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Yazar O, Willems S, Zonnebeld N, Salemans PB, Wong C, Bouwman LH. Single-Center Mid-term Experience with E-Liac Branched Device from Artivion®. Ann Vasc Surg 2024:S0890-5096(24)00441-2. [PMID: 39029895 DOI: 10.1016/j.avsg.2024.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/14/2024] [Accepted: 05/20/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND The use of iliac branch device (IBD) is increasing due to the less invasive character and accumulated experience of physicians in this endovascular technique. Clinical data regarding the E-liac stent graft from Artivion®, however, are scarce. This study shows the mid-term outcomes of the E-liac stent graft from a large single center. METHODS Patients treated with IBD for (aorto-)iliac aneurysms between September 2015 and December 2022 with follow-up in our center were included. (Post)operative (technical success, reintervention, 30-day mortality) and mid-term outcomes (endoleak, reintervention, hypogastric patency, mortality) were analyzed. RESULTS 63 patients (60 male, median age 70 years (IQR 66-76)) were treated with 82 E-liac stent grafts for aorto-iliac aneurysms with a median follow-up of 38 months (IQR 22-51). The technical success rate was 95%. Ninety-seven point six percent of the interal iliac arteries remained patent during follow-up. No 30-day mortality was encountered. During follow-up one patient had an endoleak type 1b of both hypogastric arteries, however the patient refused additional interventions. One other patient had a type 2 endoleak with contained rupture. Palliative treatment was chosen because of the patient's severe comorbidities. One (1.6%) IBD-related reintervention was performed with relining of the stent graft. Secondary patency of the interal iliac artery was 95.1% and the mortality was 25.4% during follow-up. CONCLUSIONS This study shows high technical success rates for the E-liac stent graft, with corresponding good mid-term outcomes. The E-liac stent graft is a feasible, safe and effective stent graft in the treatment of aorto-iliac aneurysms.
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Affiliation(s)
- Ozan Yazar
- Department of Vascular and Endovascular Surgery, Zuyderland Medical Center, Heerlen, The Netherlands.
| | - Stefanie Willems
- Department of Vascular and Endovascular Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Niek Zonnebeld
- Department of Vascular and Endovascular Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Pieter B Salemans
- Department of Vascular and Endovascular Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - ChunYu Wong
- Department of Vascular and Endovascular Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Lee H Bouwman
- Department of Vascular and Endovascular Surgery, Zuyderland Medical Center, Heerlen, The Netherlands; Faculty of Science and Engineering, Maastricht University, Maastricht, The Netherlands
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Moldovan H, Tiganasu R, Câlmâc L, Voica C, Broască M, Diaconu C, Ichim V, Cacoveanu M, Mirea L, Nica C, Minoiu C, Dobra I, Gheorghiță D, Dorobanțu L, Molnar A, Iliuță L. Same Clinical Reality of Spontaneous Rupture of the Common Iliac Artery with Pseudoaneurysm Formation-Comparison of Two Therapeutical Solutions, Endovascular Stent-Graft and Open Surgical Correction, for Two Cases and Review of the Literature. J Clin Med 2023; 12:jcm12020713. [PMID: 36675646 PMCID: PMC9865574 DOI: 10.3390/jcm12020713] [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] [Received: 11/10/2022] [Revised: 12/28/2022] [Accepted: 01/06/2023] [Indexed: 01/19/2023] Open
Abstract
The incidence of isolated iliac artery aneurysms is approximately 2% and common iliac artery pseudoaneurysms are even rarer. A pseudoaneurysm is a localized hemorrhage as opposed to an actual aneurysm, which affects the entire vascular wall. They are typically asymptomatic and only detectable accidentally while looking for other causes. If large and symptomatic, they typically exhibit pressure symptoms as a result of the compression of the structures around them. Common symptoms include generalized stomach pain, urological problems, gastrointestinal bleeding, and neurological symptoms such as leg paralysis or sciatica-like back pain. Rarely, they may exhibit hemodynamic instability together with an aneurysm rupture, which has a high fatality rate. Due to the unique presentation, the diagnosis is typically rarely made and there is little experience with treating it. We report two cases of common iliac artery pseudoaneurysm found in two patients who had no notable medical history and who we chose to repair through the endovascular technique in the first case, an approach that has gained more ground for vascular repair worldwide, making it the current go-to method, and for the second case we chose a more traditional approach, through open surgery.
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Affiliation(s)
- Horațiu Moldovan
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 014461 Bucharest, Romania
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
- Academy of Romanian Scientists, 54 Spl. Independentei, 050711 Bucharest, Romania
- Correspondence: (H.M.); (D.G.)
| | - Robert Tiganasu
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
| | - Lucian Câlmâc
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
| | - Cristian Voica
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
| | - Marian Broască
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
| | - Camelia Diaconu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 014461 Bucharest, Romania
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
- Academy of Romanian Scientists, 54 Spl. Independentei, 050711 Bucharest, Romania
| | - Vlad Ichim
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 014461 Bucharest, Romania
| | - Mihai Cacoveanu
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
| | - Liliana Mirea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 014461 Bucharest, Romania
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
| | - Claudia Nica
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
| | - Costin Minoiu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 014461 Bucharest, Romania
| | - Irina Dobra
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
| | - Daniela Gheorghiță
- Faculty of Materials Science and Engineering, Politehnica University of Bucharest, 060042 Bucharest, Romania
- Correspondence: (H.M.); (D.G.)
