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Torrealba JI, Grandi A, Nana P, Panuccio G, Rohlffs F, Kölbel T. Dilated Internal Iliac Artery Confers a Higher Risk of Endoleak in Iliac Branch Devices in a Single Centre Retrospective Experience. Eur J Vasc Endovasc Surg 2024; 67:895-902. [PMID: 38320646 DOI: 10.1016/j.ejvs.2024.01.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVE Iliac branch devices (IBDs) have shown good results but there is little evidence for the risk of internal iliac artery (IIA) endoleak, so there are no clear recommendations on the maximum diameter it should be. Based on limited evidence, it was hypothesised that an IIA of ≥ 11 mm in diameter presents an increased risk of type Ic endoleak. METHODS This was a single centre, retrospective case control study. Patients undergoing an IBD with the main trunk of the IIA as the target vessel, between 2015 and 2021, were identified. Two groups were created: those with a main trunk diameter of < 11 mm; and those with a diameter of ≥ 11 mm. Technical success, freedom from type Ic endoleak, and re-intervention rates were compared. A receiver operating characteristic (ROC) curve was performed to show a cutoff IIA diameter value for risk of type Ic endoleak. Multivariate analysis was performed to assess the risk of type Ic endoleak and the presence of calcification, stenosis, and landing zone length in the IIA. RESULTS There were 182 IBDs identified. The dilated IIA group (54 IBDs) had significantly lower technical success (91% vs. 98.4%; p = .002), lower freedom from type Ic endoleak (77% vs. 97.1% at 24 months; p = .001), and lower freedom from re-interventions (70% vs. 92.4% at 24 months; p = .002). The ROC curve showed that 10.5 mm was the cutoff diameter for type Ic endoleak. Moderate or severe calcification as well as landing zone length < 5 mm also correlated with type Ic endoleak. CONCLUSION IBDs have a statistically significantly higher rate of technical failure, lower freedom from type Ic endoleak, and lower freedom from re-intervention when the IIA is ≥ 11 mm in diameter.
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Affiliation(s)
- Jose I Torrealba
- German Aortic Centre Hamburg, Department of Vascular Medicine, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
| | - Alessandro Grandi
- German Aortic Centre Hamburg, Department of Vascular Medicine, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Petroula Nana
- German Aortic Centre Hamburg, Department of Vascular Medicine, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Giuseppe Panuccio
- German Aortic Centre Hamburg, Department of Vascular Medicine, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Fiona Rohlffs
- German Aortic Centre Hamburg, Department of Vascular Medicine, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Tilo Kölbel
- German Aortic Centre Hamburg, Department of Vascular Medicine, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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Banks CA, Blakeslee-Carter J, Beck AW, Pearce BJ. Hybrid Pelvic Revascularization in Complex Aortoiliac Aneurysm Repair. Ann Vasc Surg 2024; 99:356-365. [PMID: 37890769 DOI: 10.1016/j.avsg.2023.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/31/2023] [Accepted: 08/28/2023] [Indexed: 10/29/2023]
Abstract
Revascularization of complex pelvic vascular anatomy presents an ongoing clinical challenge when treating aortoiliac disease. As vascular surgeons continue to intervene upon increasingly complex aortoiliac pathology, the role of pelvic revascularization is important for the preservation of pelvic organ function and prevention of devastating spinal cord ischemia. In this study we describe the indications, techniques, and clinical outcomes of a novel hybrid pelvic revascularization repair that focuses on optimizing revascularization while limiting pelvic surgical dissection during the management of complex aortic pathology in patients physiologically or anatomically unsuitable for traditional pelvic revascularization techniques.
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Affiliation(s)
- C Adam Banks
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Juliet Blakeslee-Carter
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Benjamin J Pearce
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL.
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Lee H, Lee JM, Cho S, Hong J. The Use of an Iliac Branch Device: Single-Center Study of Endovascular Preservation of Internal Iliac Artery Flow. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:1339-1349. [PMID: 38107681 PMCID: PMC10721431 DOI: 10.3348/jksr.2023.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/17/2023] [Accepted: 06/30/2023] [Indexed: 12/19/2023]
Abstract
Purpose To determine the efficacy and safety of iliac branch device (IBD) implantation and to evaluate its limitations based on 7 years of experience in a single center. Materials and Methods This single-center study included patients with bilateral common iliac artery aneurysms (CIAAs). We investigated follow-up CT and reviewed the internal iliac artery (IIA) patency and complications related to IBD. A retrospective analysis was performed and the overall survival rate and freedom from reintervention rate were reported according to the Kaplan-Meier method. Results Of the 38 patients with CIAAs, only 10 (12 CIAAs) were suitable for IBD treatment. Five patients underwent unilateral IBD insertion with contralateral IIA embolization, and three (60%) showed claudication; however, symptoms resolved within 6 months. The 7-year freedom from IBD-related reintervention rate was 77.8%. No procedure-related deaths occurred. Conclusion IBD has good technical success and long-term patency rates; however, anatomical factors frequently limit its application, particularly in Asians. Additionally, unilateral IIA embolization showed relatively mild complications and a good prognosis; therefore, it can be performed safely for anatomically complex aortoiliac aneurysms.
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Spath P, Cardona-Gloria Y, Torsello G, Gallitto E, Öz T, Beropoulis E, Stana J, Gargiulo M, Tsilimparis N. Use of Secondary Iliac Branch Devices after Previous Endovascular Abdominal and Thoraco-Abdominal Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2023; 65:819-826. [PMID: 36707020 DOI: 10.1016/j.ejvs.2023.01.033] [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: 05/12/2022] [Revised: 11/20/2022] [Accepted: 01/19/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To assess the safety and effectiveness of iliac branch devices (IBDs), as secondary procedure, for the treatment of type Ib endoleak or evolution of iliac artery disease after prior endovascular aortic repair (EVAR) for thoraco-abdominal (TAAAs) or abdominal aortic aneurysms (AAAs). METHODS A multicentre observational study of three European centres. The study included 75 patients (age 71 ± 9 years, 96% men) with previous EVAR (n = 64, 85%) or fenestrated or branched (FB) EVAR (n = 11, 15%). Overall, 88 IBDs were implanted to treat aneurysmal iliac artery evolution in 40 (53%) and type Ib endoleak in 35 (47%) cases, respectively. Thirteen (17%) patients received bilateral IBDs. Internal iliac artery (IIA) catheterisation was done through a transaxillary access (n = 82, 93%) or up and over (n = 6, 7%) technique. The primary endpoint was technical success. Secondary endpoints were 30 day major adverse event, early and long term freedom from re-intervention and target vessel instability. RESULTS All procedures were technically successful (100%). During hospitalisation, there were four (5%) major adverse events and three (4%) early re-interventions, but no death, stroke, or damage to previous endografts. The median follow up was 47 (interquartile range 42) months, and the five year survival rate was 78 ± 6% with no aortic related death. Cox's regression analysis showed pre-operative renal function impairment (hazard ratio [HR] 3.4; 95% confidence interval [CI] 1.1 - 10.1; p = .033), and primary TAAA repair (HR 6.1; 95% CI 1.6-22.3; p = .006) as independent factors for long term mortality. Freedom from re-interventions was 85 ± 4% at five years with 11 (12%) cases (five endoleaks, four IBD thromboses, two stenoses). IIA instability was reported in three (3%) limbs and freedom from IIA instability was 95 ± 3% after 60 months. CONCLUSION Secondary IBD after EVAR is a safe and effective procedure with high technical success and low complication rates. The technique of choice to revascularise the IIA seems not to affect early and follow up results. Long term durability of IBD repair is acceptable with low rates of IIA re-intervention.
