Staged Endovascular Repair of Bilateral Internal Iliac Artery Aneurysms

Staged Endovascular Repair of Isolated Bilateral Internal Iliac Artery Aneurysms: A Case Report

This report aims to present an unusual case with isolated bilaterally located internal iliac artery aneurysms (IIAAs) that were incidentally detected. Owing to the high surgical risk of the patient and anatomical location of the aneurysms, an endovascular management was preferred. Initially, the patient underwent a percutaneous embolization of the right-sided aneurysm with coiling. A stent-graft deployment covering the orifice of the left-sided internal iliac artery and occluding the ipsilateral aneurysm followed 1 month later. The patient remains asymptomatic after 6 months. Endovascular management has been associated with lower morbidity and hospital stay compared with open repair for IIAAs, although both techniques show satisfying early and mid-term results. Especially for bilaterally located aneurysms, a staged strategy decreases the risk for ischemic complications. Finally, endovascular methods should be preferred when there are no compression symptoms or in cases of higher surgical risk.

U Stent-Graft Technique as a Treatment for Homolateral Metachronous Common Iliac and Internal Iliac Arteries Aneurysms after Open Surgery

We report a case of a metachronous common iliac artery and the internal iliac artery (IIA) aneurysm developed 8 years after an aortobi-femoral bypass for treatment of abdominal aortic aneurysm associated at chronic occlusion of the right iliac axis. To exclude the metachronous aneurysm on the left iliac axis and to maintain the pelvic circulation, an external to IIA endografts were positioned ("U stent-graft technique"). At 6-month follow-up, the computed tomography scan showed patency of the endografts, of the bypass and of the IIA, without endoleak, or other adverse events.

Preservation of pelvic circulation in one-stage endovascular repair of bilateral hypogastric artery aneurysms

Bilateral hypogastric artery aneurysms (HAAs) are relatively rare conditions that pose increased management difficulties. We report a case of one-stage endovascular repair of bilateral HAAs preserving pelvic circulation. A 67-year-old asymptomatic man with bilateral HAAs (4-cm right and 3.9-cm left) was successfully treated with an endovascular approach. The aneurysmal sac of the right hypogastric artery (HA) was embolized first and 2 covered stent grafts were deployed into the HA. Coil embolization of the left HAA was then performed followed by deployment of a covered stent graft to the common and external iliac arteries. Final angiography revealed complete exclusion of the aneurysms without endoleaks and with preservation of the pelvic flow. At the 18-month follow-up, the patient remained asymptomatic with good patency of the stent grafts. This case demonstrates an alternative endovascular approach for the treatment of bilateral HAAs that minimizes the risk of ischemic complications by preserving pelvic circulation.

Endovascular treatment of isolated internal iliac artery aneurysms

The aim of the paper is to evaluate the outcome of endovascular treatments for isolated internal iliac artery aneurysms. A systematic review of the literature using public domain databases was undertaken. All studies reporting on endovascular treatment of isolated hypogastric artery aneurysms were considered. Experience from our institution was involved in the data analysis. The primary outcome measures were technical success, perioperative, and overall mortality and morbidity. Data were extracted from 30 articles fulfilling the selection criteria, and the study cohort consisted of 55 patients having undergone treatment of 59 internal iliac artery aneurysms. Ten patients (18%) were treated on an urgent or emergency basis for a ruptured aneurysm. Technical success was achieved in 71% of the cases. The most common reason for technical failure was incomplete exclusion of the aneurysm sac. Thirty-day mortality occurred in one patient (2%). The 30-day morbidity rate was 20%, and was mostly associated with insufficiency of the pelvic circulation. One aneurysm-related death occurred during a mean follow-up period of 13 months (range 0.5–56 months). Open surgical intervention for aneurysm-related complications was required in five patients. In conclusion, endovascular treatment of isolated internal iliac artery aneurysms is an effective alternative option, with satisfactory early and mid-term results.

The management of large bilateral internal iliac artery aneurysms using the T-Stat Colon Oximeter

Internal iliac artery (IIA) aneurysms are rare and the repair of these aneurysms is associated with high risk of morbidity and mortality. Bilateral IIA aneurysms add an increased concern for ischemic complications. A case is presented where the use of a Food and Drug Administration-approved device, the T-Stat Colon Oximeter, allowed additional information for the safe and successful hybrid exclusion of bilateral large IIA aneurysms. A staged approach with the use of Amplatzer plugs, Powerlink device, Zenith iliac plug, and a femoral-femoral bypass allowed successful exclusion of the IIA aneurysms. The immediate and 18-month follow-up of the IIA aneurysms are reported.