| | - Lucian Dorobanțu
- Faculty of Medicine, Titu Maiorescu University, 040441 Bucharest, Romania
- Department of Cardiovascular Surgery, Monza Metropolitan Hospital, 040204 Bucharest, Romania
| | - Adrian Molnar
- Faculty of Medicine, Iuliu Hateganu University of Medicine and Pharmacy, 400012 Cluj Napoca, Romania
- Department of Cardiovascular Surgery, Heart Institute, 400001 Cluj Napoca, Romania
| | - Luminița Iliuță
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 014461 Bucharest, Romania
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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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Alfahhad MF, Qasem HA, Alrajhi NN, Khayat LT, Alsulami MK, Al Marri SA, Alshuqaybi HM, Aldhafyan SR, Al Jabir FM, Albaqami NA, Alyami AM, Alamrani AM, Abusabir DN, Alkhaldi AN, Al-Hawaj F. Ruptured Isolated Common Iliac Artery Aneurysm Masquerading as Renal Colic. Cureus 2021; 13:e19752. [PMID: 34938629 PMCID: PMC8684804 DOI: 10.7759/cureus.19752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 11/05/2022] Open
Abstract
Urinary stone disease is a common problem globally. Ureteric colic typically presents with flank pain and hematuria. However, several conditions may give a similar clinical picture. Hence, imaging studies are essential to make the diagnosis of urinary stone disease and evaluate for possible complications. We present the case of a 64-year-old man who presented with severe left flank pain radiating to the groin for two days. In his first visit to the emergency department, he was prescribed conservative treatment, but it failed to give any clinical improvement. The patient does not have a previous history of urinary stone disease. He had a long-standing history of hypertension, diabetes mellitus, dyslipidemia, and coronary artery disease. Further, he had a 30 pack-years history of smoking. Upon examination, the abdomen was soft and lax with generalized tenderness. Subsequently, a non-contrast computed tomography scan for the kidneys, ureters, and bladder was performed, which demonstrated a large high attenuation fluid seen in the left side of the retroperitoneum. The scan was then repeated after the administration of intravenous contrast and showed an aneurysmal dilatation of the left common iliac artery with surrounding hematoma. The patient was taken for an emergency laparotomy for evacuation of the hematoma and graft repair of the aneurysm. The patient tolerated the operation without complications. The present case highlights the importance of considering the wide differential diagnoses of flank pain in emergency settings. Physicians should keep a high index of suspicion for aneurysmal disease when they encounter patients with risk factors for arterial wall degeneration.
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Affiliation(s)
| | | | - Nermeen N Alrajhi
- College of Medicine, King Saud Bin Abdulaziz University For Health Sciences, Jeddah, SAU
| | - Luay T Khayat
- College of Medicine, King Abdulaziz University, Jeddah, SAU
| | | | | | - Hassan M Alshuqaybi
- College of Medicine, King Saud Bin Abdulaziz University For Health Sciences, Riyadh, SAU
| | - Saad R Aldhafyan
- College of Medicine, King Saud Bin Abdulaziz University For Health Sciences, Riyadh, SAU
| | - Fahad M Al Jabir
- College of Medicine, King Saud Bin Abdulaziz University For Health Sciences, Riyadh, SAU
| | - Naif A Albaqami
- College of Medicine, King Saud Bin Abdulaziz University For Health Sciences, Riyadh, SAU
| | | | | | | | | | - Faisal Al-Hawaj
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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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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Wang Y, Zhu C, Leach J, Gasper W, Saloner D, Hope M. Growth of common iliac artery aneurysms coexisting with abdominal aortic aneurysms: associated factors and potential role of intraluminal thrombus. Quant Imaging Med Surg 2020; 10:703-712. [PMID: 32269930 PMCID: PMC7136736 DOI: 10.21037/qims.2020.02.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/07/2020] [Indexed: 08/30/2023]
Abstract
BACKGROUND The factors influencing common iliac artery aneurysm (CIA) growth are not fully known. Intraluminal thrombus (ILT) has been studied as a marker of growth in abdominal aortic aneurysms (AAA), but its role in CIAs is unknown. This study aims to examine the factors associated with growth of CIAs coexistent with AAA using serial cross-sectional imaging (CT and MRI) with multiplanar reconstruction (MPR). METHODS Patients with synchronous AAA and CIA observed at contrast-enhanced CT or MRI were included. The maximal diameters of both CIA and AAA were measured using MPR. Correlation of the baseline aneurysm diameter and growth rate between CIA and AAA was evaluated. Multivariate regression analysis was used to investigate the factors associated with CIA growth. RESULTS Seventy-five AAA patients (age 74±9 years; all male) with 100 CIAs were followed for an average of 2.2±1.2 years. CIA and AAA growth were positively correlated (r=0.39, P<0.001). Multivariate analysis showed that CIA baseline diameter, AAA baseline diameter, and smoking were positively related to CIA growth. In 2-3 cm CIAs (n=59), ILT tends to be an independent predictor of AAA growth (P=0.076), and CIAs with ILT grow at more than twice the rate of CIAs without ILT (1.7 vs. 0.8 mm/year, P=0.036), despite similar baseline diameters. CONCLUSIONS CIA baseline diameter, coexisting AAA baseline diameter, and smoking are associated with CIA growth. In CIAs measuring 2-3 cm, the presence of ILT is associated with faster growth, and should be taken into account when determining surveillance intervals and timing of intervention for patients being considered for AAA repair.
