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Ikoma A, Kamisako A, Okuhira R, Fukuda K, Ueda S, Higashino N, Sato H, Minamiguchi H, Sonomura T. Retrograde embolization of internal iliac artery aneurysms that enlarged after proximal ligation: A report of 5 patients. Radiol Case Rep 2024; 19:6165-6174. [PMID: 39376947 PMCID: PMC11456813 DOI: 10.1016/j.radcr.2024.09.011] [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: 07/05/2024] [Revised: 08/31/2024] [Accepted: 09/03/2024] [Indexed: 10/09/2024] Open
Abstract
The transarterial approach is generally feasible for endovascular treatment of internal iliac artery aneurysms (IIAAs). However, this approach becomes difficult in patients who have undergone exclusion surgery (proximal ligation). We report our experience of performing transcatheter arterial embolization (TAE) using a retrograde approach from the deep femoral artery (DFA) for IIAAs that had enlarged after exclusion surgery. This case series includes 5 male patients (mean age, 57 years; range, 66-81 years) who underwent TAE of IIAAs between March 2015 and March 2024. The procedures were performed at a mean of 47 months (range, 33-108 months) after aortoiliac repair. Preoperative contrast-enhanced computed tomography (CT) or CT during aortography was performed before TAE in all cases to evaluate the development of collateral pathways. TAE was performed via the DFA using a retrograde approach with coils and cyanoacrylate glue in all cases. The procedure was technically successful in all 5 patients (100%). Intra-aneurysmal packing and embolization of the branched vessel was performed in all cases. The follow-up ranged from 6 to 66 months. All patients developed gluteal claudication but no major complications occurred during the follow-up period. No cases of aneurysm dilatation have been recorded to date. In conclusion, retrograde TAE of excluded IIAAs was a feasible and effective treatment in these 5 patients, after evaluating the development of collateral pathways on pretreatment contrast-enhanced CT.
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Affiliation(s)
- Akira Ikoma
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Atsufumi Kamisako
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Ryuta Okuhira
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Kodai Fukuda
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Shota Ueda
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | | | - Hirotatsu Sato
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | | | - Tetsuo Sonomura
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
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Esposito A, Pasqua R, Menna D, Giordano AN, Illuminati G, D’Andrea V. Percutaneous Retrograde Trans-Gluteal Embolization of Type 2 Endoleak Causing Iliac Aneurysm Enlargement after Endovascular Repair: Case Report and Literature Review. J Clin Med 2024; 13:2909. [PMID: 38792450 PMCID: PMC11122112 DOI: 10.3390/jcm13102909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/22/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Late type II endoleaks (T2ELs) arising from the internal iliac artery (IIA) may present during follow-up after endovascular aortic repair (EVAR) of aortoiliac aneurysm and may warrant embolization if enlargement of the aneurysmal sac is demonstrated. When coverage of the IIA ostium has been made due to extensive iliac disease, access options can be challenging. Different treatment options have been reported over recent years, and a careful selection of the best one must be made based on the characteristics of each case. The present study reports a simple and reproducible sheathless percutaneous superior gluteal artery (SGA) access and provides a discussion based on a review of the existing literature on this topic.
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Affiliation(s)
- Andrea Esposito
- Vascular and Endovascular Surgery Division, Cardiovascular Department, San Carlo Hospital, 85100 Potenza, Italy; (A.E.); (D.M.)
| | - Rocco Pasqua
- Vascular and Endovascular Surgery Division, Cardiovascular Department, San Carlo Hospital, 85100 Potenza, Italy; (A.E.); (D.M.)
- Department of Surgery, Sapienza University of Rome, 00185 Rome, Italy; (G.I.); (V.D.)
| | - Danilo Menna
- Vascular and Endovascular Surgery Division, Cardiovascular Department, San Carlo Hospital, 85100 Potenza, Italy; (A.E.); (D.M.)
| | - Antonio Nicola Giordano
- Vascular and Endovascular Surgery Division, Cardiovascular Department, San Carlo Hospital, 85100 Potenza, Italy; (A.E.); (D.M.)
| | - Giulio Illuminati
- Department of Surgery, Sapienza University of Rome, 00185 Rome, Italy; (G.I.); (V.D.)
| | - Vito D’Andrea
- Department of Surgery, Sapienza University of Rome, 00185 Rome, Italy; (G.I.); (V.D.)
