diameter changes over time were assessed and compared in three treatment groups: totally excluded CIA, partially excluded CIA, and untreated CIA. RESULTS Among 125 patients with EVAS, 68 patients (mean age, 75 ± 8 years; 79% men) had both AAA (mean diameter, 55.8 ± 2.0 mm) and CIA (median diameter, 23.4; interquartile range, 21.3-27.0 mm), with bilateral CIAs in 33 patients. Treatment of 101 CIAs included complete CIA exclusion in 40 (39.6%), partial CIA exclusion in 33 (32.7%), and no CIA treatment in 28 (27.7%), with successful AAA exclusion in all patients. Internal iliac flow was preserved in all 122 hypogastric arteries that were patent before treatment (14 hypogastric arteries were occluded at baseline). During the 5-year follow-up period (median follow-up, 24.7 months; range, 11.5-61.7 months), three patients required secondary treatment with hypogastric occlusion and graft extension to the external iliac. Thus, internal iliac flow was maintained in 98% of at-risk hypogastric arteries. There were no aneurysm-related clinical events, except for the three secondary treatments. Totally excluded iliac aneurysms did not change in diameter over time (P = .85), whereas untreated CIAs enlarged at a rate of 0.16 mm/y (95% confidence interval, 0.09-0.23; P < .0001). Partially excluded CIAs enlarged at a higher rate of 0.59 mm/y (95% confidence interval, 0.47-0.71; P < .0001). Enlargement ≥3 mm occurred only in partially treated CIAs larger than 3 cm. CONCLUSIONS EVAS was effective in treating aortoiliac aneurysms with preservation of internal iliac patency in most cases. Complete CIA exclusion prevented aneurysm enlargement over time, whereas partial exclusion did not prevent continued CIA enlargement, particularly in larger aneurysms.
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Affiliation(s)
- Dainis K Krievins
- Department of Vascular Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia.
| | - Janis Savlovskis
- Department of Radiology, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Andrew H Holden
- Department of Interventional Radiology, Auckland City Hospital, Auckland, New Zealand
| | - Kaspars Kisis
- Department of Vascular Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Andrew A Hill
- Department of Vascular Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Marcis Gedins
- Department of Vascular Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Natalija Ezite
- Department of Radiology, Pauls Stradins Clinical University Hospital, Riga, Latvia
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Mansour W, Capoccia L, Sirignano P, Montelione N, Pranteda C, Formiconi M, Sbarigia E, Speziale F. Clinical and Functional Impact of Hypogastric Artery Exclusion During EVAR. Vasc Endovascular Surg 2016; 50:484-490. [PMID: 27651428 DOI: 10.1177/1538574416665968] [Citation(s) in RCA: 14] [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 Hypogastric artery (HA) revascularization during endovascular aneurysm repair (EVAR) is still open to debate. Moreover, exclusion-related complication rates reported in literature are not negligible. The aim of this study is to present and analyze the outcomes in patients undergoing EVAR with exclusion of 1 or both HAs at our academic center. METHODS We retrospectively reviewed our results in patients submitted to EVAR and needing HA exclusion, in terms of perioperative (30-day) and follow-up rates of intestinal and spinal cord ischemia, buttock claudication, buttock skin necrosis, and sexual dysfunction. RESULTS From January 2008 to December 2014, a total of 527 patients underwent elective standard infrarenal EVAR; among those 104 (19.7%) had iliac involvement needing HA exclusion. In 73 patients with unilateral iliac involvement (70.1%, group UH), many single HAs were excluded. Thirty-one patients (29.9%) had bilateral iliac involvement (group BH), of which 16 (51.6%) had 1 HA excluded with revascularization of the contralateral one (group BHR); in the remaining 15 patients (48.4%) both HAs were excluded (group BHE). No 30-day or follow-up aneurysm-related mortality, intestinal, or spinal cord ischemia were recorded. At 30 days, skin necrosis was observed in 2 patients. Buttock claudication and sexual dysfunction rates were significantly greater in group BHE than in group BHR (P < .05). At a mean 18.6 months follow-up (range: 4-47), buttock claudication and sexual dysfunction rates in group BHE were persistently higher than that in groups UH and BHR (P < .05); HA coil embolization was significantly associated with buttock claudication and sexual dysfunction (P < .05). CONCLUSIONS Whenever anatomically feasible, at least 1 HA should be salvaged in case of bilateral involvement. In case of unilateral HA exclusion, the rate of complications is not negligible. Coil embolization is related to a higher complication rate.