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Affiliation(s)
- Yuting Wang
- Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610072, China
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Chengcheng Zhu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Joseph Leach
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Warren Gasper
- Department of Surgery, University of California, San Francisco, CA, USA
| | - David Saloner
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Michael Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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Parker LP, Powell JT, Kelsey LJ, Venermo M, Koncar I, Norman PE, Doyle BJ. Morphology and Computational Fluid Dynamics Support a Novel Classification of Common Iliac Aneurysms. Eur J Vasc Endovasc Surg 2020; 59:786-793. [PMID: 31982309 DOI: 10.1016/j.ejvs.2019.11.035] [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] [Received: 04/24/2019] [Revised: 10/30/2019] [Accepted: 11/21/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Isolated common iliac artery aneurysms (CIAAs) are uncommon, and evidence concerning their development, progression, and management is weak. The objective was to describe the morphology and haemodynamics of isolated CIAAs in a retrospective study. METHODS Initially, a series of 25 isolated CIAAs (15 intact, 10 ruptured) in 23 patients were gathered from multiple centres, reconstructed from computed tomography, and then morphologically classified and analysed with computational fluid dynamics. The morphological classification was applied in a separate, consecutive cohort of 162 patients assessed for elective aorto-iliac intervention, in which 55 patients had intact CIAAs. RESULTS In the isolated CIAA cohort, three distinct morphologies were identified: complex (involving a bifurcation); fusiform; and kinked (distal to a sharp bend in the CIA), with mean diameters of 90.3, 48.3, and 31.7 mm, and mean time averaged wall shear stresses of 0.16, 0.31, and 0.71 Pa, respectively (both analysis of variance p values < .001). Kinked cases vs. fusiform cases had less thrombus and favourable haemodynamics similar to the non-aneurysmal contralateral common iliac artery (CIA). Ruptured isolated CIAAs were large (mean diameter 87.5 mm, range 55.5-138.0 mm) and predominantly complex. The mean CIA length for aneurysmal arteries was greatest in kinked cases followed by complex and fusiform (100.8 mm, 91.1 mm, and 80.6 mm, respectively). The morphological classification was readily applicable to a separate elective patient cohort. CONCLUSION A new morphological categorisation of CIAAs is proposed. Potentially this is associated with both haemodynamics and clinical course. Further research is required to determine whether the kinked CIAA is protected haemodynamically from aneurysm progression and to establish the wider applicability of the categorisation presented.
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Affiliation(s)
- Louis P Parker
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Australia; School of Engineering, The University of Western Australia, Perth, Australia
| | - Janet T Powell
- Vascular Surgery Research Group, Imperial College London, London, UK
| | - Lachlan J Kelsey
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Australia; School of Engineering, The University of Western Australia, Perth, Australia
| | - Maarit Venermo
- Division of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Igor Koncar
- Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
| | - Paul E Norman
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Australia; Medical School, The University of Western Australia, Perth, Australia
| | - Barry J Doyle
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Australia; School of Engineering, The University of Western Australia, Perth, Australia; Australian Research Council Centre for Personalised Therapeutics Technologies, Australia; BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK.
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Pfabe FP. [The Treatment of Aneurysms of the Extremities Arteries - a Systematic Overview - New Therapies for Isolated Iliac Artery Aneurysm Employing a New Classification]. Zentralbl Chir 2020; 145:456-466. [PMID: 31931546 DOI: 10.1055/a-1027-7164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aneurysms of arteries in the extremities have a low incidence and are often manifest through complications. The most serious complications are rupture and extremity-threatening ischemia. Both usually lead to the diagnosis. Absolute indications for therapy are symptomatic aneurysms and asymptomatic aneurysms of 2 cm diameter or more. The extrailiacal gold standard is interponat or bypass with venous graft material. Endovascular methods are reserved for inoperable patients and clinical decisions on special cases. In contrast, complex endovascular techniques have been established in isolated iliac aneurysms and have significantly improved treatment options. Their implementation is bound to the existence of a suitable landing zone. This is the basis for a new classification of isolated iliac artery aneurysm. With the help of morphological subtypes, this classification permits standardised procedure planning for perfusion preservation of the internal iliac artery. The present article gives an overview of the current treatment strategy for aneurysms of extremities arteries. Similarities and regional differences in therapy are discussed.
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Affiliation(s)
- Frank-Peter Pfabe
- Klinik für Gefäßmedizin, Asklepios Klinikum Uckermark GmbH, Schwedt, Deutschland
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Asad M, Venigalla K, Rahi MA. An uncommon presentation and hybrid approach for the management of an unruptured 8 cm common iliac artery aneurysm. Int J Surg Case Rep 2019; 66:126-129. [PMID: 31838431 PMCID: PMC6920193 DOI: 10.1016/j.ijscr.2019.11.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Common Iliac Artery Aneurysms are rare in the general population and can be difficult to diagnose. PRESENTATION OF CASE An 82-year-old lady initially presented to her GP with non specific symptoms, but was found to have a right iliac fossa mass on examination. Initial Blood Tests and clinical observations were unremarkable. A CT scan demonstrated a large, 8 cm Isolated Right Common Iliac Aneurysm. She was admitted following the scan for monitoring and surgical intervention. In view of her mild frailty, she underwent a hybrid approach: Right Aorto-Uni-Iliac Stent Graft and Right to Left femoro-femoral crossover graft and right internal iliac artery embolization. DISCUSSION We discuss the rarity, variety of clinical presentations and aetiology of Common Iliac Artery Aneurysms. These aneurysms are at high risk of rupture and in the elective setting, many are repaired when they reach over 3.5 cm. With the advancement and preference of minimally invasive techniques, Endovascular Aneurysm Repair (EVAR) is replacing Open Surgery. In some instances, such as our case, the anatomy is unsuitable for a standalone EVAR procedure. Thus a hybrid operation was performed. CONCLUSION Common Iliac Artery Aneurysms should be considered in a differential diagnosis of lower abdominal mass. If presenting in this manner, the aneurysm can be of significant size and at high risk of rupture, requiring urgent surgical intervention.
