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George JM, Hatzis CM, Ritzer L, Khera S, Tang G, Kini A, Faries P, Tadros RO. Surgical External Iliac Artery Access for Transcatheter Aortic Valve Replacement Is a Safe, Suitable Alternative to Common Femoral Artery Access. Cureus 2023; 15:e40028. [PMID: 37425500 PMCID: PMC10323864 DOI: 10.7759/cureus.40028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Background Many patients undergoing transcatheter aortic valve replacement (TAVR) have peripheral artery disease necessitating surgical access. This study reviews the preoperative risk factors, procedural characteristics, and outcomes in patients undergoing surgical common femoral artery (CFA) and external iliac artery (EIA) access through a retro-inguinal groin incision for TAVR. Methods A single-center TAVR database was retrospectively analyzed for patients undergoing surgical cutdown (January 1, 2016 - December 31, 2020). Access sites were evaluated on preoperative imaging. Data on demographics, imaging, procedural characteristics, and outcomes were collected. The vascular surgeon selected the cutdown site. Results A hundred and thirty TAVR patients had surgical cutdown. The choice of access site was either the common femoral artery (82 patients, 63%) or the iliac artery (48 patients, 37%). There was no difference in age, BMI, or medical risk factors. There was no difference in iliac diameter or circumferential iliac calcium. In the iliac group, there was a smaller mean CFA size and a higher incidence of circumferential CFA calcium. In the femoral group, there was: a lower mean sheath-to-CFA ratio, a trend toward increased unplanned endarterectomy, and a higher incidence of 30-day readmission. There was no difference in adjunct procedure use. Conclusion EIA surgical access had similar complication rates and length of stay with a reduced tendency for unplanned endarterectomy when compared to CFA access. The EIA is a suitable access site for TAVR in select patients.
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Affiliation(s)
- Justin M George
- Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Lukas Ritzer
- Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Sahil Khera
- Interventional Cardiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Gilbert Tang
- Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Peter Faries
- Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Rami O Tadros
- Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, USA
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Clampless In-Situ Immobilized Branching (CLIMB) to Reconstruct the Internal Iliac Artery. LIFE (BASEL, SWITZERLAND) 2022; 12:life12111928. [PMID: 36431063 PMCID: PMC9697542 DOI: 10.3390/life12111928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/09/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Surgical reconstruction of the internal iliac artery (IIA) or its branches is sometimes demanding because of difficulty in distal clamping and suturing in the narrow pelvic space. Here we present a hybrid technique of ClampLess In-situ imMobilized Branching (CLIMB) to reconstruct IIA. METHODS in the CLIMB technique, an 8 mm artificial graft is sutured onto the surface of the common iliac artery (CIA) without clamping. Following puncture of the CIA wall, stent grafts are bridged from IIA to the graft. Finally, the graft is sutured to the ipsilateral external iliac artery (EIA). Concomitant endovascular aneurysm repair or IIA branch embolization can also be performed. We applied this technique to the patients unsuited for other IIA reconstruction. RESULTS eleven patients underwent the current technique. All but one patient underwent contralateral IIA interruption. Seven patients had a history of aorto-iliac repair before the index surgery. Iliac extender, internal iliac component, Viabahn VBX or Fluency covered stent were used for bridging the graft. Simultaneous IIA branch embolization was performed in 2 patients. Distal landing zones were IIA in 7 grafts, superior gluteal artery in 4 grafts and inferior gluteal artery (IGA) in 1 graft. Technical success was achieved in all cases. No patient complained of buttock claudication or other ischemic symptoms on the treatment side. During a mean follow-up period of 38 months, 11 out of 12 grafts were patent without any related endoleak. One IGA graft occluded at 56 months after surgery. CONCLUSIONS the CLIMB technique is a viable alternative to preserve IIA with an acceptable mid-term durability.
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Patel S, Lalani A, Bray J, Chawla A, Danos D, Sheahan CM, Sheahan MG. A Novel Clinically Based Classification System for the Profunda Femoris Artery and the Circumflex Femoral Arteries. Ann Vasc Surg 2022; 85:204-210. [PMID: 35339601 DOI: 10.1016/j.avsg.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The profunda femoris artery (PFA) supplies important collateral branches to both the ipsilateral internal iliac and the distal superficial femoral artery (SFA). The size and patency of these collateral pathways can determine the risk of pelvic malperfusion, spinal cord ischemia, and lower extremity limb loss following vascular interventions. Despite its importance, the anatomy of the PFA is rarely characterized in clinical studies involving the pelvic or lower extremity circulation. This discussion may be limited by the lack of a comprehensive classification system. Our objective was to describe the most common PFA anatomic variants and present a classification system based on its branching patterns. METHODS We dissected 155 fixed and non-fixed femoral artery systems from 88 cadavers. Seventy-seven female and 78 male femoral exposures were performed. Vessel diameters, branch configurations and relative distances between the inguinal ligament, PFA, lateral circumflex femoral artery (LCFA), and medial circumflex femoral artery (MCFA) were recorded. RESULTS The mean diameters of the common femoral artery, SFA and PFA in males were 10.3mm, 8.0mm and 6.9mm, and 8.9mm, 6.9mm and 6.1 in females, respectively (p < 0.05). The mean distances from the inguinal ligament for PFA, MCFA and LCFA were 41mm, 41.7mm and 52.5mm respectively. No significant differences were noted relative to laterality or fixation. We developed a clinically applicable classification system based on the orientation of the PFA, LCFA, and MCFA. Six PFA, 5 LCFA and 5 MCFA variations were identified and ranked by frequency. The five most common combinations accounted for 56.1% of our cadaver series. CONCLUSION The anatomic orientation of the PFA and its branches is highly variable. We propose a novel classification system of this rich collateral system to facilitate consistent communication in academic and clinical vascular surgery.
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Affiliation(s)
- Shivik Patel
- Louisiana State University Health Sciences Center.
| | | | - Jacob Bray
- Louisiana State University Health Sciences Center
| | - Amit Chawla
- Louisiana State University Health Sciences Center
| | - Denise Danos
- Louisiana State University Health Sciences Center
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Tajima Y, Goto H, Akamatsu D, Serizawa F, Suzuki S, Horii S, Ogasawara N, Takahashi H, Nagaoka Y, Kamei T. Prevention of Buttock Claudication by Preserving Antegrade Bilateral Superior Gluteal Arterial Blood Flow in EVAR for Aorto-Iliac Aneurysm Accompanied by Bilateral Internal Iliac Artery Aneurysms. Ann Vasc Dis 2022; 15:53-57. [PMID: 35432652 PMCID: PMC8958409 DOI: 10.3400/avd.cr.21-00107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/18/2021] [Indexed: 11/24/2022] Open
Abstract
Buttock claudication (BC) is a complication of surgery for aorto-iliac aneurysms (AIAs) caused by sacrificing blood flow in the internal iliac artery (IIA). However, the preservation of antegrade blood flow of IIAs is often challenging when performing both open surgery and endovascular aneurysm repair (EVAR) for AIAs accompanied by IIA aneurysms. We performed EVAR and successfully preserved the antegrade blood flow of bilateral superior gluteal arteries using the GORE EXCLUDER iliac branch endoprosthesis with the VIABAHN endograft. BC did not occur, both subjectively and objectively, after surgery. This approach can be minimally invasive yet an effective procedure to prevent BC.