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Affiliation(s)
- Wassim Mansour
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Laura Capoccia
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Pasqualino Sirignano
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Nunzio Montelione
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Chiara Pranteda
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Martina Formiconi
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Enrico Sbarigia
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Francesco Speziale
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
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Kouvelos GN, Katsargyris A, Antoniou GA, Oikonomou K, Verhoeven ELG. Outcome after Interruption or Preservation of Internal Iliac Artery Flow During Endovascular Repair of Abdominal Aorto-iliac Aneurysms. Eur J Vasc Endovasc Surg 2016; 52:621-634. [PMID: 27600731 DOI: 10.1016/j.ejvs.2016.07.081] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 07/19/2016] [Indexed: 11/25/2022]
Abstract
AIM The aim was to conduct a systematic review of the literature investigating outcomes after interruption or preservation of the internal iliac artery (IIA) during endovascular aneurysm repair (EVAR). METHODS A systematic review was undertaken using the MEDLINE and EMBASE databases to identify studies reporting IIA management during EVAR. The search identified 57 articles: 30 reported on IIA interruption (1468 patients) and 27 on IIA preservation (816 patients). RESULTS The pooled 30 day buttock claudication (BC) rate was 29.2% (95% CI 24.2-34.7). Patients undergoing bilateral IIA interruption had a higher incidence of BC than patients with unilateral IIA interruption (36.5% vs. 27.2%, OR 1.7, 95% CI 1.11-2.6, p = .01). During a median follow up of 17 months, the pooled rate of persistent BC was 20.5% (95% CI 15.7-26.2). Of the patients, 93.9% underwent an endovascular revascularization procedure for IIA preservation. Most patients (87.6%) had an iliac branched device, and technical success was 96.2%. Within 30 days of EVAR, 4.3% of internal iliac branches occluded. During a median follow up of 15 months, the pooled occlusion rate at the site of IIA revascularization was 8.8% (95% CI 6.8-11.3). In patients treated with an iliac-branched device, 5.2% of internal iliac branches and 1.7% of external iliac arteries occluded. The pooled BC rate on the side of the IIA revascularization during follow up was 4.1% (95% CI 2.9-5.9). Pooled rates of late device related endoleak type I or III and secondary procedures on the side of the previous IIA revascularization were 4.6% (95% CI 3.2-6.5) and 7.8% (95% CI 5.7-10.7) respectively. CONCLUSION Unilateral or bilateral IIA occlusion during EVAR seems to carry a substantial risk of significant ischemic complications in nearly one quarter of patients. Bilateral IIA occlusion was related to a significantly higher rate of BC. IIA preservation techniques represent a significant improvement in the treatment of aorto-iliac aneurysms and have been associated with high technical success and low morbidity.
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Affiliation(s)
- G N Kouvelos
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Germany.