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Affiliation(s)
- Maria Asad
- The School of Medical Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Stopford Building, 99 Oxford Road, M13 9PG, United Kingdom.
| | - Krishna Venigalla
- Lancashire Teaching Hospital NHS Trust, Regional Vascular Centre, Royal Preston Hospital, Sharoe Green Ln, Fulwood, Preston, PR2 9HT, United Kingdom
| | - Muhammad Asad Rahi
- Lancashire Teaching Hospital NHS Trust, Regional Vascular Centre, Royal Preston Hospital, Sharoe Green Ln, Fulwood, Preston, PR2 9HT, United Kingdom
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Morgan-Bates K, Dey R, Chaudhuri A. Ultrasound Assisted On-Table Management of Type III Endoleak at Endovascular Repair of Isolated Giant Common Iliac Aneurysm. EJVES Short Rep 2019; 45:17-21. [PMID: 31687476 PMCID: PMC6820109 DOI: 10.1016/j.ejvssr.2019.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/20/2019] [Accepted: 09/24/2019] [Indexed: 12/27/2022] Open
Abstract
Objectives This report presents the endovascular treatment of a large isolated common iliac artery aneurysm, focusing on the use of on table ultrasonography to characterise and treat an early endoleak that could not be defined by angiography alone. Report A 58 year old man presented with an asymptomatic, large (13cm) left common iliac artery aneurysm (LCIAA) whilst being investigated for change in bowel habit. This was treated successfully via a percutaneous approach using left internal iliac embolisation followed by endovascular aneurysm repair (EVAR) with deployment of an aorto-uni-iliac converter system from the LCIA origin to the external iliac artery. A non-characterised endoleak at the end of the procedure was shown to be a type IIIb endoleak by application of immediate on table ultrasonography, allowing immediate supplementary targeted stent graft deployment to cover the leaking segment. Discussion The patient was discharged uneventfully and will remain on follow up. On table ultrasonography allowed both localisation and characterisation of an immediate intra-procedural endoleak and confirmed cessation of the endoleak with supplementary stent grafting and thrombosis within the sac. Conclusions Isolated CIAA is rare, and endovascular therapy is appropriate for them, given that open surgery, whilst feasible, carries a high morbidity and mortality risk. Application of on-table ultrasound allows definition and targeted treatment of endoleaks, reducing the need for further intervention at a later stage, and thus also reducing the risk of continued pressurisation of the large sac post-EVAR till the next surveillance episode. Isolated common iliac artery aneurysms (CIAAs) are very rare. They can be asymptomatic but have a high risk of rupture. Open repair is high risk and associated with high morbidity/mortality. This paper highlights successful endovascular repair of a giant isolated CIAA. On table ultrasound helps immediately to characterise and treat endoleaks at EVAR.
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Affiliation(s)
- Kersten Morgan-Bates
- Bedfordshire - Milton Keynes Vascular Centre, Bedford Hospital NHS Trust, Kempston Road, Bedford MK42 9DJ, UK
| | - Ramita Dey
- Bedfordshire - Milton Keynes Vascular Centre, Bedford Hospital NHS Trust, Kempston Road, Bedford MK42 9DJ, UK
| | - A Chaudhuri
- Bedfordshire - Milton Keynes Vascular Centre, Bedford Hospital NHS Trust, Kempston Road, Bedford MK42 9DJ, UK
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Ultrasound Surveillance of Common Iliac Artery Aneurysms. Ann Vasc Surg 2019; 65:166-173. [PMID: 31669342 DOI: 10.1016/j.avsg.2019.10.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/09/2019] [Accepted: 10/09/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND The surveillance of patients with common iliac artery aneurysms (CIAA) does not follow a defined protocol such as the one adopted for the management of abdominal aortic aneurysms. This study explores CIAA growth rate, and seeks to determine correlations with related parameters which may serve to influence aneurysm expansion with the view of devising an effective local surveillance protocol. METHODS Vascular laboratories across the UK were invited to participate in an online survey. Questions were designed to assess current clinical practice in regards to the surveillance of patients with CIAA. Additionally, a retrospective audit was performed using the clinical reports of patients attending a regional vascular laboratory to undergo an aorto-iliac duplex scan (USS). Expansion rate of aneurysms was studied in patients who had ≥2 USS scans; data was recorded at 6 and/or 12 monthly intervals up to 5 years. Kaplan Meier estimates of patient mortality (all cause) and intervention rate during the surveillance period were performed. Patient age, initial CIAA diameter, bilateral/unilateral CIAA and coinciding aortic aneurysm diameter were recorded to determine if these specific features were associated with CIAA growth rates. Pearson's correlation coefficient was used to determine the strength of association between variables. RESULTS Nine hundred and ninety-five of one thousand and sixty patient records were suitable for review: 21.6% (215/995) of patients had a CIAA. Isolated CIAA accounted for 23% (50/215). Mean CIAA growth was 1.5 ± 0.3 mm/year. A strong correlation was found between CIAA diameter versus time from diagnosis (r = 0.820; P = 0.004); CIAA with smaller initial diameters (15-20 mm) expanded more rapidly than those of larger diameter at diagnosis (r = 0.871; P = 0.005). CIAA measured at >30 mm demonstrated an unpredictable growth trajectory which was also evident in those CIAA coinciding with larger AAA (>50 mm; r = 0.208; P = 0.655). CONCLUSIONS The results obtained in this study may form the basis for a dedicated CIAA surveillance protocol.
