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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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Zhou G, Ma H, Liu J, Sun X, Liu Y, Luan J, Li Y, Guo M. Quadruple fenestration aortic stent implantation combined with unilateral IBE and internal iliac artery stent implantation for complex abdominal aortic aneurysm: one case report. Front Cardiovasc Med 2023; 10:1276064. [PMID: 37881725 PMCID: PMC10595028 DOI: 10.3389/fcvm.2023.1276064] [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: 08/11/2023] [Accepted: 09/27/2023] [Indexed: 10/27/2023] Open
Abstract
An abdominal aortic aneurysm is a frequently encountered clinical condition, which necessitates prompt and effective remediation to avoid rupture. Surgeons must meticulously select an appropriate method of repair and assess the long-term surgical prognosis when dealing with patients with complex abdominal aortic aneurysms. In this case report, a 74-year-old man was hospitalized due to acute abdominal pain. Upon further examination, it was discovered that he was suffering from a complex abdominal aortic aneurysm. The thoracoabdominal aorta CTA showed that the aneurysm involved both renal arteries, the part below the kidney was severely twisted, the neck of the aneurysm was short, and it was accompanied by bilateral common iliac and internal iliac aneurysms, and there were considerable thrombus attached to the vessel wall. In this case, our team used 3D technology to simulate the spatial structure of the aneurysm and comprehensively evaluate the patient's condition. Ultimately, we decided to perform a quadruple fenestration aortic stent implantation and endovascular repair of aortic aneurysm, combined with right IBE and internal iliac artery stent implantation, right internal iliac artery reconstruction, and left internal iliac artery aneurysm embolization on this patient. This is an innovative surgical method. The operation was successful and the patient recovered well after the operation.
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Affiliation(s)
| | | | | | | | | | | | - Yongxin Li
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Mingjin Guo
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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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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Gu YT, Kuo TT, Chen PL, Huang CY, Shih CC, Chen IM. Internal iliac artery preservation outcomes of endovascular aortic repair for common iliac aneurysm: iliac branch device versus crossover chimney technique. Heart Vessels 2020; 36:235-241. [PMID: 32767084 DOI: 10.1007/s00380-020-01678-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/31/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare the outcomes of using iliac branch devices (IBD) and the crossover chimney (COCh) technique for preserving the internal iliac artery (IIA) during endovascular aortic repair in patients with common iliac aneurysm (CIA). METHODS From February 2010 to July 2016, we recruited 61 consecutive and elective patients. Thirty of them received the IBD, and the remaining 31 received the COCh. Their medical chart was reviewed retrospectively, and computed tomographic angiography was performed at 3, 6, and 12 months postoperatively and then yearly as a follow-up. RESULTS The median follow-up time was 19.72 ± 5.45 months. The technical success rate reached 100% in both groups. The 12-month and 24-month primary IIA patency rates between IBD and COCh group were 90.00% versus 93.54% (p = 0.67) and 83.33% versus 93.54% (p = 0.25). The numbers of stents were 1.00 ± 0.00 and 1.93 ± 0.24 in the IBD and COCh group (p < 0.001). No significant difference was observed for the incidence of type 1a (IBD/COCh = 3.33%/6.45%, p > 0.99) and type 2 endoleak (IBD/COCh = 13.33%/12.90%, p > 0.99) between two groups. Neither type 1b or type 3 endoleak nor delayed aortic rupture appeared in our series. The postoperative complication rates did not exhibit significant differences either. Free from reintervention was also similar in both groups (IBD/COCh = 22.50 ± 4.62/23.00 ± 3.87 months, p = 0.64). CONCLUSIONS The IBD and COCh techniques exhibited similar success rates and IIA patency rates at the 24-month follow-up. Both these techniques are feasible for the preservation of IIA in patients with CIA.
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Affiliation(s)
- Ya-Ting Gu
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City, Taiwan.,Department of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Tzu-Ting Kuo
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City, Taiwan.,Department of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Po-Lin Chen
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City, Taiwan.,Department of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Chun-Yang Huang
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City, Taiwan.,Department of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Chun-Che Shih
- 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, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City, Taiwan. .,Department of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan.
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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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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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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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The JOTEC iliac branch device for exclusion of hypogastric artery aneurysms: ABRAHAM study. J Vasc Surg 2019; 70:748-755. [DOI: 10.1016/j.jvs.2018.10.124] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 10/28/2018] [Indexed: 11/21/2022]
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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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Donas KP, Taneva GT, Pitoulias GA, Torsello G, Veith FJ, Austermann M, Inchingolo M, Bisdas T, Pratesi G, Barbante M, Cao P, Ferrer C, Verzini F, Parlani G, Simonte G, Pratesi C, Fargion A, Masciello F, Kölbel T, Tsilimparis N, Haulon S, Branzan D, Schmidt A, Scheinert D. Coexisting hypogastric aneurysms worsen the outcomes of endovascular treatment by the iliac branch devices within the pELVIS Registry. J Vasc Surg 2019; 69:1072-1079.e1. [DOI: 10.1016/j.jvs.2018.07.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 07/05/2018] [Indexed: 11/27/2022]
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Kayssi A, Neville RF. Hypogastric Preservation During Treatment of Aortoiliac Aneurysms. Tech Vasc Interv Radiol 2018; 21:175-180. [PMID: 30497552 DOI: 10.1053/j.tvir.2018.06.007] [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: 11/11/2022]
Abstract
The advent of endovascular technology for treating aortoiliac aneurysms has sometimes necessitated the occlusion of the hypogastric artery to prevent an endoleak or to achieve an adequate distal seal, resulting in significant morbidity for some patients. The use of iliac branch devices, in conjunction with aortic stent grafts, has made it possible to preserve the hypogastric arteries in select patients with suitable anatomy. The purpose of this review will be to discuss the indications for hypogastric preservation during treatment of aortoiliac aneurysms, as well as highlight the key procedural steps and potential technical challenges encountered during this procedure.
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Affiliation(s)
- Ahmed Kayssi
- Division of Vascular Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON
| | - Richard F Neville
- INOVA Heart and Vascular Institute, INOVA Health system, Fairfax, VA.