| | - A Katsargyris
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Germany
| | - G A Antoniou
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - K Oikonomou
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Germany
| | - E L G Verhoeven
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Germany
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31
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Bargay Juan P, Plaza Martínez Á, Ramírez Montoya M, Sala Almonacil V, Molina Nácher V, Gómez Palonés F. Resultados tras el cambio de estrategia en el sellado distal de endoprótesis aórticas infrarrenales. ANGIOLOGIA 2016. [DOI: 10.1016/j.angio.2016.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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32
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Telles GJP, Razuk Filho Á, Karakhanian WK, Saad PF, Saad KR, Park JH, Siqueira LCD, Caffaro RA. Dilatation of Common Iliac Arteries after Endovascular Infrarenal Abdominal Aortic Repair with Bell-Bottom Extension. Braz J Cardiovasc Surg 2016; 31:145-50. [PMID: 27556314 PMCID: PMC5062725 DOI: 10.5935/1678-9741.20160032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 03/28/2016] [Indexed: 11/20/2022] Open
Abstract
Objective Endovascular techniques to treat abdominal aortic aneurysms results in lower
morbidity and mortality rates. However, dilation of the common iliac
arteries prevents adequate distal sealing, which compromises the procedure
success. The aim of this study is report the long-term outcomes of patients
with abdominal aortic aneurysms associated with aneurysm of the common iliac
artery following endovascular repair using a bifurcated bell-bottom stent
graft. Methods This is a retrospective study that evaluated patients treated with bifurcated
bell-bottom extension stent grafts to repair an infrarenal abdominal aortic
aneurysm and who had at least one common iliac artery with dilatation >
1.5 cm for at least 12 months after the endovascular intervention. Results Thirty-eight patients with a mean age of 70.4±8.2 years were
included. Stent graft placement was followed by dilation of the common iliac
artery aneurysms in 35.3% of cases; endoleak and reoperation rates were
17.6% and 15.7%, respectively. Younger patients showed a higher rate of
artery diameter increase following the procedure. The average arterial
dilation was 16% in the first year, 29% in the second year, 57% in the third
year and 95% from the fourth year until the end of follow-up. Conclusion Repair of infrarenal abdominal aortic aneurysms with bifurcated bell-bottom
type stents when there is common iliac artery dilation is a good therapeutic
option to preserve hypogastric flow. The rate of endoleak was 17.6%, and
15.7% of cases required reoperation. Younger patients are more likely to
experience dilation of the common iliac artery after the procedure.
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Affiliation(s)
| | - Álvaro Razuk Filho
- Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Jong Hun Park
- Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brazil
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Hakaim AG, Lau LL, Neuhauser B, Klocker J, Oldenburg WA, McKinney JM, Paz-Fumigalli R, Stockland A. A Comparison of AneuRx Aortic Cuff and Zenith Distal Flare Exclusion of Common Iliac Artery Ectasia for Endovascular Aneurysm Repair. Vasc Endovascular Surg 2016; 38:51-6. [PMID: 14760477 DOI: 10.1177/153857440403800106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stent-grafts are ideally terminated within the common iliac artery (CIA). However, CIA ectasia may require hypogastric artery occlusion, with stent-graft extension to the external iliac artery. Alternatively, the diameter of the distal stent-graft may be increased, or flared, to allow exclusion of the abdominal aortic aneurysm. This report details the authors’ experience with this technique. Forty-one patients received bifurcated stent-grafts (BSG): 20 received an AneuRx device, and 21 received a Zenith device. CIA ectasia (diameter 15–25 mm) was treated with a distal flare of 2–4 mm greater than the CIA diameter. Patients were followed up with computed tomography scan at 1, 6, and 12 months. Statistical analysis was performed using ANOVA within groups and unpaired two-tailed t test between groups. A p value of <0.05 was considered significant. Eight of 20 patients (40%) (11 CIA) received an AneuRx device and 13/21 (62%) (17 CIA) received a Zenith device, with a distal flare. Values are (n) mean (mm) ± SE. There were no deaths, endoleaks, migrations, or conversions to open repair. Follow-up mean was 24.7 and 20.6 (range 15–28) months for AneuRx and Zenith groups, respectively. In comparing initial and 12-month CIA diameters, AneuRx grafts 20 ±0.8 vs 21.5 ±1.0 were not significantly different, p= 0.2, nor was the same comparison for Zenith, 17 ±0.5 vs 19.1 ±0.4, significant, p= 0.57. At a mean follow-up of 12 months, distal flare of iliac limbs with either AneuRx or Zenith devices affords a seal for CIA ectasia and/or aneurysms complicating EVAR.
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Affiliation(s)
- Albert G Hakaim
- Section of Vascular Surgery, Mayo Clinic, Jacksonville, FL, USA.