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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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Jiber H, Naouli H, Bouarhroum A. Urinary retention revealing a large common iliac artery aneurysm. JOURNAL DE MÉDECINE VASCULAIRE 2019; 44:86-89. [PMID: 30770087 DOI: 10.1016/j.jdmv.2018.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/02/2018] [Indexed: 11/19/2022]
Abstract
Isolated aneurysms of the common iliac artery are rare, affecting less than 0.01% of the general adult population. Most of these aneurysms are asymptomatic and are discovered as an incidental finding. We describe an elderly patient presented with a urinary retention, which the investigations had led to the diagnosis of a large left common iliac artery aneurysm.
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Affiliation(s)
- H Jiber
- Vascular surgery department, faculty of medicine and pharmacy of Fez, Sidi Mohamed Ben Abdellah university, UHC Hassan II, Fez, Morocco
| | - H Naouli
- Vascular surgery department, faculty of medicine and pharmacy of Fez, Sidi Mohamed Ben Abdellah university, UHC Hassan II, Fez, Morocco.
| | - A Bouarhroum
- Vascular surgery department, faculty of medicine and pharmacy of Fez, Sidi Mohamed Ben Abdellah university, UHC Hassan II, Fez, Morocco
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Anton S, Wiedner M, Stahlberg E, Jacob F, Barkhausen J, Goltz JP. Initial Experience with the E-liac ® Iliac Branch Device for the Endovascular Aortic Repair of Aorto-iliac Aneurysm. Cardiovasc Intervent Radiol 2018; 41:683-691. [PMID: 29299625 DOI: 10.1007/s00270-017-1868-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/14/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Occlusion of internal iliac arteries during endovascular treatment (EVAR) of abdominal aortic (AAA) and common iliac artery aneurysms might be associated with ischemic pelvic complications. This study evaluates technical and clinical success, safety and mid-term results of a novel iliac branch device (IBD) for revascularization of the internal iliac artery (IIA) during EVAR. MATERIALS AND METHODS Retrospectively, we identified 21 men (mean age 73.3 ± 6.2 years) treated for aorto-iliac aneurysms by use of a novel IBD (E-liac®, Jotec Hechingen, Germany). We analyzed safety (30-day survival), technical (no type I and III endoleaks, "EL"), clinical (no ischemic complications) success, mid-term patency of this IBD, peri-procedural complications, occurrence of type II ELs, rate of re-interventions and additional treatment of the revascularized IIA for landing zone preparation. RESULTS Twenty-three IBDs were implanted. Aneurysms of the ipsilateral IIA were present in 6/23 IIAs (26.1%). Super-selective branch embolization was performed in these patients and the landing zone for the iliac sidebranch stent-graft was within the superior gluteal artery. Mean follow-up was 341 days (range 4-1103 days). Technical success and 30-day survival were 100%. Clinical success was 95.2%. Primary patency of the IBDs was 100% at 12 months. Peri-procedural complications occurred in 3/21 patients (14.3%), none of them related to the IBD. AAA-related type II ELs were found in 6 patients (28.6%), IBD-related ELs in 4/23 IBDs (17.4%) (two type Ib, two type II endoleaks). Overall re-intervention rate was 23.8%, IBD-related 8.7%. CONCLUSION Utilization of the E-liac® IBD is safe and effective for the treatment of aorto-iliac aneurysms.
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Affiliation(s)
- Susanne Anton
- Clinic for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
| | - Marcus Wiedner
- Clinic for Surgery, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Erik Stahlberg
- Clinic for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Fabian Jacob
- Clinic for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Jörg Barkhausen
- Clinic for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Jan Peter Goltz
- Clinic for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
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Jmal H, Ben Jmaà H, Masmoudi S, Cherif T, Cheikhrouhou H, Maalej A, Elleuch N, Jemel A, Frikha I. [Management of isolated iliac aneurysms: A Tunisian center experience]. JOURNAL DE MÉDECINE VASCULAIRE 2017; 42:349-357. [PMID: 29203041 DOI: 10.1016/j.jdmv.2017.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 06/27/2017] [Indexed: 11/17/2022]
Abstract
Isolated aneurysms of the iliac arteries are rare. The diagnoses of these aneurysms become easier with non-invasive radiologic investigations. The development of endovascular treatment is a recent alternative to surgical treatment. We report our experience in the management of 8 cases of isolated iliac aneurysms in the department of cardiovascular and thoracic surgery of the Habib Bourguiba Hospital of Sfax.