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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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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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Prospective, multicenter study of endovascular repair of aortoiliac and iliac aneurysms using the Gore Iliac Branch Endoprosthesis. J Vasc Surg 2017; 66:775-785. [DOI: 10.1016/j.jvs.2017.02.041] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/10/2017] [Indexed: 11/23/2022]
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Naji F, Srivatsav V, Qadura M, Harlock J, Andrinopoulos T, Iyer V, Rapanos T. Evaluating the Effectiveness of Internal Iliac Artery Branched Endovascular Stent Grafts. Ann Vasc Surg 2017; 45:247-252. [PMID: 28689946 DOI: 10.1016/j.avsg.2017.06.126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/14/2017] [Accepted: 06/16/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of this study is to describe our institutional experience using iliac branch grafts (IBGs) in aortoiliac aneurysm repair. METHODS From October 2009 to April 2016, 41 consecutive patients (all men), mean age 71.7 years (range 55-87), underwent IBG implantation. Abdominal aortic aneurysm with common iliac artery involvement (n = 21) or bilateral common iliac artery aneurysms (n = 20) were indications. Computed tomography was used to evaluate patency and postoperative endoleaks within 1 month of implantation and after 1 year. RESULTS A total of 42 IBGs were deployed in 41 patients successfully. One hundred percent of grafts implanted were patent at 1 month and at annual follow-up. There was 1 mortality at 30 days, due to acute renal failure. Sixteen type II and 1 type Ib endoleaks were found, for which 3 reinterventions were performed and the remainder treated conservatively. Five patients had complications which required reintervention. CONCLUSIONS IBG placement has excellent short-term outcomes and potential to limit buttock claudication in the treatment of abdominal aortic aneurysms involving the iliac arteries.
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Affiliation(s)
- Faysal Naji
- Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
| | - Varun Srivatsav
- Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Mohammed Qadura
- Division of Vascular Surgery, Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - John Harlock
- Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Tara Andrinopoulos
- Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Vikram Iyer
- Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Theodore Rapanos
- Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
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Simonte G, Parlani G, Farchioni L, Isernia G, Cieri E, Lenti M, Cao P, Verzini F. Lesson Learned with the Use of Iliac Branch Devices: Single Centre 10 Year Experience in 157 Consecutive Procedures. Eur J Vasc Endovasc Surg 2017; 54:95-103. [DOI: 10.1016/j.ejvs.2017.03.026] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 03/31/2017] [Indexed: 01/29/2023]
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Yugueros X, Mestres G, Pasquadibisceglie S, Alomar X, Apodaka A, Riambau V. Parallel-Stenting Technique in a Sandwich Configuration for Hypogastric Artery Preservation during Endovascular Aneurysm Repair: An In Vitro Study. Ann Vasc Surg 2017; 44:221-228. [PMID: 28483625 DOI: 10.1016/j.avsg.2017.03.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 03/30/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of the study was to identify the best conditions in iliac sandwich procedure for hypogastric artery preservation during endovascular aneurysm repair, testing different devices, different oversizing (OS) degrees as well as different methods to measure it. METHODS Four external iliac devices (16-mm Endurant and 12-mm Aorfix limb extensions; 11- and 13-mm Viabahn endografts) were tested with 2 distinct internal iliac stent grafts (8-mm Advanta V12 and 8-mm Viabahn) inside different proximal silicon iliac limb models (10, 12, 14, 16, and 18 mm), simulating an iliac sandwich procedure for hypogastric preservation. After remodeling all devices in a saline bath at 37°C, the combinations were computed tomography scanned. Gutter size, parallel-stent compression, and inadequate parallel-stent deployment or infolding were recorded. Oversizing between both parallel stents and the iliac limb models were examined in terms of added diameter, perimeter, and area being additionally compared. RESULTS All three sizing methods (diameter, perimeter, and area) were highly correlated (diameter OS to perimeter and area OS correlation coefficient 0.998 and 0.997, respectively, P < 0.001 for both); thus, diameter OS was used for further comparisons. Increasing diameter OS (< 30%, 30-55%, 55-75%, and > 75%) showed a significant tendency toward smaller gutters (38.9, 12.2, 5.4, and 2.6 mm2, respectively, P < 0.001) but also increasing parallel-stent compression (13.5%, 28.9%, 43.9%, and 55.1%, P < 0.001) and infolding (0%, 0%, 38%, and 60%, P < 0.001). There were no significant differences between the analyzed devices. CONCLUSIONS In iliac sandwich procedures, better apposition is usually achieved when using 30-55% diameter OS; higher OS is related to smaller gutters but higher rates of malpositioning and parallel-stent compression. No clear recommendations in material selection can be performed. All sizing methods are highly correlated and predictable.
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Affiliation(s)
- Xavier Yugueros
- Vascular Surgery Division, Cardiovascular Institute, Hospital Clinic, Barcelona, Spain.
| | - Gaspar Mestres
- Vascular Surgery Division, Cardiovascular Institute, Hospital Clinic, Barcelona, Spain
| | | | - Xavier Alomar
- Department of Radiology, Clínica Creu Blanca, Barcelona, Spain
| | - Ana Apodaka
- Vascular Surgery Division, Cardiovascular Institute, Hospital Clinic, Barcelona, Spain
| | - Vincent Riambau
- Vascular Surgery Division, Cardiovascular Institute, Hospital Clinic, Barcelona, Spain
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Delay C, Deglise S, Lejay A, Georg Y, Roussin M, Schaeffer M, Saucy F, Thaveau F, Corpataux JM, Chakfe N. Zenith Bifurcated Iliac Side Branch Device: Mid-term Results and Assessment of Risk Factors for Intraoperative Thrombosis. Ann Vasc Surg 2017; 41:141-150. [PMID: 28238918 DOI: 10.1016/j.avsg.2016.08.048] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/03/2016] [Accepted: 08/23/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study is to evaluate the short- and mid-term results of the Zenith bifurcated iliac side branch device (ZBIS) in the treatment of common iliac artery (CIA) aneurysms, and to assess risk factors for intraoperative internal iliac artery (IIA) thrombosis. METHODS All patients who underwent endovascular treatment of either an isolated CIA aneurysm or an aortoiliac aneurysm using the ZBIS device in the departments of vascular surgery of Strasbourg (France) and Lausanne (Switzerland) between January 2010 and December 2014 were retrospectively collected. RESULTS Thirty-one implantations were performed: 30 patients underwent 31 endovascular CIA aneurysm treatments with the ZBIS device. Mean operative time was 188 min. Technical success was obtained in 26 implantations (84%). In 5 implantations (16%), the final angiogram revealed an IIA thrombosis. Thirty-day mortality was 3.2%. Thirty-day morbidity was 13.3%. Mean follow-up was 15 months. Overall survival was 96% at 1 year and 89% at 2 years. In intention-to-treat analysis, primary patency of the internal iliac side branch was 84% at 1 year and 76% at 2 years (5 peroperative IIA occlusions and 1 late occlusion). Freedom from reintervention was 89% at 1 and 2 years. One case of type III endoleak and 2 cases of type II endoleaks were identified. Only type III endoleak required an additional intervention with a covered stent. Aneurysm diameter decreased in 15 implantations (48%) and remained stable in 16 implantations (52%). Clinical, radiological, and peroperative parameters were analyzed to identify risk factor for intraoperative thrombosis of the internal iliac side branch. Notion of intraoperative difficulties (any additional procedure that was not initially planned and increasing the operating time) appeared as a risk factor in multivariate analysis (P < 0.01, standard deviation 1.27, odds ratio 30.6). CONCLUSIONS The main findings of our study is that the procedure can be difficult to perform in particular conditions and can lead to peroperative failure in these cases, highlighting the need for adequate patients screening. When technical success is obtained, outcomes can be considered as satisfactory.