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34
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Dube B, Ünlü Ç, de Vries JPPM. Fate of Enlarged Iliac Arteries After Endovascular or Open Abdominal Aortic Aneurysm Repair. J Endovasc Ther 2016; 23:803-8. [DOI: 10.1177/1526602816661832] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To examine the fate of untreated ectatic and aneurysmal common iliac arteries (CIAs) after open treatment and endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA). Methods: Databases of scientific literature were searched between January 1980 and February 2016 to identify publications on the follow-up of ectatic and aneurysmal CIAs after open or endovascular AAA repair. The primary outcome measure was the increase of iliac artery diameter during follow-up. The secondary outcome was the subsequent reintervention rate during follow-up. Results: Only 3 open AAA and 3 EVAR studies containing 1239 patients met the inclusion criteria for analysis. In the open AAA group, ectatic iliac arteries (defined as 12–18 mm) had a diameter progression of 1.7 to 1.8 mm during a follow-up period of 51.6 to 85.2 months. The aneurysmal iliac arteries (>18 mm) in the open repair group showed a faster growth (2.3–3.0 mm) in a follow-up period of 50.4 to 85.2 months. The pooled assessment of arteries ≥18 mm had a mean growth of 2.56 mm at 60 months of follow-up. In the entire open AAA cohort, the reintervention rate for CIA transformation was <1%. In the EVAR studies, arbitrary cutoff sizes of 16 to 20 mm for ectatic arteries and >20 mm for aneurysmal arteries were used. During a follow-up of 39.2 to 60 months, the diameter progression was 1.5 mm for the 16-mm iliac arteries and 2.7 mm for the 20-mm iliac arteries. The need for endovascular reinterventions was similar in patients with previously normal or enlarged CIAs. Conclusion: After open AAA repair, the overall size of CIA aneurysms grows slowly, but enlarged CIAs >20 mm in EVAR patients show faster growth during follow-up. However, the need for secondary interventions was similar in patients with normal or enlarged CIAs post EVAR.
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Affiliation(s)
- Bhekifa Dube
- Department of Vascular Surgery, Tertiary Livingstone Hospital, Port Elizabeth, South Africa
| | - Çağdaş Ünlü
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
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35
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Choi HR, Park KH, Lee JH. Risk Factor Analysis for Buttock Claudication after Internal Iliac Artery Embolization with Endovascular Aortic Aneurysm Repair. Vasc Specialist Int 2016; 32:44-50. [PMID: 27386451 PMCID: PMC4928603 DOI: 10.5758/vsi.2016.32.2.44] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/17/2016] [Accepted: 05/30/2016] [Indexed: 11/20/2022] Open
Abstract
Purpose: Endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs) involving the common iliac artery requires extension of the stent-graft limb into the external iliac artery. For this procedure, internal iliac artery (IIA) embolization is performed to prevent type II endoleak. In this study, we investigated the frequency and risk factor of buttock claudication (BC) in patients having interventional embolization of the IIA. Materials and Methods: From January 2010 to December 2013, a total of 110 patients with AAA were treated with EVAR in our institution. This study included 27 patients (24.5%) who had undergone unilateral IIA coil embolization with EVAR. We examined hospital charts retrospectively and interviewed by telephone for the occurrence of BC. Results: Mean age of total patients was 71.9±7.0 years and 88.9% were males. During a mean follow-up of 8.65±9.04 months, the incidence of BC was 40.7% (11 of 27 patients). In 8 patients with claudication, the symptoms had resolved within 1 month of IIA embolization, but the symptoms persisted for more than 6 months in the remaining 3 patients. In univariate and multivariate analysis, risk factors such as age, sex, comorbidity, patency of collateral arteries, and anatomical characteristics of AAA were not significantly related with BC. Conclusion: In this study, BC was a frequent complication of IIA embolization during EVAR and there was no associated risk factor. Certain principles such as checking preoperative angiogram, proximal and unilateral IIA embolization may have contributed to reducing the incidence of BC.