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Affiliation(s)
- Paolo Spath
- Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany; Department of Vascular Surgery, DIMEC, University of Bologna, Bologna, Italy.
| | - Yamel Cardona-Gloria
- Department of Vascular Surgery and Institute for Vascular Research, St. Franziskus Hospital, Münster, Germany
| | - Giovanni Torsello
- Department of Vascular Surgery and Institute for Vascular Research, St. Franziskus Hospital, Münster, Germany
| | - Enrico Gallitto
- Department of Vascular Surgery, DIMEC, University of Bologna, Bologna, Italy; Metropolitan Unit of Vascular Surgery, IRCCS University Hospital Policlinico S. Orsola, Bologna, Italy
| | - Tugce Öz
- Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Efthymios Beropoulis
- Department of Vascular Surgery and Institute for Vascular Research, St. Franziskus Hospital, Münster, Germany
| | - Jan Stana
- Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Mauro Gargiulo
- Department of Vascular Surgery, DIMEC, University of Bologna, Bologna, Italy; Metropolitan Unit of Vascular Surgery, IRCCS University Hospital Policlinico S. Orsola, Bologna, Italy
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany
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Liang S, Jia H, Zhang X, Guo W, Zhou G, Li S, Yuan P, Xiong J, Chen D. In-vitro and In-silico Haemodynamic Analyses of a Novel Embedded Iliac Branch Device. Front Cardiovasc Med 2022; 9:828910. [PMID: 35449876 PMCID: PMC9016111 DOI: 10.3389/fcvm.2022.828910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Iliac branch devices (IBDs) are valid tools for internal iliac artery preservation during endovascular abdominal aortic aneurysm and iliac aneurysm repair. The purpose of this study was to evaluate the effectiveness of a novel IBD with an embedded branch configuration. Method A typical iliac artery model was reconstructed, and two models were manufactured using three-dimensional printing technology. The novel IBD was deployed into one iliac artery model by an experienced vascular surgeon. A mock circulation loop (MCL) and a computational fluid dynamics (CFD) simulation were used to investigate the haemodynamic parameters of the iliac models without (Model A) and with (Model B) the IBD. A morphological analysis was conducted using computed tomography angiography and medical endoscopy. The flow distribution rate (FDR) and energy loss (EL) were used to quantify IBD performance. Results The FDR of the right internal iliac artery in the MCL of Model A and Model B was 18.88 ± 0.12% and 16.26 ± 0.09%, respectively (P = 0.0013). The FDR of the right internal iliac artery in the CFD simulation of Model A and Model B was 17.52 and 14.49%, respectively. The EL of Model A was greater than Model B in both the MCL and the CFD simulation. Compared with Model A, Model B had a larger region (8.46 vs. 3.64%) with a relative residence time of >20 Pa−1 at peak systole. Meanwhile, the area where the oscillatory flow index was >0.4 was significantly smaller in Model B than in Model A (0.46 vs. 0.043%). The region with an average wall shear stress of >4 Pa was greater in Model B than in Model A (0 vs. 0.22%). Conclusion The MCL and CFD simulation showed that the novel IBD had little impact on the FDR and EL of the iliac artery models. However, the IBD might be an effective tool for the treatment of abdominal aortic/iliac aneurysms that extend into branches. Further investigations are warranted to confirm whether this IBD could be useful in the clinic.
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Affiliation(s)
- Shichao Liang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Heyue Jia
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Xuehuan Zhang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Wei Guo
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Guojing Zhou
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Shilong Li
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Panpan Yuan
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Jiang Xiong
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
- Jiang Xiong
| | - Duanduan Chen
- School of Life Science, Beijing Institute of Technology, Beijing, China
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
- Wenzhou Safety (Emergency) Institute of Tianjin University, Tianjin, China
- *Correspondence: Duanduan Chen
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A systematic review and meta-analysis of the clinical effectiveness and safety of unilateral versus bilateral iliac branch devices for aortoiliac and iliac artery aneurysms. J Vasc Surg 2022; 76:1089-1098.e8. [PMID: 35314303 DOI: 10.1016/j.jvs.2022.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/04/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Iliac branch devices (IBDs) have been utilized in the treatment of aortoiliac and isolated iliac artery aneurysms. The aims of this systematic review and meta-analysis were to investigate the clinical effectiveness and safety of IBDs. METHODS A systematic review of the literature was conducted by identifying studies in the Medline, EMBASE, and Cochrane databases regarding the outcomes of IBDs in aortoiliac or isolated iliac artery aneurysms between May 2006 and December 2020. Individual studies were evaluated for the following major outcomes: technical success, 30-day mortality, primary patency, endoleak, reintervention, and rates of pelvic ischemia. Furthermore, sub-group meta-analyses were performed to compare the pelvic ischemic events in patients with bilateral IBDs, unilateral IBDs and bilateral internal iliac artery (IIA) embolization/coverage. RESULTS 45 studies with a total of 2736 patients undergoing unilateral or bilateral IBDs met inclusion criteria and were included in the analysis. The pooled technical success rate of IBD was 98.0% (CI: 97.3-98.7%). Following IBD treatment, the 30-day mortality rate was 0.4% (CI: 0.07-0.70%); 30-day patency was 98.4% (CI: 97.7-99.0%); buttock claudication developed in 1.84% (CI: 1.26-2.41%); endoleak occurred in 11.9% (CI: 9.2-14.7%) and re-intervention in 7.6% (CI: 5.65-9.58%). Furthermore, in the patients with bilateral iliac artery involvement the pooled estimate rates of buttock claudication were 0.7% in bilateral IBD group, 7.9% in unilateral IBD with contralateral IIA embolization patients and 33.8% in bilateral IIA embolization/coverage patients, which were statistically significant among the three groups. Sexual dysfunction was 5.0% in bilateral IIA occlusion group, which was significantly higher than that in IBD groups. CONCLUSIONS The utilization of IBDs in treatment of aortoiliac or isolated iliac artery aneurysms is associated with high technical success rates as well as low incidences of pelvic ischemia. The risk of postoperative buttock claudication can be further decreased with both IIA preservation if patients are anatomically suitable for bilateral IBDs.
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Torrealba J, Panuccio G, Rohlffs F, Gandet T, Gronert C, Heidemann F, Tsilimparis N, Kölbel T. One-Year Results of ZBIS Iliac Branch Device With an Off-Label Connection Limb. J Endovasc Ther 2021; 29:402-408. [PMID: 34711093 DOI: 10.1177/15266028211054760] [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
PURPOSE The purpose of this article is to study 1-year results of Zenith branch iliac endovascular graft (ZBIS) with the off-label use of a 13 mm spiral Z limb to connect to the aortic main body. MATERIALS AND METHODS A retrospective review from 2015 to 2019 of all iliac branch devices (IBDs) was performed at 1 institution that were connected to an aortic main body with a 13 mm spiral Z limb and had at least 1-year follow-up with computed tomography (CT). Primary endpoints are freedom from ZBIS separation from the connection limb, endoleak (EL), or reintervention at 1 year. Secondary endpoints are primary and secondary ZBIS patency, presence of any EL, and aortic reinterventions. RESULTS Of 149 IBDs implanted in this period, 45 ZBIS in 35 patients were connected with a 13 mm limb and had a 1-year CT; 97% of patients had common iliac artery (CIA) aneurysms, 7% of patients had hypogastric artery (HA) aneurysms, and 30% of patients had bilateral ZBIS implantation. Technical success was 98%. In 84% of cases, the Advanta V12 was used as the HA mating stent; 56% of patients had an EL, mostly type II, which resolved spontaneously in 70% at 1 year, and 9% of ZBIS required reinterventions at 1 year (2 for thrombosis, 2 for type Ic EL from HA mating stent). One-year ZBIS primary patency and secondary patency were 96% and 100%, respectively. No EL was noted to be related to the 13 mm connection limb. No migration or separation of the devices occurred. CONCLUSIONS The use of 13 mm spiral Z limb to connect a ZBIS with the main body in our series yields a high technical success rate and good 12-month outcomes without device separation or migration.