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Affiliation(s)
- Charline Delay
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Sébastien Deglise
- Department of Vascular Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Yannick Georg
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Mathieu Roussin
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Mickaël Schaeffer
- Department of Methodology and Biostatistics, University Hospital of Strasbourg, Strasbourg, France
| | - François Saucy
- Department of Vascular Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Fabien Thaveau
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Jean-Marc Corpataux
- Department of Vascular Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Nabil Chakfe
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.
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Jongsma H, Bekken JA, Bekkers WJJ, Zeebregts CJ, van Herwaarden J, Hoksbergen A, Cuypers P, de Vries JPPM, Verhagen HJ, Fioole B. Endovascular Treatment of Common Iliac Artery Aneurysms With an Iliac Branch Device. J Endovasc Ther 2016; 24:239-245. [DOI: 10.1177/1526602816679132] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To evaluate the efficacy, feasibility, and long-term outcomes of the Zenith ZBIS iliac branch device (IBD) to preserve internal iliac artery (IIA) perfusion in a large Dutch multicenter cohort. Methods: Between September 2004 and August 2015, 140 patients (mean age 70.9±7.4 years; 130 men) with 162 IBD implantations were identified in 7 vascular centers. The indication for IBD implantation was an abdominal aortic aneurysm >55 mm with a concomitant common iliac artery (CIA) aneurysm >20 mm (n=40), a CIA aneurysm with a diameter >30 mm (n=89), or revision of a type Ib endoleak after endovascular aneurysm repair (n=11). Results: Technical success (aneurysm exclusion, no type I or III endoleak, and a patent IIA) was obtained in 157 (96.9%) of 162 IBD implantations. Six (4.3%) patients developed major complications; 2 (1.4%) died. Mean follow-up was 26.6±24.1 months, during which 17 (12.1%) IBD-associated secondary interventions were performed. Including technical failures and intentional IIA embolizations, 15 (9.3%) IIA branch occlusions were identified; buttock claudication developed in 6 of these patients. The freedom from secondary intervention estimate was 75.9% (95% confidence interval 59.7 to 86.3) at 5 years. Conclusion: CIA aneurysms can be treated safely and effectively by IBDs with preservation of antegrade flow to the IIA. Secondary interventions are indicated in >10% of patients during follow-up but can be performed endovascularly in most.
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Affiliation(s)
- Hidde Jongsma
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - Joost A. Bekken
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Clark J. Zeebregts
- Department of Vascular Surgery, University Medical Center, Groningen, the Netherlands
| | - Joost van Herwaarden
- Department of Vascular Surgery, University Medical Center, Utrecht, the Netherlands
| | - Arjan Hoksbergen
- Department of Vascular Surgery, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Philip Cuypers
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Hence J. Verhagen
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Bram Fioole
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands
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21
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Kouvelos GN, Katsargyris A, Antoniou GA, Oikonomou K, Verhoeven ELG. Outcome after Interruption or Preservation of Internal Iliac Artery Flow During Endovascular Repair of Abdominal Aorto-iliac Aneurysms. Eur J Vasc Endovasc Surg 2016; 52:621-634. [PMID: 27600731 DOI: 10.1016/j.ejvs.2016.07.081] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 07/19/2016] [Indexed: 11/25/2022]
Abstract
AIM The aim was to conduct a systematic review of the literature investigating outcomes after interruption or preservation of the internal iliac artery (IIA) during endovascular aneurysm repair (EVAR). METHODS A systematic review was undertaken using the MEDLINE and EMBASE databases to identify studies reporting IIA management during EVAR. The search identified 57 articles: 30 reported on IIA interruption (1468 patients) and 27 on IIA preservation (816 patients). RESULTS The pooled 30 day buttock claudication (BC) rate was 29.2% (95% CI 24.2-34.7). Patients undergoing bilateral IIA interruption had a higher incidence of BC than patients with unilateral IIA interruption (36.5% vs. 27.2%, OR 1.7, 95% CI 1.11-2.6, p = .01). During a median follow up of 17 months, the pooled rate of persistent BC was 20.5% (95% CI 15.7-26.2). Of the patients, 93.9% underwent an endovascular revascularization procedure for IIA preservation. Most patients (87.6%) had an iliac branched device, and technical success was 96.2%. Within 30 days of EVAR, 4.3% of internal iliac branches occluded. During a median follow up of 15 months, the pooled occlusion rate at the site of IIA revascularization was 8.8% (95% CI 6.8-11.3). In patients treated with an iliac-branched device, 5.2% of internal iliac branches and 1.7% of external iliac arteries occluded. The pooled BC rate on the side of the IIA revascularization during follow up was 4.1% (95% CI 2.9-5.9). Pooled rates of late device related endoleak type I or III and secondary procedures on the side of the previous IIA revascularization were 4.6% (95% CI 3.2-6.5) and 7.8% (95% CI 5.7-10.7) respectively. CONCLUSION Unilateral or bilateral IIA occlusion during EVAR seems to carry a substantial risk of significant ischemic complications in nearly one quarter of patients. Bilateral IIA occlusion was related to a significantly higher rate of BC. IIA preservation techniques represent a significant improvement in the treatment of aorto-iliac aneurysms and have been associated with high technical success and low morbidity.