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Affiliation(s)
- Yuta Tajima
- Department of Surgery, Tohoku University Hospital
| | - Hitoshi Goto
- Department of Surgery, Tohoku University Hospital
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Bennett KM, Scarborough JE. The Effect of Hypogastric Artery Revascularization on Ischemic Colitis in Endovascular Aneurysm Repair. J Surg Res 2020; 258:246-253. [PMID: 33038602 DOI: 10.1016/j.jss.2020.07.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/17/2020] [Accepted: 07/11/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The objective of the study was to examine the effect of hypogastric revascularization maneuvers on the rate of postoperative ischemic colitis among patients undergoing endovascular aortoiliac aneurysm repair. METHODS Using the 2011-2018 Endovascular Aneurysm Repair Procedure-Targeted American College of Surgeons National Surgical Quality Improvement Program Participant Use Files, we analyzed patients undergoing elective endovascular infrarenal aortoiliac aneurysm repairs. Using multivariable modeling techniques, a cohort of patients at high risk for postoperative ischemic colitis was identified. The outcomes of this group were then compared using Pearson's chi-square testing in accordance with whether or not they underwent hypogastric revascularization. RESULTS Of 4753 patients undergoing endovascular aortoiliac aneurysm repair in the National Surgical Quality Improvement Program cohort, 1161 had concomitant hypogastric revascularization procedures. High-risk predictors of ischemic colitis included chronic obstructive pulmonary disease and concurrent renal artery or external iliac artery stenting. There was not a significant association between pelvic revascularization and postoperative ischemic colitis [1.0% with versus 0.5% without pelvic revascularization; adjusted odds ratio of ischemic colitis with revascularization 2.07 (0.96, 4.46); P = 0.06] after adjustment for patient- and procedure-related factors. In a subgroup analysis of patients with a distal aneurysm extent beyond the common iliac artery, the incidence of ischemic colitis was significantly lower in patients without pelvic revascularization (0.1% versus 1.6%, P = 0.004). CONCLUSIONS Our analysis of patients undergoing elective endovascular repair of infrarenal aortoiliac aneurysmal disease did not find a reduced incidence of postoperative ischemic colitis in patients who received a concomitant pelvic revascularization procedure, suggesting instead that such procedural adjuncts may actually increase risk for this complication.
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Affiliation(s)
- Kyla M Bennett
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
| | - John E Scarborough
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Endovascular treatment of patients with bilateral internal iliac artery disease and buttock claudication. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:565-570. [PMID: 32082798 DOI: 10.5606/tgkdc.dergisi.2018.16143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/31/2018] [Indexed: 11/21/2022]
Abstract
Background This study aims to investigate the therapeutic value of endovascular treatment in patients with buttock claudication caused by stenosis or occlusion of the bilateral internal iliac arteries. Methods This single-center, retrospective study included a total of 12 patients (9 males, 3 females; mean age 63.7±6.4 years; range 54 to 74 years) with persistent buttock claudication who underwent endovascular repair of bilateral internal iliac artery stenosis or occlusion and were treated with percutaneous transluminal angioplasty in another session at our center between July 2012 and February 2016. The iliac Doppler ultrasonography and/or computed tomography angiography were performed at six and 12 months to evaluate restenosis or occlusion. Symptom relief was considered a successful outcome. Results The median follow-up was 16.5±3.7 (range, 12 to 24) months. Four patients underwent a bilateral intervention and eight patients underwent unilateral intervention. There was a 100% technical success rate with no complications. The primary patency rate at 12 months was 87.5%. Six patients (50%) had complete and four patients (33.3%) had partial relief of the buttock claudication symptoms. Conclusion Percutaneous angioplasty of the internal iliac arteries is a technically feasible and safe method in patients with buttock claudication and bilateral internal iliac artery occlusion or stenosis. Complete or partial relief of symptoms can be achieved in the majority of patients with a high primary patency rate.
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Brewer MB, Lau DL, Lee JT. Endovascular Treatment of Claudication due to Isolated Internal Iliac Artery Occlusive Disease. Ann Vasc Surg 2018; 57:48.e1-48.e5. [PMID: 30114502 DOI: 10.1016/j.avsg.2018.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/17/2018] [Accepted: 07/17/2018] [Indexed: 11/19/2022]
Abstract
Aortoiliac occlusive disease is a common cause of lower extremity claudication. Patients are typically found to have diminished femoral pulses and abnormal noninvasive vascular studies of the lower extremities. Isolated lesions of the internal iliac arteries are much less commonly treated but can cause similar claudication symptoms in the buttocks, hips, or thighs. Occlusive disease in the internal iliac artery is more challenging to diagnose because the lower extremity pulses and vascular studies can be normal. This may falsely steer the diagnosis away from a vascular etiology. We present a case of disabling buttock claudication in a patient with normal pulses and isolated ipsilateral internal iliac artery stenosis. This was treated successfully with drug-eluting balloon angioplasty. We review the literature for similar cases of isolated internal iliac artery occlusive disease and summarize the disease characteristics and treatment modalities.
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Affiliation(s)
- Michael B Brewer
- Vascular & Endovascular Surgery, Department of Surgery, Kaiser Permanente Downey Medical Center, Downey, CA.
| | - David L Lau
- Vascular & Endovascular Surgery, Department of Surgery, Kaiser Permanente Downey Medical Center, Downey, CA
| | - James T Lee
- Vascular & Endovascular Surgery, Department of Surgery, Kaiser Permanente Downey Medical Center, Downey, CA; Department Chief, Department of Surgery, Kaiser Permanente Downey Medical Center, Downey, CA
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9
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Robaldo A, Pagliari S, Piaggio F, Colotto P. Persistent Buttock Claudication after Endovascular Abdominal Aortic Aneurysm Repair. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2018; 5:173-176. [PMID: 29766009 DOI: 10.12945/j.aorta.2017.17.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 04/15/2017] [Indexed: 11/18/2022]
Abstract
We describe the successful surgical treatment of a 71-year-old man affected by right buttock claudication after a right internal iliac artery (IIA) coil embolization as an adjunct to endovascular iliac artery aneurysm repair. Computed tomography angiography revealed extensive aortoiliac calcifications and thrombus in the vessel walls. Despite patency of the contralateral IIA and preservation of right distal collateral flow through ipsilateral hypogastric branches, the symptom was persistent and disabling. The high-risk patient underwent an "open" repair of the infrarenal abdominal aneurysm with removal of the entire stent-graft and concomitant revascularization of the right IIA. Post-operative recovery was uneventful, and the patient remained asymptomatic during a 30-month follow-up. This case underscores the importance of considering all potential solutions, including open surgery, to preserve pelvic inflow after aortoiliac stent grafting, particularly for high-risk patients with vulnerable plaque and higher risk of thrombus embolization.