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Affiliation(s)
- Jose Torrealba
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Giuseppe Panuccio
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fiona Rohlffs
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Gandet
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Catharina Gronert
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Franziska Heidemann
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nikolaos Tsilimparis
- Vascular Surgery Department, Hospital of the Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Lima GB, Tenorio ER, Marcondes GB, Khasawneh MA, Mendes BC, DeMartino RR, Shuja F, Colglazier JJ, Kalra M, Oderich GS. Outcomes of balloon-expandable versus self-expandable stent graft for endovascular repair of iliac aneurysms using iliac branch endoprosthesis. J Vasc Surg 2021; 75:1616-1623.e2. [PMID: 34695551 DOI: 10.1016/j.jvs.2021.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/06/2021] [Indexed: 01/21/2023]
Abstract
PURPOSE The purpose of this study was to compare outcomes of internal iliac artery (IIA) stenting using balloon-expandable (BESG) or self-expandable stent grafts (SESG) during endovascular repair of aortoiliac aneurysms with iliac branch endoprosthesis (IBE; W. L. Gore, Flagstaff, Ariz). METHODS We retrospectively reviewed all consecutive patients treated for aortoiliac aneurysms using IBE between 2014 and 2020. IIA stenting was performed using either the IIA side branch SESG or a Gore VBX BESG (W. L. Gore). Indications for use of BESGs were "up-and-over" IBE technique for type IB endoleak after prior endovascular aortic aneurysm repair (EVAR), short IIA length, and need for IIA extension into divisional branches (outside instructions for use). End points included technical success, freedom from buttock claudication, primary IIA patency, and freedom from IIA branch instability (eg, branch-related death or rupture, occlusion, disconnection, or reintervention for stenosis, kink, or endoleak), freedom from type IC/IIIC endoleak, and freedom from secondary interventions. RESULTS There were 90 patients (86 males and 4 females) with a mean age of 74 ± 7 years treated by EVAR with 108 IBEs. Choice of stent was BESG in 43 and SESG in 65 targeted IIAs. BESGs were used more frequently in patients with prior EVAR (22% vs 2%; P = .003,), isolated IBEs (31% vs 2%; P < .001), and in patients with IIA aneurysms requiring stenting into divisional branches (36% vs 5%; P < .001). Technical success was similar for BESGs and SESGs (97% vs 100%; P = .40), respectively. The mean follow-up was 25 ± 16 months (range, 11-34 months). At 2 years, freedom from buttock claudication was 100% for BESG and 95 ± 3% for SESG (Log-rank 0.26), with no difference in primary patency (BESG, 100% vs SESG, 94 ± 4%; Log-rank 0.94). There were four (9%) IIA-related endoleaks in the BESG group and one (2%) in the SESG group (P = .08). Freedom from IIA branch instability was 87 ± 6% for BESG and 96 ± 3% for SESG at 2 years (Log-rank 0.043). Freedom from type IC/IIIC endoleak was 87 ± 7% for BESG and 98 ± 2% for SESG at the same interval (Log-rank 0.06). There was no difference in freedom from reinterventions for BESG and SESG (92 ± 6% vs 98 ± 2%; Log-rank 0.34), respectively. CONCLUSIONS BESGs were used more frequently during IBE procedures indicated for failed EVAR, isolated common iliac aneurysms, and IIA aneurysms requiring extension into divisional branches. Despite these differences and BESG being used outside instructions for use, both stent types had similar primary patency, freedom from buttock claudication, and freedom from reinterventions. However, BESGs were associated with higher rates of IIA-related branch instability.
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Affiliation(s)
- Guilherme B Lima
- The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Tex
| | - Emanuel R Tenorio
- The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Tex
| | - Giulianna B Marcondes
- The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Tex
| | | | - Bernardo C Mendes
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | | | - Fahad Shuja
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Jill J Colglazier
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Manju Kalra
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Gustavo S Oderich
- The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Tex.
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Bracale UM, Turchino D, Accarino G, Petrone A, Del Guercio L, Sodo M, Fornino G, Accarino G, Ielapi N, Serraino GF, Mastroroberto P, Provenzano M, Andreucci M, Serra R. Efficacy and Safety of Jotec E-Ventus BX Stent Graft for Iliac Branch Device Procedure: A Retrospective Clinical Study. Ann Vasc Surg 2021; 77:202-207. [PMID: 34437964 DOI: 10.1016/j.avsg.2021.05.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/21/2021] [Accepted: 05/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The endovascular aneurysm repair (EVAR) is a successful treatment for aorto-iliac aneurysms. The success of EVAR is enhanced by the use of devices that maintain the patency of targeted arteries namely the iliac branch device (IBD) With this study we aimed to evaluate the association between the use of Jotec E-ventus during EVAR with IBD and prognosis in patients with aorto-iliac aneurysms. METHODS This is a retrospective, multicentric study enrolling patients referred to our Vascular Surgery Units from January 2015 to January 2020. All patients underwent EVAR with IBD using Jotec E-ventus as bridging stent. Primary endpoint was the development of types I and III endoleaks. Secondary endpoint was the onset of device occlusion with loss of vascular patency. RESULTS We studied 32 patients (mean age 71.7±4.5y). Of these, 25 patients were treated with standard EVAR procedure whereas 7 were treated with isolated IBD due to extension of disease involving iliac bifurcation. Median follow-up lasted 15[IQR11-27] months. During follow-up, incidence rates for endoleaks and occlusion were 3.98(95%CI 0.48-14.41) and 1.99(95%CI 0.05-11.12) per 100 pts/year. CONCLUSIONS Jotec E-ventus during EVAR is associated with a low rate of severe complications in a small cohort of patients with aorto-iliac aneurysms.
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Affiliation(s)
| | - Davide Turchino
- Department of Public Health, University of Naples "Federico II", Naples, Italy; Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Giancarlo Accarino
- Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Anna Petrone
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Luca Del Guercio
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Maurizio Sodo
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Giovanni Fornino
- Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Giulio Accarino
- Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Nicola Ielapi
- Department of Public Health and Infectious Disease, "Sapienza" University of Rome, Roma, Italy
| | | | - Pasquale Mastroroberto
- Department of Experimental and Clinical Medicine, University of Catanzaro, Catanzaro, Italy
| | - Michele Provenzano
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Viale Europa Catanzaro, Italy
| | - Michele Andreucci
- Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Raffaele Serra
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Viale Europa Catanzaro, Italy; Interuniversity Center of Phlebolymphology (CIFL), "Magna Graecia" University, Catanzaro, Italy.