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Affiliation(s)
- G N Kouvelos
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Germany.
| | - A Katsargyris
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Germany
| | - G A Antoniou
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - K Oikonomou
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Germany
| | - E L G Verhoeven
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Germany
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22
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Telles GJP, Razuk Filho Á, Karakhanian WK, Saad PF, Saad KR, Park JH, Siqueira LCD, Caffaro RA. Dilatation of Common Iliac Arteries after Endovascular Infrarenal Abdominal Aortic Repair with Bell-Bottom Extension. Braz J Cardiovasc Surg 2016; 31:145-50. [PMID: 27556314 PMCID: PMC5062725 DOI: 10.5935/1678-9741.20160032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 03/28/2016] [Indexed: 11/20/2022] Open
Abstract
Objective Endovascular techniques to treat abdominal aortic aneurysms results in lower
morbidity and mortality rates. However, dilation of the common iliac
arteries prevents adequate distal sealing, which compromises the procedure
success. The aim of this study is report the long-term outcomes of patients
with abdominal aortic aneurysms associated with aneurysm of the common iliac
artery following endovascular repair using a bifurcated bell-bottom stent
graft. Methods This is a retrospective study that evaluated patients treated with bifurcated
bell-bottom extension stent grafts to repair an infrarenal abdominal aortic
aneurysm and who had at least one common iliac artery with dilatation >
1.5 cm for at least 12 months after the endovascular intervention. Results Thirty-eight patients with a mean age of 70.4±8.2 years were
included. Stent graft placement was followed by dilation of the common iliac
artery aneurysms in 35.3% of cases; endoleak and reoperation rates were
17.6% and 15.7%, respectively. Younger patients showed a higher rate of
artery diameter increase following the procedure. The average arterial
dilation was 16% in the first year, 29% in the second year, 57% in the third
year and 95% from the fourth year until the end of follow-up. Conclusion Repair of infrarenal abdominal aortic aneurysms with bifurcated bell-bottom
type stents when there is common iliac artery dilation is a good therapeutic
option to preserve hypogastric flow. The rate of endoleak was 17.6%, and
15.7% of cases required reoperation. Younger patients are more likely to
experience dilation of the common iliac artery after the procedure.
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Affiliation(s)
| | - Álvaro Razuk Filho
- Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Jong Hun Park
- Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brazil
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Massmann A, Mosquera Arochena NJ, Shayesteh-Kheslat R, Buecker A. Endovascular anatomic reconstruction of the iliac bifurcation with covered stentgrafts in sandwich-technique for the treatment of complex aorto-iliac aneurysms. Int J Cardiol 2016; 222:332-339. [PMID: 27500759 DOI: 10.1016/j.ijcard.2016.07.226] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 07/29/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Endovascular anatomic reconstruction of iliac artery bifurcation in aorto-iliac aneurysms using commercial stentgrafts in sandwich-technique by bilateral transfemoral approach. METHODS 24 patients (mean 73.8±standard deviation 6.8years) with complex aorto-iliac aneurysms (AAA): n=17; diameter 64±15 [48-100]mm; common-iliac-artery (CIA): n=27; 43±15 [30-87]mm; internal-iliac-artery (IIA): n=14; 28±8 [15-43]mm) were prospectively enrolled for EVAR with preservation of the IIA (n=31; bi-lateral n=7). Maintenance of antegrade flow to IIA by iliac reconstruction was performed in sandwich-technique prior to EVAR. Follow-up of 15.0±10.8 [1-40]months included contrast-enhanced ultrasound and computed-tomography after 1week, 3, 6 and every 12months. RESULTS Initial technical success for anatomic reconstruction of the iliac arteries in 31 instances was 100%. Primary patency of iliac neo-bifurcations was 90.9% (20/22) at 6months and 84.2% (16/19) at 1year. Postprocedural gutter-endoleaks type 1b were obvious in 6.5% (2/31) of cases, which disappeared 3months later. Aortic/iliac aneurysm-size after 1year decreased (>5mm) in 61.5% of patients. No aneurysm-size increase or late rupture occurred. CONCLUSIONS Endovascular reconstruction of the iliac bifurcation with commercial standard stentgrafts is safe and effective. Transfemoral approach allows extension of distal landing zone for EVAR while preserving the internal iliac artery blood-flow, even in unfavorable iliac anatomy.
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Affiliation(s)
- Alexander Massmann
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, 66421 Homburg, Saar, Germany.
| | | | - Roushanak Shayesteh-Kheslat
- Clinic for Vascular and Endovascular Surgery, Saarland University Medical Center, 66421 Homburg, Saar, Germany.
| | - Arno Buecker
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, 66421 Homburg, Saar, Germany.
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24
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Shiraev TP, Dubenec S. Novel Use of an Iliac Branch Device in the Treatment of an Abdominal Aortic Aneurysm. Ann Vasc Surg 2016; 34:272.e1-4. [PMID: 27174353 DOI: 10.1016/j.avsg.2016.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 12/29/2015] [Accepted: 01/03/2016] [Indexed: 12/20/2022]
Abstract
Iliac branch devices (IBDs) are commonly used to treat iliac artery aneurysms and maintain patency of the internal iliac artery or its branches. This case report illustrates another possible application for an IBD. We present the case of a 77-year-old male who underwent repair of his infrarenal aneurysm with an IBD as a bifurcated aortic stent-graft in a small diameter aorta to maintain bilateral common iliac artery patency.