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Affiliation(s)
- Hye Ryeon Choi
- Division of Vascular and Endovascular Surgery, Department of Surgery, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Ki Hyuk Park
- Division of Vascular and Endovascular Surgery, Department of Surgery, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Jae Hoon Lee
- Division of Vascular and Endovascular Surgery, Department of Surgery, Daegu Catholic University College of Medicine, Daegu, Korea
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Falkensammer J, Hakaim AG, Oldenburg WA, Neuhauser B, Paz-Fumagalli R, McKinney JM, Hugl B, Biebl M, Klocker J. Natural History of the Iliac Arteries after Endovascular Abdominal Aortic Aneurysm Repair and Suitability of Ectatic Iliac Arteries as a Distal Sealing Zone. J Endovasc Ther 2016; 14:619-24. [DOI: 10.1177/152660280701400503] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To investigate the natural history of dilated common iliac arteries (CIA) exposed to pulsatile blood flow after endovascular abdominal aortic aneurysm repair (EVAR) and the suitability of ectatic iliac arteries as sealing zones using flared iliac limbs. Methods: Follow-up computed tomograms of 102 CIAs in 60 EVAR patients were investigated. Diameter changes in CIAs ≤16 mm (group 1) were compared with changes in vessels where a dilated segment >16 mm in diameter continued to be exposed to pulsatile blood flow (group 2). Within group 2, cases in which the stent terminated proximal to the dilated artery segment (2a) were compared with those that had been treated with a flared limb (2b). Results: The mean CIA diameter increased by 1.0±1.0 mm in group 1 (p<0.001 versus immediately after EVAR) and by 1.5±1.7 mm in group 2 (p<0.001 versus immediately after EVAR) within an average follow-up of 43.6±18.0 months. Diameter increase was more pronounced in dilated CIAs (p=0.048), and it was not significantly different between groups 2a and 2b (p=0.188). No late distal type I endoleak or stent-graft migration associated with CIA ectasia was observed. Conclusion: Dilatation of the CIA is significant after EVAR, and it is more pronounced in ectatic iliac arteries. Although ectatic iliac arteries appear to be suitable sealing zones in the short term, continued follow-up is mandatory.
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Affiliation(s)
- Juergen Falkensammer
- Sections of 1 Vascular Surgery, Mayo Clinic Jacksonville, Florida, USA
- Department of Vascular Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Albert G. Hakaim
- Sections of 1 Vascular Surgery, Mayo Clinic Jacksonville, Florida, USA
| | | | - Beate Neuhauser
- Sections of 1 Vascular Surgery, Mayo Clinic Jacksonville, Florida, USA
- Department of Vascular Surgery, Innsbruck Medical University, Innsbruck, Austria
| | | | - J. Mark McKinney
- Sections of Interventional Radiology, Mayo Clinic Jacksonville, Florida, USA
| | - Beate Hugl
- Sections of 1 Vascular Surgery, Mayo Clinic Jacksonville, Florida, USA
- Department of Vascular Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Matthias Biebl
- Sections of 1 Vascular Surgery, Mayo Clinic Jacksonville, Florida, USA
- Department of Vascular Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Josef Klocker
- Sections of 1 Vascular Surgery, Mayo Clinic Jacksonville, Florida, USA
- Department of Vascular Surgery, Innsbruck Medical University, Innsbruck, Austria
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Millon A, Della Schiava N, Arsicot M, De Lambert A, Feugier P, Magne JL, Lermusiaux P. Preliminary Experience with the GORE® EXCLUDER® Iliac Branch Endoprosthesis for Common Iliac Aneurysm Endovascular Treatment. Ann Vasc Surg 2016; 33:11-7. [DOI: 10.1016/j.avsg.2015.12.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/10/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
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38
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Hossain S, Steinmetz OK, Corriveau MM, MacKenzie KS. Patency of the contralateral internal iliac artery in aortouni-iliac endografting. J Vasc Surg 2016; 63:974-82. [DOI: 10.1016/j.jvs.2015.10.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 10/06/2015] [Indexed: 11/25/2022]
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39
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Lahoz C, Gracia CE, García LR, Montoya SB, Hernando ÁB, Heredero ÁF, Tembra MS, Velasco MB, Guijarro C, Ruiz EB, Pintó X, de Ceniga MV, Moñux Ducajú G. [Not Available]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2016; 28 Suppl 1:1-49. [PMID: 27107212 DOI: 10.1016/s0214-9168(16)30026-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Carlos Lahoz
- Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Carlos III, Madrid, España.