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Affiliation(s)
- H Jmal
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib-Bourguiba, avenue Mmajida-Boulila, 3029 Sfax, Tunisie
| | - H Ben Jmaà
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib-Bourguiba, avenue Mmajida-Boulila, 3029 Sfax, Tunisie.
| | - S Masmoudi
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib-Bourguiba, avenue Mmajida-Boulila, 3029 Sfax, Tunisie
| | - T Cherif
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib-Bourguiba, avenue Mmajida-Boulila, 3029 Sfax, Tunisie
| | - H Cheikhrouhou
- Service d'anesthésie-réanimation, hôpital Habib-Bourguiba, 3029 Sfax, Tunisie
| | - A Maalej
- Service de radiologie, hôpital Habib-Bourguiba, 3029 Sfax, Tunisie
| | - N Elleuch
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib-Bourguiba, avenue Mmajida-Boulila, 3029 Sfax, Tunisie
| | - A Jemel
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib-Bourguiba, avenue Mmajida-Boulila, 3029 Sfax, Tunisie
| | - I Frikha
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib-Bourguiba, avenue Mmajida-Boulila, 3029 Sfax, Tunisie
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Ardita V, Giaquinta A, Veroux M, Sanfiorenzo A, Virgilio C, D’Arrigo G, Veroux P. Endovascular repair of bilateral common iliac artery aneurysms using GORE Excluder iliac branch endoprosthesis without aortobi-iliac stent graft conjunction: A case report. Medicine (Baltimore) 2017; 96:e5977. [PMID: 28207510 PMCID: PMC5319499 DOI: 10.1097/md.0000000000005977] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Bilateral common iliac artery (CIA) aneurysm (CIAA) is a rare entity. In the past decade, different endovascular approaches have been adopted for patients with several comorbidities or unfit for open repair (OR). Recently, the use of iliac branch stent graft has been proposed, resulting in satisfactory patency rates and decrease in morbidity. Currently, according to instruction for use, the iliac branch stent graft is to be used with aortobi-iliac stent graft conjunction. We describe a case of a successful endovascular repair of bilateral CIAAs using the GORE Excluder iliac branch endoprosthesis (IBEs) without aortobi-iliac stent graft conjunction. CASE PRESENTATION An 83-year-old man was admitted with abdominal pain and presence of pulsatile mass in the right and left iliac fossa. Computed tomographic (CT) angiography showed the presence of large bilateral CIAAs (right CIA = 66 mm; left CIA = 38 mm), without concomitant thoracic or abdominal aorta aneurysm. Moreover, CT scan demonstrated the presence of bilateral lower accessory renal artery close to the aortic bifurcation. Due to the high operative risk, the patient was scheduled for endovascular repair with bilateral IBEs, without the aortobi-iliac stent graft conjunction to avoid the renal ischemia as a consequence of renal arteries covering. The procedure was completed without complications and duplex ultrasound demonstrated the complete exclusion of both aneurysms without any type of endoleaks at 1 month of follow-up. CONCLUSIONS GORE IBEs without aortobi-iliac stent graft conjunction seem to be a feasible and effective procedure for the treatment of isolated CIAAs in patients with highly selected anatomical conditions.
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Affiliation(s)
- Vincenzo Ardita
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Via Santa Sofia, Catania
- Vascular Surgery Unit, Guzzardi Hospital of Vittoria, Via Papa Giovanni XXIII, Vittoria
| | - Alessia Giaquinta
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Via Santa Sofia, Catania
| | - Massimiliano Veroux
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Via Santa Sofia, Catania
- Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Via Santa Sofia, Catania
| | - Angelo Sanfiorenzo
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Via Santa Sofia, Catania
| | - Carla Virgilio
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Via Santa Sofia, Catania
| | - Giuseppe D’Arrigo
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Via Santa Sofia, Catania
| | - Pierfrancesco Veroux
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Via Santa Sofia, Catania
- Department of Surgical Specialties, University Hospital of Catania, Via Santa Sofia, Catania, Italy
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17
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Song YG, Jang H, Park HO, Moon SH, Kim JW, Kim SH, Yang JH, Byun JH. Inferior Mesentery Artery and Internal Iliac Artery Preservation with Covered Self-Expanding Stents during Endovascular Aneurysm Repair. Vasc Specialist Int 2017; 32:190-194. [PMID: 28042560 PMCID: PMC5198767 DOI: 10.5758/vsi.2016.32.4.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/07/2016] [Accepted: 12/02/2016] [Indexed: 11/20/2022] Open
Abstract
We report an endovascular aneurysm repair in a patient with isolated bilateral common iliac artery aneurysms, a prominent inferior mesentery artery (IMA), and bilateral proximal internal iliac artery (IIA) aneurysms using covered self-expanding stents to preserve the IMA and bilateral internal iliac arteries. A follow-up computed tomography angiography was obtained at 1 month. Pelvic circulation was well preserved without bowel ischemia. IMA and bilateral IIA preservation with covered self-expanding stents during endovascular aneurysm repair is a safe and effective method.