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Affiliation(s)
- Alessandro Robaldo
- Vascular and Endovascular Surgery Unit, Imperia Hospital, Imperia, Italy
| | - Stefano Pagliari
- Vascular and Endovascular Surgery Unit, Imperia Hospital, Imperia, Italy
| | - Filippo Piaggio
- Vascular and Endovascular Surgery Unit, Imperia Hospital, Imperia, Italy
| | - Patrizio Colotto
- Vascular and Endovascular Surgery Unit, Imperia Hospital, Imperia, Italy
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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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Sexual Dysfunction After Abdominal Aortic Aneurysm Surgical Repair: Current Knowledge and Future Directions. Eur J Vasc Endovasc Surg 2018; 55:267-280. [DOI: 10.1016/j.ejvs.2017.11.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/27/2017] [Indexed: 12/26/2022]
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The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg 2018; 67:2-77.e2. [DOI: 10.1016/j.jvs.2017.10.044] [Citation(s) in RCA: 1150] [Impact Index Per Article: 191.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Mansukhani NA, Havelka GE, Helenowski IB, Rodriguez HE, Hoel AW, Eskandari MK. Hybrid Endovascular Aortic Aneurysm Repair: Preservation of Pelvic Perfusion with External to Internal Iliac Artery Bypass. Ann Vasc Surg 2017; 42:162-168. [PMID: 28286187 DOI: 10.1016/j.avsg.2016.10.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/02/2016] [Accepted: 10/19/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Diminished pelvic arterial flow as a result of intentional coverage/embolization of internal iliac arteries (IIA) during isolated endovascular common iliac artery aneurysm (CIAA) repair or endovascular repair of abdominal aortic aneurysms (EVAR) may result in symptomatic pelvic ischemia. Although generally well tolerated, in severe cases, pelvic ischemia may manifest as recalcitrant buttock claudication, vasculogenic impotence, or perineal, vesicle, rectal, and/or spinal cord ischemia. Branched graft technology has recently become available; however, many patients are not candidates for endovascular repair with these devices. Therefore, techniques to preserve pelvic arterial flow are needed. We reviewed our outcomes of isolated endovascular CIAA repair or EVAR in conjunction with unilateral external-internal iliac artery bypass. METHODS Single-center, retrospective review of 10 consecutive patients who underwent hybrid endovascular abdominal aortic aneurysm (AAA) or CIAA repair with concomitant external-internal iliac artery bypass between 2006 and 2015. Demographics, index procedural details, postoperative symptoms, hospital length of stay (LOS), follow-up imaging, and bypass patency were recorded. RESULTS The cohort of 10 patients was all men with a mean age of 71 years (range: 56-84). Hybrid repair consisted of contralateral IIA coil embolization followed by EVAR with external iliac artery-internal iliac artery (EIA-IIA) bypass. All EIA-IIA bypasses were performed via a standard lower quadrant retroperitoneal approach with a prosthetic bypass graft. Technical success was 100%, and there were no perioperative deaths. One patient developed transient paraplegia, 1 patient had buttock claudication on the side of his hypogastric embolization contralateral to his iliac bypass, and 1 developed postoperative impotence. 20% of patients sustained long-term complications (buttock claudication and postoperative impotence). Mean LOS was 2.8 days (range: 1-9 days). Postoperative imaging was obtained in 90% of patients, and mean follow-up was 10.8 months (range: 0.5-36 months). All bypasses remained patent. CONCLUSIONS Although branched graft technology continues to evolve, strategies to maintain adequate pelvic circulation are necessary to avoid the devastating complications of pelvic ischemia. We have demonstrated that a hybrid approach combining EVAR or isolated endovascular common iliac artery exclusion with a unilateral external-internal iliac bypass via a retroperitoneal approach is well tolerated with a short LOS and excellent patency rates.
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Affiliation(s)
- Neel A Mansukhani
- Division of Vascular Surgery, Department of Surgery, Northwestern University, Chicago, IL
| | - George E Havelka
- Division of Vascular Surgery, Department of Surgery, Northwestern University, Chicago, IL
| | | | - Heron E Rodriguez
- Division of Vascular Surgery, Department of Surgery, Northwestern University, Chicago, IL
| | - Andrew W Hoel
- Division of Vascular Surgery, Department of Surgery, Northwestern University, Chicago, IL
| | - Mark K Eskandari
- Division of Vascular Surgery, Department of Surgery, Northwestern University, Chicago, IL.
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Oliveira FAC, Amorelli CEDS, Campedelli FL, Heckmann D, Barreto JC, Amorelli MCR, Campedelli AFG, Silva PMD. Tratamento endovascular do aneurisma aortoilíaco: relato do primeiro caso utilizando endoprótese brasileira com ramo ilíaco. J Vasc Bras 2017; 16:63-67. [PMID: 29930627 PMCID: PMC5829696 DOI: 10.1590/1677-5449.011116] [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] [Indexed: 11/30/2022] Open
Abstract
O aneurisma aortoilíaco tem representado desafio terapêutico principalmente em relação ao tratamento endovascular, visto que a embolização das artérias ilíacas internas pode levar a graves complicações. Inúmeras técnicas cirúrgicas convencionais e endovasculares têm sido descritas para a preservação de ao menos um ramo ilíaco interno. Dentre as opções de tratamento totalmente endovascular, podemos citar as endopróteses ramificadas e a técnica de próteses paralelas. Os autores relatam o primeiro caso de tratamento endovascular com preservação de ramo ilíaco interno utilizando endoprótese nacional ramificada.
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15
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Smeds MR, Charlton-Ouw KM. Infrarenal endovascular aneurysm repair: New developments and decision making in 2016. Semin Vasc Surg 2016; 29:27-34. [PMID: 27823586 DOI: 10.1053/j.semvascsurg.2016.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
New developments in infrarenal abdominal aortic aneurysm stent-graft devices have made more patients eligible for endovascular aneurysm repair (EVAR). Recent US Food and Drug Administration approval for fenestrated endograft repair and impending approval for iliac branch devices extend the proximal and distal landing zones. Better deployment systems allow for partial deployment of endografts to facilitate repositioning, and more flexible designs allow for treatment of angulated infrarenal aneurysm necks and tortuous iliac arteries. New iterations of endografts have smaller delivery catheter diameters, which facilitate traversal of smaller access vessels. Long-term outcomes data are still accumulating and it remains to be seen whether EVAR for this expanded-indication abdominal aortic aneurysms anatomy has the same durability as standard EVAR. More options for repair also mean vascular surgeons must select the best EVAR device based on each patient's abdominal aortic aneurysm anatomy.