| | - Carlos Esteban Gracia
- Servicio de Angiología y Cirugía Vascular, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | | | - Sergi Bellmunt Montoya
- Servicio de Angiología y Cirugía Vascular, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Ángel Brea Hernando
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital San Pedro, Logroño, España
| | | | - Manuel Suárez Tembra
- Unidad de Lípidos y Riesgo Cardiovascular, Servicio de Medicina Interna, Hospital San Rafael, A Coruña, España
| | - Marta Botas Velasco
- Servicio de Angiología y Cirugía Vascular, Hospital de Cabueñes, Gijón, España
| | - Carlos Guijarro
- Consulta de Riesgo Vascular, Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Esther Bravo Ruiz
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario de Basurto, Bilbao, España
| | - Xavier Pintó
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, L' Hospitalet de Llobregat, Barcelona, España
| | - Melina Vega de Ceniga
- Servicio de Angiología y Cirugía Vascular, Hospital de Galdakao-Usansolo, Vizcaya, España
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40
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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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41
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Development of Delirium in the Intensive Care Unit in Patients after Endovascular Aortic Repair: A Retrospective Evaluation of the Prevalence and Risk Factors. Crit Care Res Pract 2015; 2015:405817. [PMID: 26421186 PMCID: PMC4572402 DOI: 10.1155/2015/405817] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/31/2015] [Accepted: 08/02/2015] [Indexed: 11/17/2022] Open
Abstract
Delirium is an acute form of nervous system dysfunction often observed in patients in the intensive care unit. Endovascular aortic repair (EVAR) is considered a minimally invasive surgical treatment for abdominal aortic aneurysm. Although the operation method is widely used, there are few investigations of the rate and risk factors of delirium development after the operation. In this study, we retrospectively examined the rate of delirium development in the intensive care unit (ICU) after EVAR, as well as the associated preoperative risk factors and effects on the lengths of ICU and hospital stays. We examined the 81 consecutive patients who underwent elective EVAR between November 2013 and August 2014. The Intensive Care Delirium Screening Checklist was used to diagnose delirium. Twenty patients (24.7%) were diagnosed with delirium in this study. The ICU and hospital length of stays of patients with delirium were 3.3 ± 2.4 days and 14.5 ± 11.9 days, respectively, the latter of which was significantly longer than that of patients without delirium (p = 0.019). Additionally, renal dysfunction, preoperative benzodiazepine use, and intraoperative transfusion were found to be risk factors for the development of delirium after elective EVAR.
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42
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Ferrero E, Psacharopulo D, Ripepi M, Ferri M, Viazzo A, Tallia C, Trucco A, Nessi F. U Stent-Graft Technique as a Treatment for Homolateral Metachronous Common Iliac and Internal Iliac Arteries Aneurysms after Open Surgery. Ann Vasc Surg 2015; 29:1659.e1-7. [PMID: 26256709 DOI: 10.1016/j.avsg.2015.06.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 06/01/2015] [Accepted: 06/01/2015] [Indexed: 11/19/2022]
Abstract
We report a case of a metachronous common iliac artery and the internal iliac artery (IIA) aneurysm developed 8 years after an aortobi-femoral bypass for treatment of abdominal aortic aneurysm associated at chronic occlusion of the right iliac axis. To exclude the metachronous aneurysm on the left iliac axis and to maintain the pelvic circulation, an external to IIA endografts were positioned ("U stent-graft technique"). At 6-month follow-up, the computed tomography scan showed patency of the endografts, of the bypass and of the IIA, without endoleak, or other adverse events.
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Affiliation(s)
- Emanuele Ferrero
- Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy.
| | - Daniele Psacharopulo
- Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy
| | - Matteo Ripepi
- Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy
| | - Michelangelo Ferri
- Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy
| | - Andrea Viazzo
- Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy
| | - Caterina Tallia
- Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy
| | - Andrea Trucco
- Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy
| | - Franco Nessi
- Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy
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43
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Morishita A, Tomioka H, Katahira S, Hoshino T, Hanzawa K. Open Surgery for Giant Bilateral Internal Iliac Artery Aneurysms with Compression of Neighboring Abdominal Structures: A Case Report. Ann Vasc Dis 2015; 8:265-7. [PMID: 26421081 DOI: 10.3400/avd.cr.15-00065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/16/2015] [Indexed: 11/13/2022] Open
Abstract
We describe a patient with successfully treated giant bilateral internal iliac artery aneurysms that were associated with acute renal failure secondary to bilateral hydronephrosis, lumbosacral plexopathy, and ileus. After hemodialysis for 1 month, the patient underwent graft replacement of the abdominal aorta and iliac arteries, including complete obliteration of the internal iliac artery branches, reconstruction of the inferior mesenteric artery, and ureterolysis. Weaning from hemodialysis was achieved and postoperative renal function improved. Although the patient had serious preoperative co-morbidities, emergency traditional open surgery should be the gold standard for securely releasing compression of the neighboring organs instead of endovascular treatment.