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Huang CY, Chen PL, Lu HY, Hsu HL, Kuo TT, Chen IM, Hsu CP, Shih CC. Midterm result of custom-made iliac branch device for common iliac aneurysm with and without abdominal aortic aneurysm. Interact Cardiovasc Thorac Surg 2021; 32:97-105. [PMID: 33346345 DOI: 10.1093/icvts/ivaa229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/18/2020] [Accepted: 09/04/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Although commercial iliac branch devices offer a new and valid endovascular approach to treating iliac aneurysm and effectively preserve antegrade flow of the internal iliac artery, their use may not be suited for all types of challenging anatomy, especially isolated common iliac artery aneurysm. Our custom-made iliac bifurcation device has a unique design and excludes both combined and isolated iliac branch aneurysm. This study validated the efficacy and safety of the custom device by comparing clinical outcomes between groups receiving commercial and custom devices. METHODS Data of consecutive patients receiving iliac bifurcation device implantation for iliac aneurysm with or without concomitant endovascular repair for abdominal aortic aneurysm from January 2010 to May 2019 were reviewed. RESULTS Iliac bifurcation device implantation with or without concomitant abdominal aortic aneurysm stent grafting was completed in 46 patients (commercial, n = 35; custom, n = 11). No significant differences were observed regarding postoperative complications, occlusion or endoleak. Comparisons of primary (80.8% vs 85.7%, P = 0.88) and secondary (86.5% vs 85.7%, P = 0.85) patency and freedom from reintervention (88.2% vs 100%, P = 0.33), all-cause mortality (78.6% vs 100%, P = 0.25) and aneurysm-related mortality (100% vs 100%, P = 1.00) also indicated no differences at a 5-year surveillance point. Furthermore, the iliac aneurysms of the groups displayed similar shrinkage 1 year after procedures. CONCLUSIONS For iliac aneurysm, the novel custom-made iliac bifurcation device is an adaptable design not inferior to commercial devices with regard to postoperative complications, bridge occlusion, endoleak and short-term aneurysm remodelling. It provides an alternative for treatment, particularly when certain anatomic challenges are present. CLINICAL TRIAL REGISTRATION 2018-07-050BC, 2017-01-023ACF.
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Affiliation(s)
- Chun-Yang Huang
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Po-Lin Chen
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsin-Ying Lu
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Taipei Municipal Wanfang Hospital, Taipei, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Hung-Lung Hsu
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Tzu-Ting Kuo
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - I-Ming Chen
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chiao-Po Hsu
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chun-Che Shih
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Taipei Municipal Wanfang Hospital, Taipei, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
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11
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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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12
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Spanos K, Kölbel T, Scheerbaum M, Donas KP, Austermann M, Rohlffs F, Verzini F, Tsilimparis N. Iliac Branch Devices With Standard vs Fenestrated/Branched Stent-Grafts: Does Aneurysm Complexity Produce Worse Outcomes? Insights From the pELVIS Registry. J Endovasc Ther 2020; 27:910-916. [PMID: 32748727 DOI: 10.1177/1526602820944611] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To compare the outcomes of iliac branch devices (IBD) used in combination with standard endovascular aneurysm repair (EVAR) vs with fenestrated/branched EVAR (f/bEVAR) to treat complex aortoiliac aneurysms. Materials and Methods: The pELVIS Registry database containing the outcomes of IBD use at 8 European centers was interrogated to identify all IBD procedures that were combined with either standard EVAR or f/bEVAR. Among 669 patients extracted from the database, 629 (mean age 72.1±8.8 years; 597 men) had received an IBD combined with standard EVAR vs 40 (mean age 71.1±8.0 years; 40 men) who underwent f/bEVAR with an IBD. The mean aortic aneurysm diameters were 46.4±13.3 mm in the f/bEVAR patients vs 45.0±15.5 mm in the standard EVAR cases. The groups were similar in terms of baseline clinical characteristics and aneurysm morphology. The Kaplan-Meier method was used to compare patient survival, IBD occlusion, type III endoleak, and aneurysm-related reinterventions in follow-up. The estimates are presented with the 95% confidence interval (CI). Results: Technical success was 100% in the f/bEVAR+IBD group and 99% in the EVAR+IBD group (p=0.85). The 30-day mortality was 0% vs 0.5%, respectively (p=0.66), while the 30-day reintervention rates were 7.5% vs 4.1% (p=0.31). The mean follow-up was 32.1±21.3 months for f/bEVAR+IBD patients (n=30) and 35.5±26.8 months for EVAR+IBD patients (n=571; p=0.41). The 12-month survival estimates were 93.4% (95% CI 93.2% to 93.6%) in the EVAR+IBD group vs 93.6% (95% CI 93.3% to 93.9%) for the f/bEVAR+IBD group (p=0.93). There were no occlusions or type III endoleaks in the f/bEVAR+IBD group at 12 months, while the estimates for freedom from occlusion and from type III endoleak in the EVAR+IBD group were 97% (95% CI 96.8% to 97.2%) and 98.5% (95% CI 98.4% to 98.6%), respectively. The 12-month estimates for freedom for aneurysm-related reintervention were 93% (95% CI 92.7% to 93.3%) in the EVAR+IBD group vs 86.4% (95% CI 85.9% to 86.9%) in the f/bEVAR+IBD patients (p=0.046). Conclusion: Treatment of complex aortoiliac disease with f/bEVAR+IBD can achieve equally good early and 1-year outcomes compared to treatment with IBDs and standard bifurcated stent-grafts, except for a somewhat higher reintervention rate in f/bEVAR patients.
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Affiliation(s)
- Konstantinos Spanos
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Tilo Kölbel
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scheerbaum
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Konstantinos P Donas
- Department of Vascular and Endovascular Surgery, St. Franziskus Hospital / University of Münster, Germany
| | - Martin Austermann
- Department of Vascular and Endovascular Surgery, St. Franziskus Hospital / University of Münster, Germany
| | - Fiona Rohlffs
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Fabio Verzini
- Department of Vascular Surgery, University of Perugia, Turin, Italy
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery, Ludwig-Maximilians-University Hospital, Munich, Germany
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13
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Fargion AT, Masciello F, Pratesi G, Torsello G, Donas KP, Pratesi C. Results of Iliac Branch Devices in Octogenarians Within the pELVIS Registry. J Endovasc Ther 2020; 28:157-164. [PMID: 32715874 DOI: 10.1177/1526602820942210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To evaluate if the elderly could benefit from the implantation of iliac branch devices (IBDs) to preserve the patency of the internal iliac artery (IIA) in aneurysms involving the iliac bifurcation. Materials and Methods: From January 2005 to April 2017, 804 patients enrolled in the pELVIS registry underwent endovascular aneurysm repair with 910 IBDs due to aneurysmal involvement of the iliac bifurcation. Among the 804 patients, 157 (19.5%) were octogenarians (mean age 82.9±2.5 years; 157 men) with 171 target IIAs for preservation. Outcomes at 30 days included technical success, death, conversion to open surgery, and major complications. Outcomes evaluated in follow-up were patency of the IBD and target vessels, type I and type III endoleaks, aneurysm-related reinterventions, aneurysm-related death, and overall patient survival. Kaplan-Meier analyses were employed to evaluate the late outcome measures; the estimates are presented with the 95% confidence interval (CI). Results: Technical success was 99.4% with no intraoperative conversions or deaths (1 bridging stent could not be implanted, and the IIA was sacrificed). Perioperative mortality was 1.9%. The overall perioperative aneurysm-related complication rate was 8.9% (14/157), with an early reintervention rate of 5.1% (8/157). Median postoperative radiological and clinical follow-up were 21.8 months (range 1-127) and 29.3 months (range 1-127), respectively. Estimated rates of freedom from occlusion of the IBD, the IIA, and the external iliac artery at 60 months were 97.7% (95% CI 96.1% to 99.3%), 97.3% (95% CI 95.7% to 98.9%), and 98.6% (95% CI 97% to 99.9%), respectively. Estimated rates of freedom from type I and type III endoleaks and device migration at 60 months were 90.9% (95% CI 87% to 94.3%), 98.7% (95% CI 97.5% to 99.8%), and 98% (95% CI 96.4% to 99.6%), respectively. Freedom from all cause reintervention at 60 months was 87.4% (95% CI 82.6% to 92.2%). The estimated overall survival rate at 60 months was 59% (95% CI 52.4% to 65.6%). Conclusion: IBD implantation in octogenarians provided acceptable perioperative mortality and morbidity rates, with satisfying long-term freedom from IBD-related complications and should be considered a feasible repair option for selected elderly patients affected by aneurysms involving the iliac bifurcation.