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Affiliation(s)
- Yun Gyu Song
- Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Jinju, Korea
| | - Hong Jang
- Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Jinju, Korea
| | - Hyun Oh Park
- Department of Thoracic and Cardiovascular Surgery, College of Medicine and Institute of Health Sciences, Gyeongsang National University Changwon Hospital, Changwon, Jinju, Korea
| | - Seong Ho Moon
- Department of Thoracic and Cardiovascular Surgery, College of Medicine and Institute of Health Sciences, Gyeongsang National University Changwon Hospital, Changwon, Jinju, Korea
| | - Jong Woo Kim
- Department of Thoracic and Cardiovascular Surgery, College of Medicine and Institute of Health Sciences, Gyeongsang National University Changwon Hospital, Changwon, Jinju, Korea
| | - Sung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, College of Medicine and Institute of Health Sciences, Gyeongsang National University Changwon Hospital, Changwon, Jinju, Korea
| | - Jun Ho Yang
- Department of Thoracic and Cardiovascular Surgery, College of Medicine and Institute of Health Sciences, Gyeongsang National University Hospital, Jinju, Korea
| | - Joung Hun Byun
- Department of Thoracic and Cardiovascular Surgery, College of Medicine and Institute of Health Sciences, Gyeongsang National University Changwon Hospital, Changwon, Jinju, Korea
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18
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Dube B, Ünlü Ç, de Vries JPPM. Fate of Enlarged Iliac Arteries After Endovascular or Open Abdominal Aortic Aneurysm Repair. J Endovasc Ther 2016; 23:803-8. [DOI: 10.1177/1526602816661832] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To examine the fate of untreated ectatic and aneurysmal common iliac arteries (CIAs) after open treatment and endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA). Methods: Databases of scientific literature were searched between January 1980 and February 2016 to identify publications on the follow-up of ectatic and aneurysmal CIAs after open or endovascular AAA repair. The primary outcome measure was the increase of iliac artery diameter during follow-up. The secondary outcome was the subsequent reintervention rate during follow-up. Results: Only 3 open AAA and 3 EVAR studies containing 1239 patients met the inclusion criteria for analysis. In the open AAA group, ectatic iliac arteries (defined as 12–18 mm) had a diameter progression of 1.7 to 1.8 mm during a follow-up period of 51.6 to 85.2 months. The aneurysmal iliac arteries (>18 mm) in the open repair group showed a faster growth (2.3–3.0 mm) in a follow-up period of 50.4 to 85.2 months. The pooled assessment of arteries ≥18 mm had a mean growth of 2.56 mm at 60 months of follow-up. In the entire open AAA cohort, the reintervention rate for CIA transformation was <1%. In the EVAR studies, arbitrary cutoff sizes of 16 to 20 mm for ectatic arteries and >20 mm for aneurysmal arteries were used. During a follow-up of 39.2 to 60 months, the diameter progression was 1.5 mm for the 16-mm iliac arteries and 2.7 mm for the 20-mm iliac arteries. The need for endovascular reinterventions was similar in patients with previously normal or enlarged CIAs. Conclusion: After open AAA repair, the overall size of CIA aneurysms grows slowly, but enlarged CIAs >20 mm in EVAR patients show faster growth during follow-up. However, the need for secondary interventions was similar in patients with normal or enlarged CIAs post EVAR.
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Affiliation(s)
- Bhekifa Dube
- Department of Vascular Surgery, Tertiary Livingstone Hospital, Port Elizabeth, South Africa
| | - Çağdaş Ünlü
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
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19
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Very Big Trouble: Giant Infected Internal Iliac Artery Pseudoaneurysm. Am J Med 2016; 129:583-5. [PMID: 26724588 DOI: 10.1016/j.amjmed.2015.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 12/07/2015] [Accepted: 12/07/2015] [Indexed: 11/21/2022]
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20
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Millon A, Della Schiava N, Arsicot M, De Lambert A, Feugier P, Magne JL, Lermusiaux P. Preliminary Experience with the GORE® EXCLUDER® Iliac Branch Endoprosthesis for Common Iliac Aneurysm Endovascular Treatment. Ann Vasc Surg 2016; 33:11-7. [DOI: 10.1016/j.avsg.2015.12.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/10/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
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21
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George G. Management of a Common Iliac Artery Aneurysm Causing Contralateral Iliac Venous Thrombosis. ACTA ACUST UNITED AC 2015. [DOI: 10.17352/2455-5452.000004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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22
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Perigraft Plug Embolization of the Internal Iliac Artery and Implantation of a Bifurcated Stentgraft: One Treatment Option for Insufficient Tubular Stentgraft Repair of a Common Iliac Artery Aneurysm. Cardiovasc Intervent Radiol 2015; 39:304-8. [PMID: 26122740 DOI: 10.1007/s00270-015-1161-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 06/03/2015] [Indexed: 10/23/2022]
Abstract
We report an endovascular technique for the treatment of type Ia endoleak after a plain tubular stentgraft had been implanted for a large common iliac artery aneurysm with an insufficient proximal landing zone and without occlusion of the hypogastric in another hospital. CT follow-up showed an endoleak with continuous sac expansion over 12 months. This was classified as type Ia by means of dynamic contrast-enhanced MRI. Before a bifurcated stentgraft was implanted to relocate the landing zone more proximally, the still perfused ipsilateral hypogastric artery was embolized to prevent a type II endoleak. A guidewire was manipulated alongside the indwelling stentgraft. The internal iliac artery could then be selectively intubated followed by successful plug embolization of the vessel's orifice despite the stentgraft being in place.