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Affiliation(s)
- Matthew R Smeds
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street #520-2, Little Rock, AR 72205-7199.
| | - Kristofer M Charlton-Ouw
- Division of Vascular and Endovascular Surgery, Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), TX
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Vinogradova M, Lee HJ, Armstrong EJ, Laird J, Humphries MD. Patency of the Internal Iliac Artery after Placement of Common and External Iliac Artery Stents. Ann Vasc Surg 2016; 38:184-189. [PMID: 27793624 DOI: 10.1016/j.avsg.2016.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/03/2016] [Accepted: 10/07/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Treatment of severe aortoiliac occlusive disease (AIOD) frequently requires long-segment stenting of the common and external iliac arteries (CIA and EIA, respectively). This study aims to analyze the patency of the internal iliac artery (IIA) after placement of a CIA and EIA stents across the orifice. METHODS A retrospective analysis of all patients who underwent de novo ipsilateral stent placement in the CIA and EIA between 2006 and 2013 was performed. Kaplan-Meier analysis was used to analyze patency of the IIA, and Cox proportional hazard models were used to identify characteristics associated with occlusion. RESULTS We identified 77 patients and 93 limbs where ipsilateral CIA and EIA stents were placed. Preintervention angiographic review found 52 cases of a patent ipsilateral IIA where stents were placed across the origin of the IIA in 31 cases and staggered across the orifice in 20 limbs. Kaplan-Meier analysis demonstrated a 37% patency in limbs where the stent covered the IIA orifice compared to 78% patency in uncovered arteries (P = 0.04). New-onset buttock claudication developed in 4 patients, 2 with patent IIAs and 2 with occluded. New-onset impotence also developed in 3 patients with occluded IIA and 5 patients with patent IIAs. CONCLUSIONS Placement of stents across the origin of the IIA may not result in immediate occlusion, but long-term patency of covered IIAs is decreased compared to uncovered IIAs. This study is limited by a small sample size, but when treating AIOD, coverage of the internal iliac origin should be avoided to maintain patency of the pelvic circulation.
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Affiliation(s)
| | - Hye Joon Lee
- Division of Vascular Surgery, UC Davis Medical Center, Sacramento, CA
| | | | - John Laird
- Division of Vascular Surgery, UC Davis Medical Center, Sacramento, CA
| | - Misty D Humphries
- Division of Vascular Surgery, UC Davis Medical Center, Sacramento, CA.
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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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Kansal V, Jetty P, Kubelik D, Hajjar G, Hill A, Brandys T, Nagpal S. Internal iliac coverage during endovascular repair of abdominal aortic aneurysms is a safe option: A preliminary study. Vascular 2016; 25:28-35. [PMID: 27000384 DOI: 10.1177/1708538116640077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Endovascular aneurysm repairs lacking suitable common iliac artery landing zones occasionally require graft limb extension into the external iliac artery, covering the internal iliac artery origin. The purpose of this study was to assess incidence of type II endoleak following simple coverage of internal iliac artery without embolization during endovascular aneurysm repair. Three hundred eighty-nine endovascular aneurysm repairs performed by a single surgeon (2004-2015) were reviewed. Twenty-seven patients underwent simple internal iliac artery coverage. Type II endoleak was assessed from operative reports and follow-up computed tomography imaging. No patient suffered type II endoleak from a covered internal iliac artery in post-operative computed tomography scans. Follow-up ranged from 0.5 to 9 years. No severe pelvic ischemic complications were observed. In conclusion, for selected cases internal iliac artery coverage without embolization is a safe alternative to embolization in endovascular aneurysm repairs, where the graft must be extended into the external iliac artery.
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Affiliation(s)
- Vinay Kansal
- 1 Faculty of Medicine, University of Ottawa, Ottawa, Canada.,2 Division of Vascular Surgery, University of Ottawa, Ottawa, Canada
| | - Prasad Jetty
- 2 Division of Vascular Surgery, University of Ottawa, Ottawa, Canada.,3 Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Dalibor Kubelik
- 2 Division of Vascular Surgery, University of Ottawa, Ottawa, Canada.,3 Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - George Hajjar
- 2 Division of Vascular Surgery, University of Ottawa, Ottawa, Canada.,3 Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Andrew Hill
- 2 Division of Vascular Surgery, University of Ottawa, Ottawa, Canada.,3 Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Tim Brandys
- 2 Division of Vascular Surgery, University of Ottawa, Ottawa, Canada.,3 Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Sudhir Nagpal
- 2 Division of Vascular Surgery, University of Ottawa, Ottawa, Canada.,3 Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
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Borges L, Machado R, Pereira C, Matos A, Almeida R. Técnica híbrida de exclusão endovascular de aneurisma ilíaco comum e revascularização cirúrgica da artéria ilíaca interna. ANGIOLOGIA E CIRURGIA VASCULAR 2015. [DOI: 10.1016/j.ancv.2015.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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20
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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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Kobayashi Y, Sakaki M, Yasuoka T, Iida O, Dohi T, Uematsu M. Endovascular repair with contralateral external-to-internal iliac artery bypass grafting: a case series. BMC Res Notes 2015; 8:183. [PMID: 25935638 PMCID: PMC4434537 DOI: 10.1186/s13104-015-1144-6] [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: 09/16/2014] [Accepted: 04/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To report a technique of keeping unilateral blood flow in the internal iliac artery in cases of an abdominal aortic aneurysm in achieving successful Endovascular abdominal aortic aneurysm repair using an external-to-internal artery bypass. CASE PRESENTATION 6 japanese patients with infra-renal abdominal aortic aneurysms were treated using the retroperitoneal approach via a left (right) paramedian incision followed by an external-to-internal artery bypass. Endovascular abdominal aortic aneurysm repair was conducted on mean postoperative day 29 ± 18 and was performed because the contralateral internal iliac artery, which was not involved in the external-to-internal artery bypass, was treated with a coil embolization. No complications developed during the postoperative follow-up period (17 ± 1.5 months). In all 6 patients, patent grafts were evident on computed tomography angiography scans even after 1-3 months. CONCLUSIONS Endovascular abdominal aortic aneurysm repair with unilateral internal iliac artery embolization and contralateral external-to-internal artery bypass is feasible with a relatively low risk. It is a safe procedure and reduces the incidence of postoperative complications.
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Affiliation(s)
- Yasuhiko Kobayashi
- Department of Cardiovascular Surgery, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan.
| | - Masayuki Sakaki
- Department of Cardiovascular Surgery, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan.
| | - Takashi Yasuoka
- Department of Cardiovascular Surgery, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan.
| | - Osamu Iida
- Departments of Cardiology, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan.
| | - Tomoharu Dohi
- Departments of Cardiology, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan.
| | - Masaaki Uematsu
- Departments of Cardiology, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan.