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Affiliation(s)
- Aaron Thomas Fargion
- Department of Vascular Surgery, Division of Vascular Surgery, Azienda Ospedaliera Universitaria Careggi, University of Florence, Italy
| | - Fabrizio Masciello
- Department of Vascular Surgery, Division of Vascular Surgery, Azienda Ospedaliera Universitaria Careggi, University of Florence, Italy
| | - Giovanni Pratesi
- Department of Vascular Surgery, Division of Vascular and Endovascular Surgery, Ospedale Policlinico San Martino, University of Genoa, Italy
| | - Giovanni Torsello
- Department of Vascular Surgery, St. Franziskus Hospital Münster, Germany
| | - Konstantinos P Donas
- Department of Vascular Surgery and Vascular Research Centre, Asclepios Clinic Langen, Teaching Hospital University of Frankfurt, Germany
| | - Carlo Pratesi
- Department of Vascular Surgery, Division of Vascular Surgery, Azienda Ospedaliera Universitaria Careggi, University of Florence, Italy
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14
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Wang SK, Motaganahalli RL, Maijub JG, Sawchuk AP. Treatment of a traumatic aortic bifurcation injury with an iliac branch endoprosthesis. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:317-319. [PMID: 32685793 PMCID: PMC7355387 DOI: 10.1016/j.jvscit.2020.04.002] [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: 02/26/2020] [Accepted: 04/08/2020] [Indexed: 11/12/2022]
Abstract
We present the case of a 62-year-old man who sustained a traumatic distal aortic injury associated with an adjacent lumbar vertebral body fracture resulting from a 20-ft fall. Given the site of injury, an iliac artery branched endograft was deployed off-label to preserve the aortic bifurcation and cover a limited amount of healthy aorta to preserve the collaterals. The procedure was successful, with no intraoperative complications or evidence of an endoleak. The aortic bifurcation and distal iliac arteries remained widely patent by computed tomography angiography at the follow-up examination without evidence of sequelae.
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Affiliation(s)
- S Keisin Wang
- Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Raghu L Motaganahalli
- Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - John G Maijub
- Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Alan P Sawchuk
- Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind
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15
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Mylonas SN, Ioannides G, Ahmad W, Brunkwall JS. Comparison of Two Iliac Branch Devices and Their Midterm Performance in Maintaining Blood Flow to the Internal Iliac Artery. J Endovasc Ther 2020; 27:818-825. [PMID: 32580623 DOI: 10.1177/1526602820934762] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To compare and contrast the midterm outcomes of the E-liac and Zenith (ZBIS) iliac branch devices (IBDs) for the preservation of the internal iliac artery (IIA) in aneurysms involving the iliac bifurcation. Materials and Methods: Between January 2014 and December 2018, 84 consecutive patients (median age 74 years; 76 men) were electively treated with the E-liac (n=44) or ZBIS (n=40) IBDs and were retrospectively analyzed to evaluate the technical success, patency, need for reintervention, and mortality associated with these devices. Results: Technical success was achieved in 95 of 99 implantations (95.9%) without any statistically significant difference between the groups (93.7% vs 98.0%, p=0.114). During the first 30 days, 3 occlusions in the ZBIS group and 1 in the E-liac group were identified. There was 1 perioperative death in the ZBIS group. The median follow-up was 37 months for the ZBIS group and 28 months for the E-liac group (p=0.657). Six patients from the ZBIS group and 7 from the E-liac group were lost to follow-up. Among the remaining, there were 2 further deaths recorded, 1 in each group. Four further reinterventions in the E-liac group and 2 in the ZBIS group were performed during follow-up. The Kaplan-Meier estimates of freedom from reintervention were 87.2% (95% CI 82.6% to 90.2%) for the ZBIS group and at 86.0% (95% CI 83.7% to 89.1%) for the E-liac group (p=0.563); the freedom from occlusion estimates were 89.7% (95% CI 85.8% to 94.5%) and 95.3% (95% CI 92% to 98.7%; p=0.317), respectively. Conclusion: The E-liac and the ZBIS IBDs showed equally high technical success, midterm patency, and low reintervention rates.
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Affiliation(s)
- Spyridon N Mylonas
- Department of Vascular and Endovascular Surgery, University of Cologne, Germany
| | - Giorgos Ioannides
- Department of Vascular and Endovascular Surgery, University of Cologne, Germany
| | - Wael Ahmad
- Department of Vascular and Endovascular Surgery, University of Cologne, Germany
| | - Jan S Brunkwall
- Department of Vascular and Endovascular Surgery, University of Cologne, Germany
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16
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Giosdekos A, Antonopoulos CN, Sfyroeras GS, Moulakakis KG, Tsilimparis N, Kakisis JD, Lazaris A, Chatziioannou A, Geroulakos G. The use of iliac branch devices for preservation of flow in internal iliac artery during endovascular aortic aneurysm repair. J Vasc Surg 2020; 71:2133-2144. [DOI: 10.1016/j.jvs.2019.10.087] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/19/2019] [Indexed: 01/24/2023]
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17
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Massière B, Leão R, Vescovi A, Leal D, Vivas P, Vasconcelos A, von Ristow A. Outcomes of bell-bottom technique compared to standard endovascular aneurysm repair. Vascular 2020; 29:817-821. [PMID: 32370623 DOI: 10.1177/1708538120920500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The bell-bottom technique is a widely used technique to treat aortoiliac aneurysms with preservation of the hypogastric arteries. The published data are scarce with conflicting results regarding the evolution. The aim of this study was to compare the outcomes of patients submitted to endovascular abdominal aortic aneurysm repair with standard technique (S-EVAR) versus bell-bottom technique. METHODS This retrospective cohort study compared the outcomes of standard endovascular aneurysm repair (<16 mm iliac limbs) and bell-bottom technique (≥16 mm iliac limbs) in a tertiary vascular center between 2010 and 2015. The end points of this study were type IB endoleak, reintervention and 30-day mortality. The follow-up protocol included CT scans within 30 days of implantation and 12 months. Duplex ultrasound was performed yearly thereafter. RESULTS Two hundred and three patients were treated with bell-bottom technique (n = 84, mean age 72.2 ± 8.9) and S-EVAR (n = 119, mean age 72.7 ± 8.4). The overall 30-day mortality was 1.9%, with no significant difference between groups. There was higher prevalence of coronary heart disease in the bell-bottom technique group compared to the S-EVAR group (41.6% vs. 18.4%, p < 0.01). One patient in the S-EVAR group (0.85%) and four patients in the bell-bottom technique (4.6%) developed type IB endoleak. The mean follow-up period was 35.2 ± 30.4 months. By Kaplan-Meier analysis, freedom from type IB endoleak in 80 months was 85.2% in the bell-bottom technique group and 98.7% in the S-EVAR group (p = 0.05). The freedom from reintervention in 80 months was 74.0% in the bell-bottom technique group and 94.1% in the S-EVAR group (p = 0.6). CONCLUSIONS This study shows lower freedom from type IB endoleak in the bell-bottom group compared to the standard repair group. There is no significant difference in reoperation rate and 30-day mortality.