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Affiliation(s)
- Atsushi Morishita
- The Department of Cardiovascular Surgery, Numata Neurosurgery Heart-Disease Hospital, Numata, Gunma, Japan
| | - Hideyuki Tomioka
- The Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Womens Medical University, Tokyo, Japan
| | | | - Takeshi Hoshino
- The Department of Anesthesiology, Minami Machida Hospital, Machida, Tokyo, Japan
| | - Kazuhiko Hanzawa
- The Department of Thoracic and Cardiovascular Surgery, Niigata University School of Medicine, Niigata, Niigata, Japan
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44
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Akinwande O, Ahmad A, Ahmad S, Coldwell D. Review of pelvic collateral pathways in aorto-iliac occlusive disease: demonstration by CT angiography. Acta Radiol 2015; 56:419-27. [PMID: 24622738 DOI: 10.1177/0284185114528172] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The pelvic collateral system is a robust network of communicating vessels that provide the functional reserve to withstand chronic aorto-iliac occlusive disease. For establishment of collateral circulation, the afferent vessel must originate proximal to the occlusion and anastomose with vessel/s distal to the occlusion. These collateral pathways can be classified as viscero-systemic, systemic-systemic, and visceral-visceral. CT angiography (CTA) is often the initial modality for evaluating patients with atherosclerotic vascular disease, because it is non-invasive and has been shown to be comparable to conventional angiography. Most collateral pathways are well demonstrated on CTA, which therefore is a useful tool for preoperative planning and regional interventional procedures.
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Affiliation(s)
| | - Aamir Ahmad
- Department of Radiology, University of Louisville, Louisville, KY, USA
| | - Shakeeb Ahmad
- School of Medicine, University of Louisville, Louisville, KY, USA
| | - Douglas Coldwell
- Department of Radiology, University of Louisville, Louisville, KY, USA
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45
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Tonak J, Kleemann M, Wiedner M, Barkhausen J, Goltz JP. The "buddy balloon technique" facilitates retrograde ipsilateral access to postdilate an iliac side branch after endovascular aneurysm repair. J Vasc Surg Cases 2015; 1:57-60. [PMID: 31724567 PMCID: PMC6849895 DOI: 10.1016/j.jvsc.2014.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 11/06/2014] [Indexed: 11/29/2022] Open
Abstract
If unilateral common iliac aneurysms occur simultaneously with abdominal aortic aneurysm, endovascular treatment consists of implantation of a bifurcated stent graft with extension into the external iliac artery while the ipsilateral internal iliac artery is often occluded. The internal iliac artery may be preserved by an iliac branch device (IBD). In this technical note, we describe a technique to probe the side branch of an IBD for postdilation through an ipsilateral retrograde access using one balloon to block the way upstream while directing a second percutaneous transluminal angioplasty balloon into the side branch despite the hostile angle of side branch and IBD.