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Das isolierte Iliakaaneurysma – eine morphologische Klassifikation unter endovaskulären Gesichtspunkten. GEFÄSSCHIRURGIE 2014. [DOI: 10.1007/s00772-013-1266-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Endovascular treatment of abdominal aortic aneurysms involving iliac bifurcation: role of iliac branch graft device in prevention of buttock claudication. Ann Vasc Surg 2013; 27:851-5. [PMID: 23540668 DOI: 10.1016/j.avsg.2012.08.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Revised: 02/10/2012] [Accepted: 08/09/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND The aim of this study was to describe our early experience with the use of iliac branch grafts (IBGs) in aortoiliac aneurysm repair at our institution and to evaluate the technical feasibility, short-term patency rate, and potential clinical benefits, with special focus on prevention of buttock claudication. METHODS From March 2009 to November 2010, 9 consecutive patients (all men), mean age 71.1 years (range 62-80 years), underwent IBG implantation at our institution. Indications were abdominal aortic aneurysm (AAA) with common iliac artery (CIA) involvement (n = 7), bilateral CIA aneurysm (n = 1), and AAA with bilateral CIA and unilateral IIA involvement (n = 1). Postoperative endoleaks and patency rate were determined with computed tomography (CT) within 1 month of implantation and 1 year thereafter, with concurrent clinical evaluation for pelvic ischemia. Mean follow-up period was 14.7 (range 9-29) months. RESULTS Technical success rate, as defined by successful implantation of the iliac branch graft (IBG) with no intraprocedural type I or type III endoleak, was 100%. The mean hospitalization duration was 4 days (range 3-6 days), with 0% mortality at 30 days. There were 3 cases of type II endoleak detected perioperatively, which were treated conservatively. Two endoleaks sealed spontaneously on the 1-month CT scan and 1 persists without aneurysm sac expansion. All stent-implanted aortic and iliac aneurysms remained stable in size during follow-up, with no aneurysm rupture or death recorded. All stent-implanted iliac branches remained patent on follow-up and all patients were asymptomatic. CONCLUSIONS Iliac branch graft placement is a feasible technique with excellent short-term results in the treatment of abdominal aortic aneurysms involving the iliac bifurcation. This technique can efficiently prevent buttock claudication.
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Lobato AC, Camacho-Lobato L. The sandwich technique to treat complex aortoiliac or isolated iliac aneurysms: Results of midterm follow-up. J Vasc Surg 2013; 57:26S-34S. [DOI: 10.1016/j.jvs.2012.09.081] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Revised: 09/26/2012] [Accepted: 09/29/2012] [Indexed: 11/29/2022]
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Maurel B, Bartoli MA, Jean-Baptiste E, Reix T, Cardon A, Goueffic Y, Martinez R, Cochennec F, Albertini JN, Chauffour X, Steinmetz E, Haulon S. Perioperative Evaluation of Iliac ZBIS Branch Devices: A French Multicenter Study. Ann Vasc Surg 2013; 27:131-8. [DOI: 10.1016/j.avsg.2011.02.052] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 02/07/2011] [Accepted: 02/08/2011] [Indexed: 10/27/2022]
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Stokmans RA, Willigendael EM, Teijink JAW, Ten Bosch JA, van Sambeek MRHM, Cuypers PWM. Challenging the evidence for pre-emptive coil embolisation of the internal iliac artery during endovascular aneurysm repair. Eur J Vasc Endovasc Surg 2013; 45:220-6. [PMID: 23305786 DOI: 10.1016/j.ejvs.2012.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 12/06/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES We retrospectively analysed the results of a strategy in which coverage of the internal iliac artery (IIA) during endovascular aneurysm repair (EVAR) was routinely performed without coil embolisation. METHODS From January 2010 until May 2012, 32 patients (96.9% men; mean age 73.0 years, range 52-89 years) underwent EVAR with stent grafts extended into the external iliac artery (EIA), all without prior coil embolisation. Aneurysm morphology was determined on preoperative computed tomography (CT) images. During follow-up, patients were interviewed about buttock claudication, and the occurrence of endoleaks and evolution of aneurysm diameter were recorded. RESULTS At baseline, the mid-common iliac artery (CIA) diameter was 33.5 ± 16.8 mm and seven patients presented with ruptured aneurysms. Mean follow-up was 14.3 ± 7.4 months. There were eight deaths, none related to IIA coverage. Buttock claudication occurred in seven (22.6%) patients, which persisted after 6 months in two cases of bilateral IIA coverage. No Type-I or -II endoleaks occurred related to IIA coverage. Aneurysm growth was not observed. CONCLUSION Endovascular treatment of aortoiliac and iliac aneurysm without pre-emptive coil embolisation of the IIA appears safe and effective. No IIA-related endoleaks or re-interventions occurred in our series. This approach saves operating time, contrast load and costs and may reduce complications. However, a larger population and longer follow-up is required to confirm our findings.
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Affiliation(s)
- R A Stokmans
- Department of Vascular Surgery, Catharina Hospital, Michelangelolaan 2, PO Box 1350, 5602 ZA Eindhoven, The Netherlands
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27
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Outcomes of endovascular aneurysm repair with selective internal iliac artery coverage without coil embolization. J Vasc Surg 2012; 56:298-303. [DOI: 10.1016/j.jvs.2011.08.063] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 08/03/2011] [Accepted: 08/11/2011] [Indexed: 11/15/2022]
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Single-Center Experience and 1-Year Follow-up Results of “Sandwich Technique” in the Management of Common Iliac Artery Aneurysms During EVAR. Cardiovasc Intervent Radiol 2012; 35:1195-200. [DOI: 10.1007/s00270-012-0378-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Accepted: 03/15/2012] [Indexed: 10/28/2022]
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29
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Naughton PA, Park MS, Kheirelseid EAH, O’Neill SM, Rodriguez HE, Morasch MD, Madhavan P, Eskandari MK. A comparative study of the bell-bottom technique vs hypogastric exclusion for the treatment of aneurysmal extension to the iliac bifurcation. J Vasc Surg 2012; 55:956-62. [PMID: 22226182 PMCID: PMC3319281 DOI: 10.1016/j.jvs.2011.10.121] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 10/19/2011] [Accepted: 10/26/2011] [Indexed: 12/01/2022]
Abstract
INTRODUCTION A significant proportion of patients undergoing endovascular aneurysm repair (EVAR) have common iliac artery aneurysms (CIAA). Aneurysmal involvement at the iliac bifurcation potentially undermines long-term durability. METHODS Patients with CIAA who underwent EVAR were identified in two teaching hospitals. Bell-bottom technique (BBT; iliac limb ≥20 mm) or internal iliac artery embolization and limb extension to the external iliac artery (IIE + EE) were used. Outcome between these two approaches was compared. RESULTS We identified 185 patients. Indication for EVAR included asymptomatic abdominal aortic aneurysm (AAA) in 157, symptomatic or ruptured aneurysm in 19, and CIAA in nine. Mean AAA diameter was 59 mm. Among 260 large CIAAs that were treated, BBT was used to treat 166 CIAA limbs, and 94 limbs underwent IIE + EE. Total reintervention rates were 11% for BBT (n = 19) and 19.1% for IIE + EE (n = 18; P = .149). Rates of reintervention for type Ib or III endoleak were 4% for BBT (n = 7) and 4% for IIE + EE (n = 4; P > .99). The difference in limb patency rates was not significant. The 30-day mortality rate was 1%. Median follow-up was 22 months. Complications did not differ significantly between the two groups; however, the combined incidence of perioperative complications and reinterventions was higher in the IIE + EE group (49% vs 22%; P = .002). CONCLUSIONS The combined incidence of perioperative complications and reinterventions is significantly higher with IIE + EE than with BBT; therefore, when feasible, BBT is desirable.