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Affiliation(s)
- Bernardo Massière
- Division of Vascular Surgery, Centervasc-Rio, Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil.,Division of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ronaldo Leão
- Division of Cardiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alberto Vescovi
- Division of Vascular Surgery, Centervasc-Rio, Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Daniel Leal
- Division of Vascular Surgery, Centervasc-Rio, Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paula Vivas
- Division of Vascular Surgery, Centervasc-Rio, Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Adriana Vasconcelos
- Division of Vascular Surgery, Centervasc-Rio, Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Arno von Ristow
- Division of Vascular Surgery, Centervasc-Rio, Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
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18
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D'Oria M, Tenorio ER, Oderich GS, DeMartino RR, Kalra M, Shuja F, Colglazier JJ, Mendes BC. Outcomes after Standalone Use of Gore Excluder Iliac Branch Endoprosthesis for Endovascular Repair of Isolated Iliac Artery Aneurysms. Ann Vasc Surg 2020; 67:158-170. [PMID: 32234400 DOI: 10.1016/j.avsg.2020.03.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/07/2020] [Accepted: 03/17/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The aim of our study was to describe outcomes of stand-alone use (i.e., without concomitant implantation of an aortic stent graft) of the Gore Excluder iliac branch endoprosthesis (IBE) for elective endovascular repair of isolated iliac artery aneurysms. METHODS We evaluated all consecutive patients electively treated for isolated iliac artery aneurysms using standalone Gore Excluder IBE (January 2014-December 2018). Early (i.e., 30-day) endpoints were technical success, mortality, major adverse events (MAEs), and major access-site complications. Late endpoints were survival, freedom from aortic-related mortality (ARM), internal iliac artery (IIA) primary patency, IIA branch instability, graft-related adverse events (GRAEs), secondary interventions, endoleaks (ELs), aneurysm sac behavior, and new-onset buttock claudication (BC). RESULTS A total of 11 consecutive patients (10 men; median age 75 years) were included. The technical success rate was 100%. At 30 days, mortality, MAEs, and major access-site complications were all 0%. Survival and freedom from ARM were 91% and 100%, respectively; only one nonaortic related death was recorded during follow-up. At a median follow-up of 14 months, IIA primary patency, IIA branch instability, and GRAEs were 100%, 0%, and 0%, respectively. No instances of graft migration ≥10 mm were detected. No graft-related secondary interventions were recorded, and 2 patients required a procedure-related secondary intervention 3 months after the index procedure (1 common femoral artery endarterectomy and 1 external iliac artery stenting). Although new-onset type 1 or type 3 ELs were never noted, one patient developed a new-onset type 2 EL. Aneurysm sac regression ≥5 mm was noted in 6 patients (55%), whereas in the remaining ones, the sac size was stable. No instances of new-onset BC were noted. CONCLUSIONS Use of standalone Gore Excluder IBE for elective endovascular repair of isolated iliac artery aneurysms is a safe, feasible, and effective treatment option. These results may support use of the technique as an effective means of endovascular reconstruction in patients with suitable anatomy.
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Affiliation(s)
- Mario D'Oria
- Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic, Rochester, MN
| | - Emanuel R Tenorio
- Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic, Rochester, MN
| | - Gustavo S Oderich
- Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic, Rochester, MN
| | - Randall R DeMartino
- Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic, Rochester, MN
| | - Manju Kalra
- Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic, Rochester, MN
| | - Fahad Shuja
- Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic, Rochester, MN
| | - Jill J Colglazier
- Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic, Rochester, MN
| | - Bernardo C Mendes
- Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic, Rochester, MN.
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19
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A propensity score-matched comparison of two commercially available iliac branch devices in patients with similar clinical and anatomic preoperative features. J Vasc Surg 2020; 71:1207-1214. [DOI: 10.1016/j.jvs.2019.07.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 07/12/2019] [Indexed: 11/24/2022]
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20
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The Use of Iliac Branched Devices in the Acute Endovascular Repair of Ruptured Aortoiliac Aneurysms. Ann Vasc Surg 2020; 67:171-177. [PMID: 32205247 DOI: 10.1016/j.avsg.2020.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/03/2020] [Accepted: 02/16/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the feasibility and midterm outcomes of iliac branch devices (IBDs) to preserve the internal iliac artery perfusion in emergent endovascular repair of ruptured aorto-iliac aneurysms. METHODS Between December 2012 and July 2017, a total of 8 IBDs were implanted in 6 patients (the median age 65 years; all men) in a single tertiary referral center. The indication for IBD implantation was a ruptured abdominal aortic aneurysm with a concomitant common iliac artery aneurysm (n = 4) or isolated CIA aneurysms (n = 2). The main outcome measures were technical and clinical success. The secondary outcomes were primary and primary assisted patency, the occurrence of type I/III endoleaks, and reinterventions. RESULTS All patients were hemodynamically stable during the procedures, which were performed under local anesthesia. Technical success was achieved in all cases (the median total procedure time of 188 min and the median IBD procedure time of 28 min). The median follow-up was 34 months (interquartile range 19-78). There were no deaths during the follow-up and no major complications unrelated to the IBD. Two (25%) secondary interventions were performed for IBD occlusion in patients with bilateral IBDs. The other reintervention was a type II endoleak embolization in 1 of these 2 patients. The freedom from reintervention estimate was 75% through 2 years. The overall primary assisted patency was 100% through 3 years. CONCLUSIONS The use of IBDs in the acute setting is feasible to exclude ruptured aortoiliac aneurysms while maintaining pelvic circulation. The secondary intervention rate is considerable; however, the midterm assisted primary patency rates are promising. Further studies are needed to guide patient selection and to evaluate longer term outcomes.
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Seligson MT, Lim S, Ambur V, Kirksey L. A Hybrid Internal Iliac Artery Reconstruction for Open Common Iliac Artery Aneurysm Repair. Vasc Endovascular Surg 2020; 54:292-296. [PMID: 31896316 DOI: 10.1177/1538574419896522] [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: 11/16/2022]
Abstract
Common iliac artery (CIA) aneurysms present across a spectrum of anatomic variants that can pose unique operative challenges. A wide variety of procedural approaches have been described in the literature with current therapeutic options including both open and endovascular repair. These techniques may involve either ligation or embolization of the internal iliac artery (IIA) with reliance on collateralized blood flow to the pelvis to mitigate postoperative complications. However, preservation of the IIA is often preferred. This case report describes a hybrid surgical approach for treating CIA aneurysms while preserving IIA perfusion. Our technique mitigates the risks of hypogastric artery dissection (including hypogastric vein injury) in the presence of a large CIA aneurysm.