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Affiliation(s)
- Timothy P Shiraev
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
| | - Steven Dubenec
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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25
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Duvnjak S. Endovascular treatment of aortoiliac aneurysms: From intentional occlusion of the internal iliac artery to branch iliac stent graft. World J Radiol 2016; 8:275-280. [PMID: 27027393 PMCID: PMC4807336 DOI: 10.4329/wjr.v8.i3.275] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/23/2015] [Accepted: 01/04/2016] [Indexed: 02/06/2023] Open
Abstract
Approximately 20%-40% of patients with abdominal aortic aneurysms can have unilateral or bilateral iliac artery aneurysms and/or ectasia. This influences and compromises the distal sealing zone during endovascular aneurysm repair. There are a few endovascular techniques that are used to treat these types of aneurysms, including intentional occlusion/over-stenting of the internal iliac artery on one or both sides, the “bell-bottom” technique, and the more recent method of using an iliac branch stent graft. In some cases, other options include the “snorkel and sandwich” technique and hybrid interventions. Pelvic ischemia, represented as buttock claudication, has been reported in 16%-55% of cases; this is followed by impotence, which has been described in 10%-17% of cases following internal iliac artery occlusion. The bell-bottom technique can be used for a common iliac artery up to 24 mm in diameter given that the largest diameter of the stent graft is 28 mm. There is a paucity of data and evidence regarding the “snorkel and sandwich” technique, which can be used in a few clinical scenarios. The hybrid intervention is comprised of a surgical operation, and is not purely endovascular. The newest branch stent graft technology enables preservation of the anterograde flow of important side branches. Technical success with the newest technique ranges from 85%-96.3%, and in some small series, technical success is 100%. Buttock claudication was reported in up to 4% of patients treated with a branch stent graft at 5-year follow-up. Mid- and short-term follow-up results showed branch patency of up to 88% during the 5-6-year period. Furthermore, branch graft occlusion is a potential complication, and it has been described to occur in 1.2%-11% of cases. Iliac branch stent graft placement represents a further development in endovascular medicine, and it has a high technical success rate without serious complications.
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26
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Are abdominal aortic aneurysms with hostile neck really unsuitable for EVAR? Our experience. Radiol Med 2016; 121:528-35. [DOI: 10.1007/s11547-016-0620-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 01/13/2016] [Indexed: 12/19/2022]
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27
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Treatment of iliac artery bifurcation aneurysms with the second-generation straight iliac bifurcated device. J Vasc Surg 2015; 62:1168-75. [DOI: 10.1016/j.jvs.2015.06.135] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 06/03/2015] [Indexed: 11/24/2022]
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28
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Lindblad B, Bin Jabr A, Holst J, Malina M. Chimney Grafts in Aortic Stent Grafting: Hazardous or Useful Technique? Systematic Review of Current Data. Eur J Vasc Endovasc Surg 2015; 50:722-31. [PMID: 26371416 DOI: 10.1016/j.ejvs.2015.07.038] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 07/13/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The chimney graft (CG) technique was introduced to rescue accidentally covered aortic branches during aortic endovascular repair. It extends the sealing zone. There is concern about "gutter" type I endoleak (EL-I) and about the durability of CGs. The aim of the present report was to analyze the rapidly increasing existing data. METHODS A search was performed (PRISMA criteria) for all studies of visceral and thoracic/arch chimney grafts. Technical and clinical details and outcome were assessed. RESULTS The present review includes 831 patients who underwent EVAR/TEVAR (endovascular aneurysm repair/thoracic endovascular aneurysm repair) with one or more chimney, periscope, or sandwich grafts. For aortic visceral vessels 517 patients received 911 visceral CGs and 314 patients received 364 arch CGs. Most procedures (81% visceral and 69% arch CGs) were elective. Thirty day mortality was 4% for both groups. The rate of early EL-I was 13% (visceral CGs) and 11% (arch CGs). Most EL-I were handled conservatively (observation: 70% for visceral CG and 45% for arch CG). Early CG patency was high (97-99%) and remained high during follow up (median 17 months). Late (after 30 days) EL-I was reported in nine visceral (2%) and 12 arch (4%) CG cases. Few other late complications were reported, but those losing a kidney at the initial repair seemed to have a high risk of requiring permanent hemodialysis. CONCLUSION Increasing amounts of data support the benefit of visceral and arch chimney graft techniques. In particular, the low early mortality and complication rates and high long-term patency seem advantageous; however, the majority of cases have been treated electively, and there is a high risk of bias in all studies. Mid- to long-term data suggest few late complications, except in cases where one renal artery was sacrificed. The CG technique is valuable for complex urgent patients and needs further documentation for other patient groups.
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Affiliation(s)
- B Lindblad
- Department of Vascular Diseases, Skåne University Hospital, Malmö, Sweden.
| | - A Bin Jabr
- Department of Vascular Diseases, Skåne University Hospital, Malmö, Sweden
| | - J Holst
- Department of Vascular Diseases, Skåne University Hospital, Malmö, Sweden
| | - M Malina
- Department of Vascular Diseases, Skåne University Hospital, Malmö, Sweden
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29
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Shahverdyan R, Gray D, Gawenda M, Brunkwall J. Technical feasibility of endovascular aortoiliac aneurysm repair combining Anaconda fenestrated and Zenith iliac side-branched stent grafts. J Vasc Surg 2015; 61:1324-8. [DOI: 10.1016/j.jvs.2013.10.089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 10/21/2013] [Accepted: 10/21/2013] [Indexed: 10/25/2022]
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30
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Gray D, Shahverdyan R, Jakobs C, Brunkwall J, Gawenda M. Endovascular Aneurysm Repair of Aortoiliac Aneurysms with an Iliac Side-branched Stent graft: Studying the Morphological Applicability of the Cook Device. Eur J Vasc Endovasc Surg 2015; 49:283-8. [DOI: 10.1016/j.ejvs.2014.12.021] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 12/15/2014] [Indexed: 11/29/2022]
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31
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Gray D, Gawenda M. Commentary: The Degenerating Distal Landing Zone After EVAR: Iliac Side Branch Devices to Treat Type Ib Endoleak. J Endovasc Ther 2014; 21:587-8. [DOI: 10.1583/14-4712c.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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32
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Chowdhury MM, Schiro A, Farquharson F, Smyth JV, Serracino-Inglott F, Murray D. Treatment of Aortoiliac Aneurysms With the Iliac Bifurcated Device for Preservation of Internal Iliac Artery Flow. Vasc Endovascular Surg 2013; 48:153-8. [DOI: 10.1177/1538574413509494] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: The iliac bifurcated device (IBD) is an innovative endovascular device for aortoiliac aneurysm repair. The objective of this study is to provide further evidence on the efficacy and safety of the device. Study Design: Case series study with retrospective analysis of prospectively collected nonrandomized data. Methods: Between 2007 and 2010, all consecutive IBD placements were analyzed. The main outcomes included (1) technical failure; (2) morbidity and mortality; and (3) late outcomes. Prospective follow-up was performed by interval computed tomography scanning. Results: In all, 27 consecutive patients had elective placement of 28 IBDs. Mean operating time was 251.1 ± 65.4 minutes, mean fluoroscopy time was 63.9 ± 27.2 minutes, and mean contrast volume used was 186.2 ± 106.7 mL. Periprocedural type I endoleak occurred in 2 patients. No aneurysm-related adverse events were recorded. Conclusion: We demonstrate that IBDs can be used in patients with aortoiliac aneurysms and are associated with satisfactory medium-term results as expressed by high patency and low reintervention rates.