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Affiliation(s)
- Peter A. Naughton
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Vascular Surgery, St. James Hospital, Dublin, Ireland
| | - Michael S. Park
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - EAH Kheirelseid
- Department of Vascular Surgery, St. James Hospital, Dublin, Ireland
| | - Sean M. O’Neill
- Department of Vascular Surgery, St. James Hospital, Dublin, Ireland
| | - Heron E. Rodriguez
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mark D. Morasch
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Prakash Madhavan
- Department of Vascular Surgery, St. James Hospital, Dublin, Ireland
| | - Mark K. Eskandari
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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Lee JH, Kim HJ, Choi SK, Shin WY, Kim JY, Hong KC, Jeon YS, Cho SG. Effectiveness of Embolization of Internal Iliac Artery during Endovascular Aneurysm Repair. Vasc Specialist Int 2011. [DOI: 10.5758/kjves.2011.27.4.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Joo Hyung Lee
- Department of Surgery, Inha University College of Medicine, Incheon, Korea
| | - Hyun Ji Kim
- Department of Surgery, Inha University College of Medicine, Incheon, Korea
| | - Sun Keun Choi
- Department of Surgery, Inha University College of Medicine, Incheon, Korea
| | - Woo Young Shin
- Department of Surgery, Inha University College of Medicine, Incheon, Korea
| | - Jang Yong Kim
- Department of Surgery, Inha University College of Medicine, Incheon, Korea
| | - Kee Chun Hong
- Department of Surgery, Inha University College of Medicine, Incheon, Korea
| | - Yong Sun Jeon
- Department of Radiology, Inha University College of Medicine, Incheon, Korea
| | - Soon Gu Cho
- Department of Radiology, Inha University College of Medicine, Incheon, Korea
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Melas N, Saratzis A, Dixon H, Saratzis N, Lazaridis J, Perdikides T, Kiskinis D. Isolated Common Iliac Artery Aneurysms:A Revised Classification to Assist Endovascular Repair. J Endovasc Ther 2011; 18:697-715. [PMID: 21992642 DOI: 10.1583/11-3519.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Hosaka A, Kato M, Kato I, Isshiki S, Okubo N. Outcome after concomitant unilateral embolization of the internal iliac artery and contralateral external-to-internal iliac artery bypass grafting during endovascular aneurysm repair. J Vasc Surg 2011; 54:960-4. [DOI: 10.1016/j.jvs.2011.03.266] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 03/17/2011] [Accepted: 03/17/2011] [Indexed: 10/18/2022]
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Lobato AC. Sandwich technique for aortoiliac aneurysms extending to the internal iliac artery or isolated common/internal iliac artery aneurysms: a new endovascular approach to preserve pelvic circulation. J Endovasc Ther 2011; 18:106-11. [PMID: 21314358 DOI: 10.1583/10-3320.1] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE To describe a new endovascular approach to preserve internal iliac artery (IIA) flow in patients with abdominal aortic aneurysm (AAA) involving the common iliac artery(ies) (CIA) or in cases of isolated CIA/IIA aneurysm. TECHNIQUE The sandwich technique for isolated CIA/IIA aneurysms or aortoiliac aneurysms extending to the IIA includes 5 steps: (1) bifurcated stent-graft main body insertion through an ipsilateral femoral approach and positioned such that the distal end of the iliac limb is 1 cm above the IIA origin; (2) catheterization of the ipsilateral IIA through a left brachial access with a long 5-F multipurpose catheter and a 0.035-inch extra stiff floppy tip guidewire; (3) placement of a covered self-expanding stent 2 cm inside the IIA with a 6-cm overlap into the iliac limb, followed by positioning of an iliac limb extension 1 cm below the covered stent's proximal end (the iliac limb extension is deployed first and then the covered stent); (4) modeling of the iliac limb stent-grafts using a latex balloon and dilation of the covered stent with an angioplasty balloon; and (5) deployment of the contralateral iliac limb. For bilateral CIA aneurysms extending to both IIAs, repeat steps 2-4. CONCLUSION This technique was developed to overcome current anatomical and device constraints, expanding the limits of endovascular aneurysm repair (EVAR) in a safe, easy to perform, and cost-effective manner. The sandwich technique appears a promising tool in the EVAR armamentarium, but more experience with the method is warranted.
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Affiliation(s)
- Armando C Lobato
- São Paulo Vascular and Endovascular Surgery Institute, São Paulo, Brazil.
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Stent graft implantation combined with coil embolization and external-internal iliac artery bypass surgery: report of a case. Surg Today 2010; 40:1079-83. [PMID: 21046509 DOI: 10.1007/s00595-010-4360-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 06/13/2010] [Indexed: 10/18/2022]
Abstract
A 73-year-old male patient was found to have an abdominal aortic aneurysm complicated with bilateral common iliac artery aneurysms. He also had hepatitis C, chronic liver cirrhosis (Child-Pugh class B), a rupture of esophageal varices, hepatocellular carcinoma, and intractable ascites. The functions of other systemic organs were also impaired. We first performed a right internal iliac artery coil embolization prior to stent graft implantation combined with a left external-internal iliac artery bypass. These additional procedures allowed for safe treatment with stent graft implantation, without any serious complications.
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Cochennec F, Marzelle J, Allaire E, Desgranges P, Becquemin JP. Open vs endovascular repair of abdominal aortic aneurysm involving the iliac bifurcation. J Vasc Surg 2010; 51:1360-6. [DOI: 10.1016/j.jvs.2010.01.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 01/13/2010] [Accepted: 01/14/2010] [Indexed: 10/19/2022]
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Oderich GS, Ricotta JJ. Novel Surgeon-Modified Hypogastric Branch Stent Graft to Preserve Pelvic Perfusion. Ann Vasc Surg 2010; 24:278-86. [DOI: 10.1016/j.avsg.2009.10.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 10/13/2009] [Accepted: 10/19/2009] [Indexed: 11/17/2022]
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Thompson K, Cook P, Dilley R, Saeed M, Knowles H, Terramani T, Kansal N. Internal Iliac Artery Angioplasty and Stenting: An Underutilized Therapy. Ann Vasc Surg 2010; 24:23-7. [DOI: 10.1016/j.avsg.2009.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 04/17/2009] [Accepted: 05/21/2009] [Indexed: 10/20/2022]
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Chaikof EL, Brewster DC, Dalman RL, Makaroun MS, Illig KA, Sicard GA, Timaran CH, Upchurch GR, Veith FJ. The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. J Vasc Surg 2009; 50:S2-49. [PMID: 19786250 DOI: 10.1016/j.jvs.2009.07.002] [Citation(s) in RCA: 453] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 07/06/2009] [Accepted: 07/06/2009] [Indexed: 02/08/2023]
Affiliation(s)
- Elliot L Chaikof
- Department of Surgery, Emory University, Atlanta, Ga 30322, USA.