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Affiliation(s)
- Marc T Seligson
- Department of Vascular Surgery, Sydell and Arnold Miller Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Sungho Lim
- Department of Vascular Surgery, Sydell and Arnold Miller Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Vishnu Ambur
- Department of Vascular Surgery, Sydell and Arnold Miller Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Lee Kirksey
- Department of Vascular Surgery, Sydell and Arnold Miller Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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D'Oria M, Mendes BC, Bews K, Hanson K, Johnstone J, Shuja F, Kalra M, Bower T, Oderich GS, DeMartino RR. Perioperative Outcomes After Use of Iliac Branch Devices Compared With Hypogastric Occlusion or Open Surgery for Elective Treatment of Aortoiliac Aneurysms in the NSQIP Database. Ann Vasc Surg 2020; 62:35-44. [DOI: 10.1016/j.avsg.2019.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 04/09/2019] [Accepted: 04/13/2019] [Indexed: 12/20/2022]
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Extension of Iliac Branch Device Repair Into the Superior Gluteal Artery Is a Safe and Effective Maneuver. Ann Vasc Surg 2020; 62:195-205. [DOI: 10.1016/j.avsg.2019.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/22/2019] [Accepted: 06/04/2019] [Indexed: 11/18/2022]
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Brunkwall JS, Vaquero-Puerta C, Heckenkamp J, Egaña Barrenechea JM, Szopinski P, Mertikian G, Seifert S, Rümenapf G, Buz S, Assadian A, Majd P, Mylonas S, Calavia AR, Theis T, de Blas Bravo M, Pleban E, Schupp J, Esche M, Kocaer C, Hirsch K, Oberhuber A, Schäfer JP. Prospective Study of the Iliac Branch Device E-liac in Patients with Common Iliac Artery Aneurysms: 12 Month Results. Eur J Vasc Endovasc Surg 2019; 58:831-838. [DOI: 10.1016/j.ejvs.2019.06.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 06/12/2019] [Accepted: 06/17/2019] [Indexed: 11/17/2022]
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Oliveira-Pinto J, Martins P, Mansilha A. Endovascular treatment of iliac aneurysmal disease with internal iliac artery preservation: a review of two different approaches. INT ANGIOL 2019; 38:494-501. [PMID: 31782280 DOI: 10.23736/s0392-9590.19.04215-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The feasibility of endovascular aneurysm repair (EVAR) is often challenged by the concurrent presence of common iliac artery aneurysms, which prevent the attainment of a successful distal sealing. The present review aims to portray the safety and efficacy of two internal iliac artery (IIA) preservation strategies in the endovascular treatment of aortoiliac aneurysms: the iliac branch extension device (IBED) and the parallel graft - "sandwich" technique (PG-ST). EVIDENCE ACQUISITION A comprehensive literature review was conducted to identify publications on endovascular treatment of iliac aneurysmal disease using IBED or PG-ST. Primary endpoints were freedom from endoleak, IIA branch occlusion and secondary interventions. EVIDENCE SYNTHESIS Twenty-eight studies were selected for analysis describing a total of 1316 patients, 1169 in the IBED group and 147 in the PG-ST group. The technical success rates were akin for IBED and PG-ST (83.9-100% versus 81.3-100%). The defined primary endpoints were reported by fourteen articles. Freedom from endoleak, IIA branch occlusion and reintervention, at 6 months, were as follows: 82-100% versus 86%, 90-94% versus 88%, and 90-98% versus 87%, respectively for IBED and PG-ST. Later outcomes were only recorded in the IBED group, and freedom from endoleak, IIA branch occlusion and reintervention, at 9 years, were 83%, 81-90%, and 64-75%, respectively. CONCLUSIONS Both IBED and PG-ST have proven to be safe and valid approaches. However, while IBED has established as a durable procedure, mid-term data lacks on PGs performance and further studies are required to attest durability of the latter procedure.
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Affiliation(s)
- José Oliveira-Pinto
- Department of Surgery and Physiology, Faculty of Medicine of Porto, Porto, Portugal -
| | - Pedro Martins
- Department of Surgery and Physiology, Faculty of Medicine of Porto, Porto, Portugal
| | - Armando Mansilha
- Department of Surgery and Physiology, Faculty of Medicine of Porto, Porto, Portugal
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Iliac Aneurysms Treated with Endovascular Iliac Branch Device: A Systematic Review and Meta-analysis. Ann Vasc Surg 2019; 56:303-316. [DOI: 10.1016/j.avsg.2018.07.058] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 07/16/2018] [Accepted: 07/19/2018] [Indexed: 11/22/2022]
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Early and Late Outcome of Common Iliac Aneurysms Treated by Flared Limbs or Iliac Branch Devices during Endovascular Aortic Repair. J Vasc Interv Radiol 2019; 30:503-510. [DOI: 10.1016/j.jvir.2018.10.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/18/2018] [Accepted: 10/22/2018] [Indexed: 11/17/2022] Open
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Current Status of Endovascular Preservation of the Internal Iliac Artery with Iliac Branch Devices (IBD). Cardiovasc Intervent Radiol 2019; 42:935-948. [DOI: 10.1007/s00270-019-02199-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/06/2019] [Indexed: 02/06/2023]
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Surgical internal iliac artery preservation associated with endovascular repair of infrarenal aortoiliac aneurysms to avoid buttock claudication and distal type I endoleaks. J Vasc Surg 2018; 68:1736-1743. [DOI: 10.1016/j.jvs.2018.03.416] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 03/05/2018] [Indexed: 11/21/2022]
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30
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Femoral Access for Iliac Branched Endoprosthesis Deployment in Patients with a Prior Bifurcated Aortic Stent Graft. Ann Vasc Surg 2018; 53:262-265. [DOI: 10.1016/j.avsg.2018.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 03/26/2018] [Accepted: 04/27/2018] [Indexed: 11/21/2022]
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Robalo C, Sousa J, Mansilha A. Internal iliac artery preservation strategies in the endovascular treatment of aortoiliac aneurysms. INT ANGIOL 2018; 37:346-355. [DOI: 10.23736/s0392-9590.18.04004-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Morphology-Related Limitations of Endovascular Aneurysm Repair Applicability in the Treatment of Abdominal Aortic Aneurysm in West-Central Poland. Ann Vasc Surg 2018; 52:49-56. [PMID: 29772324 DOI: 10.1016/j.avsg.2018.02.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/12/2018] [Accepted: 02/28/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Morphology is one of the most important factors influencing the long-term durability of endovascular repair of an infrarenal abdominal aortic aneurysm (AAA). The knowledge of morphological characteristics of AAA that may differ in various populations seems to be important for further development of a technology of endovascular repair as well as for planning of treatment strategies. To analyze the current applicability of endovascular aneurysm repair (EVAR) in patients with an infrarenal AAA with an indication for elective treatment in west-central Poland. METHODS Computed tomography angiograms of 100 consecutive patients with infrarenal AAA deemed to require treatment were analyzed with an OsiriX DICOM viewer in 3D-multiplanar reconstruction mode. Proximal neck diameter, length, angulation, shape, the presence of thrombus and calcification, distal neck diameter, and morphology of the iliac arteries were determined. Three sets of morphological criteria were established. The optimal criteria consisted of a nonconical proximal neck without moderate or severe calcification or thrombus, with a diameter of 18-28 mm, length of ≥15 mm, and β angulation of <60%; a distal neck with a diameter of ≥20 mm; a landing zone in the common iliac arteries (CIAs) with a length of ≥10 mm and diameter of ≤20 mm; and external iliac arteries with diameters of ≥7 mm. The suboptimal criteria included proximal neck diameters of 18-32 mm, neck lengths ≥10 mm, infrarenal neck angulations of up to 75°, and CIA diameters of up to 25 mm. Finally, the extended suboptimal criteria included proximal neck diameters of 16-34 mm and infrarenal neck angulations ≤90°, without limits in the maximal diameter of the CIAs. RESULTS The median maximum aneurysm diameter was 61 mm. The optimal, suboptimal, and extended suboptimal criteria were met by 23%, 32%, and 53% of patients, respectively. The most common deviations were wide, conical, and angulated proximal necks and aneurysmal iliac arteries. CONCLUSIONS The majority of patients with AAA deemed to be candidates for elective repair do not meet the most favorable criteria for EVAR. Availability of better endovascular solutions for conical, angulated, and wide necks and aneurysmal iliac arteries would likely expand EVAR applicability. Open repair remains a valid option.