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Affiliation(s)
- Julia Tonak
- Clinic for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Markus Kleemann
- Clinic for Surgery, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marcus Wiedner
- Clinic for Surgery, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Jörg Barkhausen
- Clinic for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Jan Peter Goltz
- Clinic for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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46
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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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47
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Zhang T, Guo W, Ma X, Jia X, Liu X, Dong Y, Xiong J, Jia S. Novel-Designed Iliac Branch Stent Graft for Internal Iliac Artery Reconstruction during Aneurysm Repair. Ann Vasc Surg 2015; 29:189-96. [DOI: 10.1016/j.avsg.2014.07.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 07/13/2014] [Accepted: 07/17/2014] [Indexed: 10/24/2022]
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48
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Kim WC, Jeon YS, Hong KC, Kim JY, Cho SG, Park JY. Internal iliac artery embolization during an endovascular aneurysm repair with detachable interlock microcoils. Korean J Radiol 2014; 15:613-21. [PMID: 25246822 PMCID: PMC4170162 DOI: 10.3348/kjr.2014.15.5.613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 06/09/2014] [Indexed: 12/25/2022] Open
Abstract
Objective The purpose of this study was to evaluate the effectiveness of detachable interlock microcoils for an embolization of the internal iliac artery during an endovascular aneurysm repair (EVAR). Materials and Methods A retrospective review was conducted on 40 patients with aortic aneurysms, who had undergone an EVAR between January 2010 and March 2012. Among them, 16 patients were referred for embolization of the internal iliac artery for the prevention of type II endoleaks. Among 16 patients, 13 patients underwent embolization using detachable interlock microcoils during an EVAR. Computed tomographic angiographies and clinical examinations were performed during the follow-up period. Technical success, clinical outcome, and complications were reviewed. Results Internal iliac artery embolizations using detachable interlock microcoils were technically successful in all 13 patients, with no occurrence of procedure-related complications. Follow-up imaging was accomplished in the 13 cases. In all cases, type II endoleak was not observed with computed tomographic angiography during the median follow-up of 3 months (range, 1-27 months) and the median clinical follow-up of 12 months (range, 1-27 months). Two of 13 (15%) patients had symptoms of buttock pain, and one patient died due to underlying stomach cancer. No significant clinical symptoms such as bowel ischemia were observed. Conclusion Internal iliac artery embolization during an EVAR using detachable interlock microcoils to prevent type II endoleaks appears safe and effective, although this should be further proven in a larger population.
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Affiliation(s)
- Woo Chul Kim
- Department of Radiology, Inha University Hospital, Inha University School of Medicine, Incheon 400-711, Korea
| | - Yong Sun Jeon
- Department of Radiology, Inha University Hospital, Inha University School of Medicine, Incheon 400-711, Korea
| | - Kee Chun Hong
- Department of Vascular Surgery, Inha University Hospital, Inha University School of Medicine, Incheon 400-711, Korea
| | - Jang Yong Kim
- Department of Vascular and Endovascular Surgery, The Catholic University of Korea School of Medicine, Seoul 137-701, Korea
| | - Soon Gu Cho
- Department of Radiology, Inha University Hospital, Inha University School of Medicine, Incheon 400-711, Korea
| | - Jae Young Park
- Department of Vascular Surgery, Inha University Hospital, Inha University School of Medicine, Incheon 400-711, Korea
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49
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Early outcomes of iliac branch grafts in the endovascular repair of abdominal aortic aneurysms with concomitant bilateral common iliac artery aneurysms at a Japanese institution. Surg Today 2014; 45:688-94. [DOI: 10.1007/s00595-014-0927-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 04/01/2014] [Indexed: 10/25/2022]
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50
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A'Court J, Yiannoullou P, Pearce L, Hill J, Donnelly D, Murray D. Rectourethral fistula secondary to a bowel management system. Intensive Crit Care Nurs 2014; 30:226-30. [PMID: 24457039 DOI: 10.1016/j.iccn.2013.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 11/07/2013] [Accepted: 12/17/2013] [Indexed: 11/19/2022]
Abstract
A 67-year-old Caucasian male was admitted under the vascular team with critical lower limb ischaemia. Bypass surgery was performed and he was admitted to the intensive care unit post-operatively. The patient experienced a turbulent post-operative recovery complicated by pneumonia, poor respiratory wean and faecal incontinence. A bowel management system was inserted but after 18 days it was reported faecal matter was bypassing his catheter. A CT scan demonstrated an area of necrosis where the bowel management system had been sited which formed a rectourethral fistula. Bowel management systems are frequently used in intensive care unit settings where a high proportion of patients suffer from faecal incontinence. If used correctly they can reduce skin contamination, infection and maintain patient hygiene. However, appropriate assessment and investigations should be addressed before inserting such devices. This case report highlights serious adverse effects of these devices and describes the first documented case of these devices causing a rectourethral fistula.
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Affiliation(s)
- Jamie A'Court
- Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom.
| | - Petros Yiannoullou
- Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom
| | - Lyndsay Pearce
- Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom
| | - James Hill
- Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom
| | - David Donnelly
- Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom
| | - David Murray
- Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom
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