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Affiliation(s)
- Mohammed M. Chowdhury
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Central Manchester Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Andrew Schiro
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Central Manchester Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Finn Farquharson
- Department of Radiology, Manchester Royal Infirmary, Central Manchester Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - J. V. Smyth
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Central Manchester Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Ferdinand Serracino-Inglott
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Central Manchester Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - David Murray
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Central Manchester Hospitals NHS Foundation Trust, Manchester, United Kingdom
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You JH, Park HK, Park CB. Endovascular repair of bilateral iliac artery aneurysm with branched iliac stents: case report and review of the current literature. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2013; 85:145-8. [PMID: 24020025 PMCID: PMC3764367 DOI: 10.4174/jkss.2013.85.3.145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 03/29/2013] [Accepted: 04/17/2013] [Indexed: 11/30/2022]
Abstract
Common iliac artery aneurysm (CIA) often occurs in conjunction with an abdominal aortic aneurysm (AAA), which extends into one or both CIAs in 20% to 30% of patients. Conventional endovascular treatment includes coil embolization of the internal iliac artery (IIA), followed by extension of the main bifurcated AAA stent-graft into the external iliac artery. However, complications from intentional occlusion of unilateral or bilateral IIAs are frequent and sometimes serious. Several methods try to preserve the unilateral or bilateral IIA. Here we report a case of concomitant bilateral CIA and AAA successfully treated with bilateral branched iliac stent-grafts.
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Affiliation(s)
- Ji Hoon You
- Department of Thoracic Surgery, Seoul Veterans Hospital, Seoul, Korea
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Lee J, Ullery B, Zarins C, Olcott C, Harris E, Dalman R. EVAR Deployment in Anatomically Challenging Necks Outside the IFU. Eur J Vasc Endovasc Surg 2013; 46:65-73. [DOI: 10.1016/j.ejvs.2013.03.027] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 03/27/2013] [Indexed: 10/26/2022]
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From the “Bell-Bottom” to a Migrated “Running Stent” and Then a Successful Conversion to Hypogastric Branched Endograft. Ann Vasc Surg 2013; 27:671.e7-10. [DOI: 10.1016/j.avsg.2012.06.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 05/14/2012] [Accepted: 06/14/2012] [Indexed: 11/21/2022]
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Wong S, Greenberg RK, Brown CR, Mastracci TM, Bena J, Eagleton MJ. Endovascular repair of aortoiliac aneurysmal disease with the helical iliac bifurcation device and the bifurcated-bifurcated iliac bifurcation device. J Vasc Surg 2013; 58:861-9. [PMID: 23790453 DOI: 10.1016/j.jvs.2013.02.033] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 02/14/2013] [Accepted: 02/14/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND Iliac branch device (IBD) treatment of common and internal iliac artery (CIA and IIA) aneurysms has been controversial in the context of available embolization techniques or off-label adjunctive procedures. Two devices exist, a straight IBD (S-IBD) and a helical IBD (H-IBD). We report our midterm results with the latter and present outcomes with a third device intended to treat disease in the presence of short CIAs termed the bifurcated-bifurcated IBD (BB-IBD). METHODS Data were prospectively collected from IBD-treated patients with infrarenal aortoiliac or thoracoabdominal aortoiliac aneurysms. Preoperative aneurysmal characteristics were collected in accordance with the endovascular reporting standards document, including presence of IIA stenosis, CIA diameters, and the presence of an IIA aneurysm. Technical success was defined as IBD device placement, branch placement, and patency without type I or III endoleak at implantation in addition to 24 hours survival. Follow-up computed tomography scans at 1, 6 (optional), 12 months, and annually thereafter were performed and reinterventions, sac morphology changes, and endoleaks noted. Survival and patency were evaluated with life-table analyses, and differences among anatomic groups were compared with log-rank tests, whereas t-tests and Fisher exact tests were used to compare simple variables. RESULTS Between 2003 and 2012, 138 IBD devices were placed into 130 patients (98 H-IBD and 40 BB-IBD). Median follow-up was 20.3 months (range, 1-72 months) with 30- day, 12-month, 3- and 5-year survival rates of 99%, 90%, 79%, and 62%, respectively. Technical success was 94%, and branch patency was 94.6% at 30 days and 81.8% at 5 years. Thirty-five percent (35%) of branches were placed into patients with IIA aneurysms (in addition to their proximal disease), 20% into stenotic IIAs, and 46% into iliac systems with narrow (<16 mm) CIAs. Technical success was significantly lower in patients with IIA stenosis (81.5 vs 96.4%; Fisher exact test, P = .015) but not affected by the presence of an IIA aneurysm or narrow CIA. Branch patency was similar in all groups throughout follow-up. No stent fractures or component separations were noted in the IBDs or mating devices throughout the study period. CONCLUSIONS The H-IBD and BB-IBD configurations have high technical success and acceptable long-term patency for the treatment of CIA and IIA aneurysms, including those with challenging anatomy difficult to treat with the straight branch design.