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23
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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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Park JK, Lee M, So A, Lee HY. Isolated Common Iliac Aneurysm and Spontaneous Ilioiliac Arteriovenous Fistula in a Patient with Subsequent Type II Endoleak and Successful Endovascular Management. J Vasc Interv Radiol 2015; 26:757-60. [PMID: 25921458 DOI: 10.1016/j.jvir.2015.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 01/04/2015] [Accepted: 01/04/2015] [Indexed: 11/19/2022] Open
Affiliation(s)
- Jonathan K Park
- Division of Interventional Radiology, Department of Radiological Sciences, Ronald Reagan University of California, Los Angeles (UCLA), Medical Center, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA 90095
| | - Margaret Lee
- Department of Radiology, Olive View-UCLA Medical Center, Sylmar, California
| | - Alexandra So
- Imaging Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Hsin-Yi Lee
- Imaging Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
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25
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Zhang T, Guo W, Ma X, Jia X, Liu X, Dong Y, Xiong J, Jia S. Novel-Designed Iliac Branch Stent Graft for Internal Iliac Artery Reconstruction during Aneurysm Repair. Ann Vasc Surg 2015; 29:189-96. [DOI: 10.1016/j.avsg.2014.07.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 07/13/2014] [Accepted: 07/17/2014] [Indexed: 10/24/2022]
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26
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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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27
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Alonso-Argüeso G, Martinez-Mira C, Fernández-Samos Gutierrez R, Sanz-Pastor N, Ortega-Martín J, Vaquero-Morillo F. Reparación endovascular de aneurismas iliacos aislados. Nuestra experiencia en los últimos 10 años. ANGIOLOGIA 2014. [DOI: 10.1016/j.angio.2013.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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28
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Peters A, Bischoff M, Meisenbacher K, Böckler D. Management isolierter Iliakalaneurysmen. GEFÄSSCHIRURGIE 2013. [DOI: 10.1007/s00772-013-1169-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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29
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Gal-Oz A, Wolf YG, Rosen G, Sharon H, Schwartz IF, Chernin G. When the chimney is blocked: malignant renovascular hypertension after endovascular repair of abdominal aortic aneurysm. BMC Nephrol 2013; 14:71. [PMID: 23531087 PMCID: PMC3637609 DOI: 10.1186/1471-2369-14-71] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 03/12/2013] [Indexed: 11/21/2022] Open
Abstract
Background The Chimney graft (CG) procedure is one of the novel modification techniques of the endovascular aneurysm repair (EVAR) surgery to treat suprarenal and juxtarenal abdominal aortic aneurysms. Other indications for the use of CG placement include thoracic and thoracoabdominal aneurysms with supraortic branches orifice involvement and cases of common iliac artery aneurysms with or without internal iliac artery involvement. The technique is used in patients who due to aortic-neck morphology and lack of adequate fixation and/or sealing zones are not eligible for standard EVAR. In this procedure, a parallel stent-graft is placed adjacent to the main body of the aortic endograft to maintain blood supply to renovisceral or supraortic branches, once the body of the aortic stent-graft is deployed. Symptomatic occlusions of the CG with novel renovascular hypertension were not described until now. Case presentation A-64-year-old male patient, presented with new-onset malignant hypertension, 13 months after an EVAR operation with CG placement to the left renal artery. The patient was on preventive clopidrogel therapy, which was withheld temporarily for several days, one month before presentation. Imaging studies revealed a novel form of iatrogenic renovascular hypertension, caused by occlusion of the CG. Any attempt to recanalize the covered stent or revascularize the left kidney was rejected and conservative treatment was chosen. Seven months after presentation, blood pressure was within normal ranges with little need for antihypertensive therapy. Conclusions Physicians should be aware that the novel emerging techniques of EVAR to overcome the limitations of the aortic-neck anatomy may still adversely influence the renal outcome with potential development of new-onset hypertension.
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Baird DLH, Mani K, Sabharwal T, Taylor PR, Zayed HA. Endovascular treatment of isolated iliac artery aneurysms using a custom-made stent graft with proximal barb fixation: early outcome. Vascular 2013; 21:92-6. [DOI: 10.1177/1708538113478720] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Current endovascular treatments for isolated iliac artery aneurysms (IIAAs) include the use of aortoiliac stent grafts with coverage of the distal aorta or stent grafts confined to the iliac artery without active proximal fixation. We report our experience in the use of custom-made Cook Zenith™ iliac limb stent grafts with proximal barb fixation. Patients treated from July 2009 to February 2011 were included. All imaging and patient records were assessed for perioperative and early outcomes. Nine IIAAs (seven patients) were treated. The mean patient age was 80 years (range 58-91 years). The mean aneurysm size was 48 mm (35-80 mm), and the mean length of the proximal landing zone (PLZ) was 29 mm (10-50 mm). The distal landing zone was in the external iliac artery after coil embolization of the internal iliac artery. The Mean diameter of the PLZ was 21 mm (20-24 mm). Technical success was achieved in eight cases. Perioperative complications included reoperation in one patient for groin bleeding and ischemia. On follow-up (mean 12 months, range 1-26), all aneurysms were successfully excluded from the circulation and there was no stent graft migration or thrombosis. Use of custom-made stent grafts with proximal barb fixation in treatment of IIAAs is a feasible option which may reduce the risk of migration when compared with stent grafts with lack of proximal fixation.
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Affiliation(s)
- D L H Baird
- Department of Vascular Surgery, Guy's and St Thomas’ Hospital, London SE1 7EH, UK
| | - K Mani
- Department of Vascular Surgery, Guy's and St Thomas’ Hospital, London SE1 7EH, UK
- Department of Surgical Sciences, Uppsala University, SE-75185, Uppsala, Sweden
| | - T Sabharwal
- Department of Interventional Radiology, Guy's and St Thomas’ Hospital, London SE1 7EH, UK
| | - P R Taylor
- Department of Vascular Surgery, Guy's and St Thomas’ Hospital, London SE1 7EH, UK
| | - H A Zayed
- Department of Vascular Surgery, Guy's and St Thomas’ Hospital, London SE1 7EH, UK
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