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Lin PH, Chen AY, Vij A. Hypogastric Artery Preservation during Endovascular Aortic Aneurysm Repair: Is It Important? Semin Vasc Surg 2009; 22:193-200. [DOI: 10.1053/j.semvascsurg.2009.07.012] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Adlakha S, Burket M, Cooper C. Percutaneous intervention for chronic total occlusion of the internal iliac artery for unrelenting buttock claudication. Catheter Cardiovasc Interv 2009; 74:257-9. [PMID: 19213070 DOI: 10.1002/ccd.21966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Internal iliac artery stenosis or occlusion has been documented to cause hip pain, erectile dysfunction, and buttock claudication. Endovascular repair for patients with significant stenosis has been well documented, but chronic total occlusion revascularizations have not been reported in the literature. The reluctance to attempt percutaneous intervention may be in part due to the extensive collateralization that forms to this vessel, or fear of complications such as wire perforation in a vessel that has a tortuous route with multiple bifurcations. This report describes two cases of patients with unrelenting buttock claudication that completely resolved after percutaneous intervention of unilateral chronic total occlusions of the internal iliac artery.
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Affiliation(s)
- Satjit Adlakha
- Cardiovascular Medicine Division, Department of Medicine, University of Toledo, Toledo, OH 43614, USA.
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Tsilimparis N, Alevizakos P, Yousefi S, Laipple A, Hagemann J, Rogalla P, Hanack U, Rückert RI. Treatment of internal iliac artery aneurysms: single-centre experience. ANZ J Surg 2009; 79:258-64. [DOI: 10.1111/j.1445-2197.2009.04856.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Afonso CT, Procópio RJ, Navarro TP, Kleinsorge GHD, Rodrigues BDES, Rodrigues MAG. Aneurisma de artéria ilíaca interna roto: relato de caso. J Vasc Bras 2009. [DOI: 10.1590/s1677-54492009005000006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aneurismas isolados da artéria ilíaca interna são raros, acometem 0,1% da população e correspondem a 1% dos aneurismas aorto-ilíacos. Na maioria das vezes, os pacientes são assintomáticos, mas podem apresentar dor abdominal, massa pulsátil no hipogástrio ou na fossa ilíaca, sintomas compressivos urinários, gastrointestinais ou neurológicos. Podem ocasionar quadro de abdome agudo, principalmente quando há ruptura. O diagnóstico precoce dos aneurismas isolados de artéria ilíaca interna é incomum, sendo identificados quando mais volumosos ou rotos, o que aumenta significativamente sua morbimortalidade e torna seu prognóstico mais reservado. Dessa forma, representam um desafio terapêutico. A ligadura cirúrgica tem sido o tratamento mais comum, entretanto a cirurgia endovascular tem mostrado bons resultados, inclusive nos aneurismas rotos. É relatado caso de aneurisma de artéria ilíaca interna isolado roto diagnosticado durante laparotomia para abordagem de abdome agudo.
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Hobo R, Sybrandy JEM, Harris PL, Buth J. Endovascular repair of abdominal aortic aneurysms with concomitant common iliac artery aneurysm: outcome analysis of the EUROSTAR Experience. J Endovasc Ther 2008; 15:12-22. [PMID: 18254666 DOI: 10.1583/07-2217.1] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND To compare outcomes following endovascular repair in abdominal aortic aneurysm (AAA) patients with and without concomitant iliac artery aneurysm disease. METHODS Data on patient characteristics and risk factors, aneurysm morphology, interventional details, complications, and mortality were retrieved from the EUROSTAR registry database for the period from October 1996 to November 2006. AAA patients without concomitant iliac aneurysm disease (group I, n = 6286) were compared to 1268 patients with aneurysmal iliac vessels (group II) regarding mortality, device-related complications, and need for secondary interventions. Logistic regression and Cox proportional hazards model were performed to assess independent associations with outcome parameters in the study groups. RESULTS Group II had more patients classified as ASA III or IV (55.1% versus 50.3% in group I; p = 0.002); they were more frequently unfit for open aortic repair (30.3% versus 23.4%; p<0.0001) and had larger-diameter aneurysms (62.3 versus 60.7 mm; p<0.0001) and infrarenal necks (24.5 versus 24.1 mm; p<0.001). In addition, group II patients had a higher rate of internal iliac artery occlusion (11.4% versus 5.2%; p<0.0001) and more significant angulation of the aortic neck (30.8% versus 24.3%; p<0.0001) and iliac artery (48.3% versus 41.9%; p<0.0001). Group II patients had higher 5-year cumulative incidences of distal type I endoleaks (9.1% versus 4.3%; p<0.0001), iliac limb occlusion (5.9% versus 4.4%; p = 0.040), secondary transfemoral intervention (17.6% versus 8.9%; p = 0.019), and aneurysm rupture (4.5% versus 1.7%; p = 0.042). CONCLUSION Although aneurysm-related mortality and mortality from other causes were similar in both study groups, concomitant iliac artery aneurysms in AAA patients were associated with an increased incidence of distal type I endoleak, iliac limb occlusion, and aneurysm rupture. Therefore, caution is warranted, and efforts should be made to avoid procedural mishaps.
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Affiliation(s)
- Roel Hobo
- EUROSTAR Data Registry Centre, Catharina Hospital, Eindhoven, The Netherlands
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Teoh AYB, Fung TMK, Lam YH, Ho SSM, Yu SCH, Lau JYW. Endovascular repair of an aortoiliac aneurysm with bilateral bifurcated branched iliac stent-grafts. SURGICAL PRACTICE 2008. [DOI: 10.1111/j.1744-1633.2008.00393.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dias NV, Resch TA, Sonesson B, Ivancev K, Malina M. EVAR of aortoiliac aneurysms with branched stent-grafts. Eur J Vasc Endovasc Surg 2008; 35:677-84. [PMID: 18378472 DOI: 10.1016/j.ejvs.2007.10.022] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2007] [Accepted: 10/24/2007] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Branched iliac stent-grafts (bSG) have recently been developed in order to preserve internal iliac artery (IIA) flow in patients with aneurysmal or short common iliac arteries. The aim of this study is to evaluate a single-center experience with bSG for the IIA. METHODS Twenty-two male patients (70 (IQR 65-79) years old) underwent EVAR with 23 bSG (1 bilateral repair) between September 2002 and August 2007. Median AAA diameter was 52 (37-60) mm while common iliac diameter on the side of the bSG was 34 (27-41) mm. Two in-house modified Zenith SG and subsequently 21 commercially available bSG (18 Zenith Iliac Side and 3 Helical Branches) were used. Follow-up (FU) included CT at one month and yearly thereafter. Data was prospectively entered in a database. RESULTS Primary technical success was 91% (21 bSG). Median FU duration was 20 (8-31) months. One patient (5 %) died after discharge from acute myocardial infarction on day 13. Another patient died 30 months after EVAR of an unrelated cause. The overall bSG patency was 74% due to 6 branch occlusions (2 intraoperative and 4 late). All patients with patent bSG were asymptomatic. Three occlusions were asymptomatic findings on CT, while the other three developed claudication (two patients with contralateral IIA occlusion and one with simultaneous occlusion of the external iliac). One patient (5%) developed an asymptomatic type III endoleak at 1 month and was successfully treated with a bridging SG. Overall, four patients (18%) required reinterventions (1 bilateral stenting of the external iliac arteries, 1 external and 1 internal SG extensions and 1 femoro-femoral cross-over bypass). Nine out of 16 patients (56%) with CT-FU>/=1 year had shrinking aneurysms. There were no postoperative aneurysm expansions. CONCLUSIONS EVAR of aortoiliac aneurysms with IIA bSG is a good alternative to occlusion of the IIA in patients with challenging distal anatomy.