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Affiliation(s)
- Shen Wong
- Department of Vascular Surgery, Cleveland Clinic, Cleveland, Ohio
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Pieper CC, Meyer C, Rudolph J, Verrel F, Schild HH, Wilhelm KE. Interventional Exclusion of Iliac Artery Aneurysms Using the Flow-Diverting Multilayer Stent. Cardiovasc Intervent Radiol 2013; 36:917-25. [DOI: 10.1007/s00270-013-0639-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 04/12/2013] [Indexed: 11/24/2022]
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Endovascular treatment of abdominal aortic aneurysms involving iliac bifurcation: role of iliac branch graft device in prevention of buttock claudication. Ann Vasc Surg 2013; 27:851-5. [PMID: 23540668 DOI: 10.1016/j.avsg.2012.08.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Revised: 02/10/2012] [Accepted: 08/09/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND The aim of this study was to describe our early experience with the use of iliac branch grafts (IBGs) in aortoiliac aneurysm repair at our institution and to evaluate the technical feasibility, short-term patency rate, and potential clinical benefits, with special focus on prevention of buttock claudication. METHODS From March 2009 to November 2010, 9 consecutive patients (all men), mean age 71.1 years (range 62-80 years), underwent IBG implantation at our institution. Indications were abdominal aortic aneurysm (AAA) with common iliac artery (CIA) involvement (n = 7), bilateral CIA aneurysm (n = 1), and AAA with bilateral CIA and unilateral IIA involvement (n = 1). Postoperative endoleaks and patency rate were determined with computed tomography (CT) within 1 month of implantation and 1 year thereafter, with concurrent clinical evaluation for pelvic ischemia. Mean follow-up period was 14.7 (range 9-29) months. RESULTS Technical success rate, as defined by successful implantation of the iliac branch graft (IBG) with no intraprocedural type I or type III endoleak, was 100%. The mean hospitalization duration was 4 days (range 3-6 days), with 0% mortality at 30 days. There were 3 cases of type II endoleak detected perioperatively, which were treated conservatively. Two endoleaks sealed spontaneously on the 1-month CT scan and 1 persists without aneurysm sac expansion. All stent-implanted aortic and iliac aneurysms remained stable in size during follow-up, with no aneurysm rupture or death recorded. All stent-implanted iliac branches remained patent on follow-up and all patients were asymptomatic. CONCLUSIONS Iliac branch graft placement is a feasible technique with excellent short-term results in the treatment of abdominal aortic aneurysms involving the iliac bifurcation. This technique can efficiently prevent buttock claudication.
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Donas KP, Bisdas T, Torsello G, Austermann M. Technical considerations and performance of bridging stent-grafts for iliac side branched devices based on a pooled analysis of single-center experiences. J Endovasc Ther 2013; 19:667-71. [PMID: 23046334 DOI: 10.1583/jevt-12-3917mr-r.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To report a pooled analysis of single-center experiences designed to determine the performance of self-expanding vs. balloon-expandable bridging stent-grafts used in iliac branch devices (IBDs) for the repair of iliac artery aneurysms. METHODS The English-language literature in the MEDLINE and EMBASE databases was searched for articles published between 2006 and 1 March 2012 on the performance of bridging stent-grafts in the internal iliac artery. Studies were eligible for the analysis if they contained the type of bridging stent-grafts used and the time and cause of any occlusion of the bridging devices. Eight of the 13 studies published between 2006 and 2011 fulfilled the eligibility criteria. The outcome measure was the patency of bridging stent-grafts defined as absence of occlusion of the side branch in the internal iliac artery. Additionally, the performance of the self-expanding stent-grafts vs. balloon-expandable stent-grafts used in conjunction with the IBDs was compared. RESULTS In the 8 studies, 100 (42%) self-expanding stent-grafts and 136 (58%) balloon-expandable stent-grafts were placed in 185 patients. Of these 236 bridging stent-grafts, 15 (6%) occluded in 13 (7%) patients: 10 within 30 days after the intervention [2 (1.5%) balloon-expandable and 8 (8%) self-expanding stent-grafts] and 5 beyond 30 days [2 (1.5%) balloon-expandable and 3 (3%) self-expanding stent-grafts]. Symptomatic presentation (hip and/or buttock claudication) of the occluded iliac branch was recorded in 7 of the 13 patients. CONCLUSION The current literature does not support robust conclusions about the performance of bridging endografts of IBDs due to the heterogeneity of the studies. However, the occlusion rate of the bridging stent-grafts was low, especially for balloon-expandable stent-grafts compared to self-expanding devices.
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Affiliation(s)
- Konstantinos P Donas
- Department of Vascular Surgery, St. Franziskus Hospital Münster, and Clinic for Vascular and Endovascular Surgery, Münster University Hospital, Münster, Germany.
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Maurel B, Bartoli MA, Jean-Baptiste E, Reix T, Cardon A, Goueffic Y, Martinez R, Cochennec F, Albertini JN, Chauffour X, Steinmetz E, Haulon S. Perioperative Evaluation of Iliac ZBIS Branch Devices: A French Multicenter Study. Ann Vasc Surg 2013; 27:131-8. [DOI: 10.1016/j.avsg.2011.02.052] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 02/07/2011] [Accepted: 02/08/2011] [Indexed: 10/27/2022]
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Lobato AC, Camacho-Lobato L. Endovascular Treatment of Complex Aortic Aneurysms Using the Sandwich Technique. J Endovasc Ther 2012; 19:691-706. [DOI: 10.1583/jevt-12-4023r.1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Pieper CC, Meyer C, Verrel F, Schild HH, Wilhelm KE. Using the Multilayer Stent as a Supplement to EVAR in Combined Abdominal Aortic Aneurysm and Iliac Artery Aneurysm With Inadequate Distal Landing Zone—A Case Report. Vasc Endovascular Surg 2012; 46:565-9. [DOI: 10.1177/1538574412456306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Combined abdominal aortic aneurysm (AAA) and iliac artery aneurysm (IAA) is a common condition. The recently approved Cardiatis Multilayer stent (Cardiatis, Isnes, Belgium) is an innovative stent system for peripheral aneurysm management that has been applied in several clinical cases. After deployment, the unique stent design reduces mean velocity and vorticity within the aneurysm sac, causing thrombus formation and thus exclusion of the aneurysm while the vessels branching from the aneurysm remain patent. We describe a case of combined AAA and IAA with successful endovascular aneurysm repair of the AAA and treatment of the internal iliac artery with the Cardiatis Multilayer stent at 12 months of follow-up.