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Maeda K, Ohki T, Kanaoka Y. Endovascular Treatment of Various Aortic Pathologies: Review of the Latest Data and Technologies. Int J Angiol 2018; 27:81-91. [PMID: 29896040 DOI: 10.1055/s-0038-1645881] [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: 12/17/2022] Open
Abstract
The technologies and innovations applicable to endovascular treatment for complex aortic pathologies have progressed rapidly over the last two decades. Although the initial outcomes of an endovascular aortic repair have been excellent, as long-term data became available, complications including endoleaks, endograft migration, and endograft infection have become apparent and are of concern. Previously, the indication for endovascular therapy was restricted to descending thoracic aortic aneurysms and abdominal aortic aneurysms. However, its indication has expanded along with the improvement of techniques and devices, and currently, it has become possible to treat pararenal aortic aneurysms and Crawford type 4 thoracoabdominal aortic aneurysm (TAAA) using the off-the-shelf devices. Additionally, custom-made devices allow for the treatment of arch or more extensive TAAAs. Endovascular treatment is applied not only to aneurysms but also to acute/chronic dissections. However, long-term outcomes are still unclear. This article provides an overview of available devices and the results of endovascular treatment for various aortic pathologies.
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Affiliation(s)
- Koji Maeda
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yuji Kanaoka
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
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Giaquinta A, Ardita V, Ferrer C, Beggs CB, Veroux M, Barbante M, Orrico M, Cao P, Veroux P. Isolated Common Iliac Artery Aneurysms Treated Solely With Iliac Branch Stent-Grafts: Midterm Results of a Multicenter Registry. J Endovasc Ther 2018; 25:169-177. [PMID: 30141378 DOI: 10.1177/1526602818754862] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess early and midterm outcomes of iliac branch device (IBD) implantation without an aortic stent-graft for the treatment of isolated common iliac artery aneurysm (CIAA). METHODS From December 2006 to June 2016, 49 isolated CIAAs in 46 patients were treated solely with an IBD at 7 vascular centers. Five patients were lost to follow-up, leaving 41 male patients (mean age 72.5±7.8 years) for analysis. Mean CIAA diameter was 39.1±10.5 mm (range 25-65). Thirty-two patients (2 with bilateral CIAAs) were treated with a Cook Zenith iliac branch device; 9 patients (1 bilateral) received a Gore Excluder iliac branch endoprosthesis. Primary endpoints were technical success, survival, aneurysm exclusion, device patency, and freedom from reintervention at 1 and 5 years. Freedom from major adverse events and aneurysm shrinkage at 1 year were also assessed. RESULTS Thirty-day mortality and the IBD occlusion rate were 2.4% and 2.3%, respectively. At a mean follow-up of 40.2±33.9 months, no patient presented buttock claudication, erectile dysfunction, or bowel or spinal cord ischemia. Three patients died within 6 months after the procedure. Estimates of cumulative survival, device patency, and freedom from reintervention were 90.2%, 95.2%, and 95.7%, respectively, at 1 and 5 years. At 1 year, CIAA shrinkage ≥5 mm was recorded in 21 of 38 survivors. No evidence of endoleak, device migration, or disconnection was found on imaging follow-up. CONCLUSION The use of IBDs without an aortic stent-graft for isolated CIAAs resulted in excellent patency, with low morbidity and mortality. This, in conjunction with no endoleak or migration and a low reintervention rate, supports the use of isolated IBDs as a stable and durable means of endovascular reconstruction in cases with suitable anatomy. Longer follow-up and a larger cohort are needed to validate these results.
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Affiliation(s)
- Alessia Giaquinta
- 1 Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Italy
| | - Vincenzo Ardita
- 1 Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Italy
| | - Ciro Ferrer
- 2 Department of Surgery "Pietro Valdoni," "Sapienza" University, Rome, Italy
| | - Clive B Beggs
- 3 Research Institute for Sport, Physical Activity and Leisure, Carnegie Faculty, Leeds Beckett University, Leeds, UK
| | - Massimiliano Veroux
- 1 Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Italy
| | - Matteo Barbante
- 4 Vascular Surgery Unit, Department of Biomedicine and Prevention, University of Rome "Tor Vergata," Rome, Italy
| | - Matteo Orrico
- 5 Department of Vascular Surgery, San Filippo Neri Hospital, Rome, Italy
| | - Piergiorgio Cao
- 6 Division of Vascular Surgery, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Piefrancesco Veroux
- 1 Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Italy
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Dawson DL, Sandri GDA, Tenorio E, Oderich GS. Up-and-Over Technique for Implantation of Iliac Branch Devices After Prior Aortic Endograft Repair. J Endovasc Ther 2018; 25:21-27. [PMID: 29313456 DOI: 10.1177/1526602817747283] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe a modified up-and-over access technique for treatment of iliac artery aneurysms in patients with prior bifurcated stent-grafts for endovascular aneurysm repair (EVAR). TECHNIQUE This technique uses a coaxial 12-F flexible sheath that is docked with a through-and-through wire into a 7-F sheath advanced from the contralateral femoral approach. This maneuver allows both sheaths to be moved as a unit while maintaining position of the apex of the system as it loops over the flow divider, avoiding damage to or displacing the extant endograft. Once the 12-F sheath is positioned in the iliac limb of the aortic stent-graft and secured in place with the through-and-through wire, the repair is extended into the internal iliac artery using a bridging stent-graft or covered stent introduced via a coaxial sheath. CONCLUSION The up-and-over technique with a flexible 12-F sheath mated with a 7-F sheath from the opposite side allows bilateral femoral access to be used for iliac branch device placement after prior aortic endograft procedures that create a higher, acutely angled bifurcation. Use of a through-and-through wire and a coaxial sheath for stent delivery creates a very stable platform for intervention.
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Affiliation(s)
- David L Dawson
- 1 Department of Surgery, Division of Vascular Surgery, University of California Davis, Sacramento, CA, USA
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Wang K, Dunkley L, Neale M. Novel Endovascular Approach Using the Gore Iliac Branch Endograft for Short Iliac Anatomy. J Endovasc Ther 2017; 25:28-30. [PMID: 29251205 DOI: 10.1177/1526602817746127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report the use of a branched iliac endograft to maintain internal iliac artery (IIA) patency in a patient with an infrarenal aortic aneurysm and short common iliac arteries (CIA). CASE REPORT A 74-year-old man presented with an asymptomatic, fusiform, 67-mm infrarenal aortic aneurysm confirmed on computed tomography. The right CIA was funnel shaped and only 15 mm in length, providing no appropriate stent-graft landing zone. The left CIA measured 14 mm in diameter and 25 mm in length. Endovascular repair of the aneurysm with preservation of the IIAs was achieved using a Gore Iliac Branch Endoprosthesis for the short right CIA and a conventional limb to land in the left CIA. Follow-up scans to 24 months have shown continued patency of the IIA and no evidence of endoleak. CONCLUSION The Gore Iliac Branch Endograft can be used to successfully treat patients with short CIA anatomy while preserving flow to the ipsilateral IIA, with maintained early patency of the IIA limb.
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Affiliation(s)
- Kejia Wang
- 1 North Shore Private Hospital, St Leonards, New South Wales, Australia
| | - Laura Dunkley
- 1 North Shore Private Hospital, St Leonards, New South Wales, Australia
| | - Michael Neale
- 1 North Shore Private Hospital, St Leonards, New South Wales, Australia
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Gray D, Shahverdyan R, Reifferscheid V, Gawenda M, Brunkwall J. EVAR with Flared Iliac Limbs has a High Risk of Late Type 1b Endoleak. Eur J Vasc Endovasc Surg 2017; 54:170-176. [DOI: 10.1016/j.ejvs.2017.05.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 05/10/2017] [Indexed: 11/16/2022]
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