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Affiliation(s)
- N V Dias
- Vascular Centre Malmö-Lund, Malmö University Hospital, Malmö, Sweden.
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Minimally invasive retrieval of a dislodged Wallstent endoprosthesis after an endovascular abdominal aortic aneurysm repair. J Vasc Surg 2008; 47:450-3. [PMID: 18241769 DOI: 10.1016/j.jvs.2007.08.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Revised: 08/10/2007] [Accepted: 08/22/2007] [Indexed: 11/21/2022]
Abstract
Endovascular abdominal aortic aneurysm repair (EVAR) is being performed more frequently in patients with concomitant iliac artery occlusive disease. We report a case of a 70-year-old male status post angioplasty and stenting of bilateral iliac arteries for occlusive disease who subsequently underwent EVAR for a rapidly expanding abdominal aortic aneurysm (AAA). One month after the placement of the endograft, it was discovered that the previously placed Wallstent had been dislodged during the endovascular abdominal aortic aneurysm repair. Minimally invasive retrieval using an Amplatz Goose Neck Snare was successful in recovering the stent. This case underscores the danger of performing EVAR in the setting of prior iliac artery stenting and the potential complications that may ensue.
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Is Internal Iliac Artery Embolization Essential Prior to Endovascular Repair of Aortoiliac Aneurysms? Cardiovasc Intervent Radiol 2008; 31:504-8. [DOI: 10.1007/s00270-007-9260-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2007] [Revised: 11/04/2007] [Accepted: 11/28/2007] [Indexed: 10/22/2022]
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Tratamiento de las arterias hipogástricas en la cirugía endovascular del aneurisma de aorta abdominal. ANGIOLOGIA 2008. [DOI: 10.1016/s0003-3170(08)01001-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kickuth R, Dick F, Triller J, Ludwig K, Schmidli J, Do DD. Internal Iliac Artery Embolization before Endovascular Repair of Aortoiliac Aneurysms with a Nitinol Vascular Occlusion Plug. J Vasc Interv Radiol 2007; 18:1081-7. [PMID: 17804768 DOI: 10.1016/j.jvir.2007.06.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To evaluate the acute and midterm effectiveness of a novel vascular occlusion device for embolization of the internal iliac artery (IIA) before endovascular repair of aortoiliac aneurysms. MATERIALS AND METHODS Between March 2005 and April 2006, nine men (mean age, 75 years +/- 5; range, 66-83 y) with aortoiliac aneurysms underwent bifurcated endovascular stent-graft procedures. All these patients were referred specifically for embolization. Pre- and perioperatively, eight patients underwent unilateral embolization and one underwent bilateral embolization of the IIA to prevent type II endoleak. Via a contralateral femoral approach with a 6-F or 8-F sheath, the embolization procedure was performed with an Amplatzer Vascular Plug, a self-expandable cylindrical device consisting of a nitinol-based wire mesh. Technical success, clinical outcome, and complications were evaluated. Follow-up at 3, 6, and 12 months was performed with clinical and radiologic examinations. RESULTS IIA embolization was technically successful in all cases and no procedure-related complications occurred. Imaging at discharge and at 3-, 6-, or 12-month follow-up was accomplished in all nine patients. Control computed tomography and magnetic resonance angiography did not reveal retrograde perfusion of the aneurysmal sac, ie, type II endoleak. Three of nine patients (33.3%) reported symptoms of buttock claudication that did not resolve completely. Clinical symptoms such as bowel ischemia or sexual dysfunction were not observed. CONCLUSIONS The midterm results of this study suggest that preoperative IIA embolization with a nitinol vascular occlusion plug during endovascular treatment of aortoiliac aneurysms is safe and effective.
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Affiliation(s)
- Ralph Kickuth
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Berne, Freiburgstrasse 20, CH-3010 Berne, Switzerland.
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Ziegler P, Avgerinos ED, Umscheid T, Perdikides T, Erz K, Stelter WJ. Branched iliac bifurcation: 6 years experience with endovascular preservation of internal iliac artery flow. J Vasc Surg 2007; 46:204-10. [PMID: 17600664 DOI: 10.1016/j.jvs.2007.04.015] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2007] [Accepted: 04/03/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of the current study was to share a 6-year experience with the iliac bifurcation device (IBD) and determine its safety and effectiveness in patients with common iliac artery aneurysms. METHODS Between 2001 and 2006, 46 patients were prospectively enrolled in a single institution study on the IBD. Indications included unilateral or bilateral common iliac artery aneurysms (CIAA) (combined or not with abdominal aortic aneurysm endovascular repair). The first 26 patients were intended to receive a first generation unibody IBD and the following 20 patients the second generation, modular, IBD. RESULTS In 33 patients out of 46 attempted (technical success per patient 72%), 35 iliac bifurcated devices (2 patients received bilateral IBD) out of 51 attempted (technical success per vessel 69%), were successfully implanted. The technical success rate (per vessel) was 58% for the first generation device and 85% for the second generation device. Inability to introduce the side branch into the IIA and intraoperative occlusions were the main reasons for technical failure. Among these failures, only two patients required open conversions. The mean +/- SD follow-up (radiological and clinical) of the 33 patients with a total of 35 successful IBD implantations was 26 +/- 17 months (median 24, range 3 to 60). During the follow-up period out of 35 successfully-implanted iliac bifurcation devices, four (11%) hypogastric side branch occlusions occurred, all within the first 12 months. Cumulative IBD side branch patency was 87% at 60 months. Comparing the first with the second generation IBD outcomes, cumulative patency rates at 2 years revealed no statistical difference (P = .774). No endoleak, and particularly no IBD, modular side branch disconnection, no late rupture, or deaths have yet been encountered. CONCLUSIONS Preservation of pelvic circulation in high risk patients treated for bilateral or unilateral common iliac aneurysms combined or without AAA is feasible and secure exclusively by endovascular repair. New generation iliac bifurcated devices show a favourable intraoperative performance and long-term outcomes.
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Affiliation(s)
- Peter Ziegler
- Städtische Kliniken, Frankfurt a.M. Höchst, Frankfurt, Germany.
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