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Affiliation(s)
| | - Carsten Meyer
- Department of Radiology, University of Bonn, Bonn, Germany
| | - Frauke Verrel
- Department of Surgery, University of Bonn, Bonn, Germany
| | - Hans H. Schild
- Department of Radiology, University of Bonn, Bonn, Germany
| | - Kai E. Wilhelm
- Department of Radiology, University of Bonn, Bonn, Germany
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Parlani G, Verzini F, De Rango P, Brambilla D, Coscarella C, Ferrer C, Cao P. Long-term results of iliac aneurysm repair with iliac branched endograft: a 5-year experience on 100 consecutive cases. Eur J Vasc Endovasc Surg 2012; 43:287-92. [PMID: 22240335 DOI: 10.1016/j.ejvs.2011.12.011] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 12/12/2011] [Indexed: 12/28/2022]
Abstract
BACKGROUND Iliac branch device (IBD) technique has been introduced as an appealing and effective solution to avoid complications occurring during repair of aorto-iliac aneurysm with extensive iliac involvement. Nevertheless, no large series with long-term follow-up of IBD are available. The aim of this study was to analyse safety and long-term efficacy of IBD in a consecutive series of patients. METHODS Between 2006 and 2011, 100 consecutive patients were enrolled in a prospective database on IBD. Indications included unilateral or bilateral common iliac artery aneurysms combined or not with abdominal aneurysms. Patients were routinely followed up with computed tomography. Data were reported according to the Kaplan-Meier method. RESULTS There were 96 males, mean age 74.1 years. Preoperative median common iliac aneurysm diameter was 40 mm (interquartile range (IQR): 35-44 mm). Sixty-seven patients had abdominal aortic aneurysm >35 mm (IQR: 40-57 mm) associated with iliac aneurysm. Eleven patients presented hypogastric aneurysm. Twelve patients underwent isolated iliac repair with IBD and 88 patients received associated endovascular aortic repair. Periprocedural technical success rate was 95%, with no mortality. Two patients experienced external iliac occlusion in the first month. At a median follow-up of 21 months (range 1-60) aneurysm growth >3 mm was detected in four iliac (4%) arteries. Iliac endoleak (one type III and two distal type I) developed in three patients and buttock claudication in four patients. Estimated patency rate of internal iliac branch was 91.4% at 1 and 5 years. Freedom from any reintervention rate was 90% at 1 year and 81.4% at 5 years. No late ruptures occurred. CONCLUSIONS Long-term results show that IBD use can ensure persistent iliac aneurysm exclusion at 5 years, with low risk of reintervention. This technique can be considered as a first endovascular option in patients with extensive iliac aneurysm disease and favourable anatomy.
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Affiliation(s)
- G Parlani
- Unit of Vascular and Endovascular Surgery, Hospital S. Maria della Misericordia, S. Andrea delle Fratte, Perugia, Italy
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Melas N, Saratzis A, Dixon H, Saratzis N, Lazaridis J, Perdikides T, Kiskinis D. Isolated Common Iliac Artery Aneurysms:A Revised Classification to Assist Endovascular Repair. J Endovasc Ther 2011; 18:697-715. [PMID: 21992642 DOI: 10.1583/11-3519.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Hosaka A, Kato M, Kato I, Isshiki S, Okubo N. Outcome after concomitant unilateral embolization of the internal iliac artery and contralateral external-to-internal iliac artery bypass grafting during endovascular aneurysm repair. J Vasc Surg 2011; 54:960-4. [DOI: 10.1016/j.jvs.2011.03.266] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 03/17/2011] [Accepted: 03/17/2011] [Indexed: 10/18/2022]
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Hypogastric preservation with Viabahn stent graft during endovascular aneurysm repair. J Vasc Surg 2011; 54:504-6. [DOI: 10.1016/j.jvs.2010.12.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 12/03/2010] [Accepted: 12/13/2010] [Indexed: 11/23/2022]
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Pua U, Tan K, Rubin BB, Sniderman KW, Rajan DK, Oreopoulos GD, Lindsey TF. Iliac branch graft in the treatment of complex aortoiliac aneurysms: early results from a North American institution. J Vasc Interv Radiol 2011; 22:542-9. [PMID: 21463759 DOI: 10.1016/j.jvir.2011.01.429] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2010] [Revised: 12/18/2010] [Accepted: 01/01/2011] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To describe early experience with the use of iliac branch grafts (IBGs) in aortoiliac aneurysm repair. MATERIALS AND METHODS From July 2007 to August 2009 (25 months), 14 patients (13 men, one woman) with a mean age of 70.1 years (range, 59.3-80.0 y) were treated with IBGs. Indications were abdominal aneurysm with common iliac artery (CIA) involvement (n = 11), juxtarenal aortic aneurysm with CIA involvement (n = 1), and bilateral CIA and internal iliac artery (IIA) aneurysms (n = 1). Postoperative endoleaks and patency rate were determined with computed tomography within 1 month of implantation and 1 year thereafter, with concurrent clinical evaluation for pelvic ischemia. Mean follow-up period was 18.7 months (range, 6-35 mo). RESULTS Technical success rate, as defined by successful implantation of IBG with no intraprocedural type I or type III endoleak, was 86% (12 of 14). A total of 14 IBGs were successfully deployed in 12 patients. Two cases of technical failure were related to excessive iliac tortuosity. The mean hospitalization duration was 6.5 days (range, 3-14 d), with zero mortality at 30 days. There were two cases of type II endoleak treated conservatively and a single case of IBG-related type III endoleak that required repeat intervention. The rest of the stent-implanted aortic and iliac aneurysms remained stable in size, with no aneurysm rupture or death recorded. All stent-implanted iliac branches remained patent on follow-up. None of the patients who received IBGs had new symptoms of pelvic ischemia. CONCLUSIONS Iliac branch graft placement is a feasible technique with excellent short-term results in the treatment of aortoiliac aneurysms.
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Affiliation(s)
- Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
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Endovascular Repair of Complex Aortic Aneurysms. Ann Vasc Surg 2011; 25:716-25. [DOI: 10.1016/j.avsg.2011.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Accepted: 03/08/2011] [Indexed: 11/18/2022]
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Boyle JR, Thompson MM, Vallabhaneni SR, Bell RE, Brennan JA, Browne TF, Cheshire NJ, Hinchliffe RJ, Jenkins MP, Loftus IM, Macdonald S, McCarthy MJ, McWilliams RG, Morgan RA, Oshin OA, Pemberton RM, Pillay WR, Sayers RD. Pragmatic Minimum Reporting Standards for Endovascular Abdominal Aortic Aneurysm Repair. J Endovasc Ther 2011; 18:263-71. [DOI: 10.1583/11-3473.1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Albertini JN, Favre JP, Bouziane Z, Haase C, Nourrissat G, Barral X. Aneurysmal Extension to the Iliac Bifurcation Increases the Risk of Complications and Secondary Procedures After Endovascular Repair of Abdominal Aortic Aneurysms. Ann Vasc Surg 2010; 24:663-9. [DOI: 10.1016/j.avsg.2010.01.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Revised: 03/04/2009] [Accepted: 01/26/2010] [Indexed: 11/25/2022]
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