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3
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Pratesi C, Esposito D, Martini R, Novali C, Zaninelli A, Annese AL, Baggi P, Bellosta R, Bianchini Massoni C, Bonardelli S, Carriero S, Cervelli R, Chisci E, Cioni R, Corvino F, DE Cobelli F, Fanelli F, Fargion AT, Femia M, Freyrie A, Gaggiano A, Gallitto E, Gennai S, Giampalma E, Giurazza F, Grego F, Guazzarotti G, Ierardi AM, Kahlberg AL, Mascia D, Mezzetto L, Michelagnoli S, Nardelli F, Niola R, Lenti M, Perrone O, Piacentino F, Piffaretti G, Pulli R, Puntel G, Puppini G, Rossato D, Rossi M, Silingardi R, Sirignano P, Squizzato F, Tipaldi MA, Venturini M, Veraldi GF, Vizzuso A, Allievi S, Attisani L, Fino G, Ghirardini F, Manzo P, Migliari M, Steidler S, Miele V, Taurino M, Orso M, Cariati M. Guidelines on the diagnosis, treatment and management of visceral and renal arteries aneurysms: a joint assessment by the Italian Societies of Vascular and Endovascular Surgery (SICVE) and Medical and Interventional Radiology (SIRM). THE JOURNAL OF CARDIOVASCULAR SURGERY 2024; 65:49-63. [PMID: 38037721 DOI: 10.23736/s0021-9509.23.12809-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
The objective of these Guidelines is to provide recommendations for the classification, indication, treatment and management of patients suffering from aneurysmal pathology of the visceral and renal arteries. The methodology applied was the GRADE-SIGN version, and followed the instructions of the AGREE quality of reporting checklist. Clinical questions, structured according to the PICO (Population, Intervention, Comparator, Outcome) model, were formulated, and systematic literature reviews were carried out according to them. Selected articles were evaluated through specific methodological checklists. Considered Judgments were compiled for each clinical question in which the characteristics of the body of available evidence were evaluated in order to establish recommendations. Overall, 79 clinical practice recommendations were proposed. Indications for treatment and therapeutic options were discussed for each arterial district, as well as follow-up and medical management, in both candidate patients for conservative therapy and patients who underwent treatment. The recommendations provided by these guidelines simplify and improve decision-making processes and diagnostic-therapeutic pathways of patients with visceral and renal arteries aneurysms. Their widespread use is recommended.
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Affiliation(s)
- Carlo Pratesi
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy
| | - Davide Esposito
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy -
| | - Romeo Martini
- Department of Angiology, San Martino Hospital, Belluno, Italy
| | - Claudio Novali
- Department of Vascular Surgery, GVM Maria Pia Hospital, Turin, Italy
| | | | - Antonio L Annese
- Department of Diagnostic and Interventional Radiology, Careggi University Hospital, Florence, Italy
| | - Paolo Baggi
- Department of Vascular Surgery, ASST Spedali Civili, Brescia, Italy
| | - Raffaello Bellosta
- Department of Vascular Surgery, Fondazione Poliambulanza, Brescia, Italy
| | | | | | - Serena Carriero
- Department of Diagnostic and Interventional Radiology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rosa Cervelli
- Department of Diagnostic and Interventional Radiology, A.O.U. Pisana, Pisa, Italy
| | - Emiliano Chisci
- Department of Vascular Surgery, S. Giovanni di Dio Hospital, Florence, Italy
| | - Roberto Cioni
- Department of Diagnostic and Interventional Radiology, A.O.U. Pisana, Pisa, Italy
| | - Fabio Corvino
- Department of Diagnostic and Interventional Radiology, AORN Cardarelli, Naples, Italy
| | - Francesco DE Cobelli
- Department of Diagnostic and Interventional Radiology, San Raffaele Hospital, Milan, Italy
| | - Fabrizio Fanelli
- Department of Diagnostic and Interventional Radiology, Careggi University Hospital, Florence, Italy
| | - Aaron T Fargion
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy
| | - Marco Femia
- Department of Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Antonio Freyrie
- Department of Vascular Surgery, University Hospital of Parma, Parma, Italy
| | - Andrea Gaggiano
- Department of Vascular Surgery, Umberto I Mauriziano Hospital, Turin, Italy
| | - Enrico Gallitto
- Department of Vascular Surgery, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Stefano Gennai
- Department of Vascular Surgery, Baggiovara Hospital, Modena, Italy
| | - Emanuela Giampalma
- Department of Diagnostic and Interventional Radiology, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Francesco Giurazza
- Department of Diagnostic and Interventional Radiology, AORN Cardarelli, Naples, Italy
| | - Franco Grego
- Department of Vascular Surgery, University Hospital of Padua, Padua, Italy
| | - Giorgia Guazzarotti
- Department of Diagnostic and Interventional Radiology, San Raffaele Hospital, Milan, Italy
| | - Anna M Ierardi
- Department of Diagnostic and Interventional Radiology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Daniele Mascia
- Department of Vascular Surgery, San Raffaele Hospital, Milan, Italy
| | - Luca Mezzetto
- Department of Vascular Surgery, University Hospital of Verona, Verona, Italy
| | | | - Floriana Nardelli
- Department of Diagnostic and Interventional Radiology, Città della Salute e della Scienza, Turin, Italy
| | - Raffaella Niola
- Department of Diagnostic and Interventional Radiology, AORN Cardarelli, Naples, Italy
| | - Massimo Lenti
- Department of Vascular Surgery, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Orsola Perrone
- Department of Diagnostic and Interventional Radiology, A.O.U. Pisana, Pisa, Italy
| | - Filippo Piacentino
- Department of Diagnostic and Interventional Radiology, Circolo Hospital, Varese, Italy
| | | | - Raffaele Pulli
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy
| | - Gino Puntel
- Department of Diagnostic and Interventional Radiology, University Hospital of Verona, Verona, Italy
| | - Giovanni Puppini
- Department of Diagnostic and Interventional Radiology, University Hospital of Verona, Verona, Italy
| | - Denis Rossato
- Department of Diagnostic and Interventional Radiology, Città della Salute e della Scienza, Turin, Italy
| | - Michele Rossi
- Department of Diagnostic and Interventional Radiology, Sant'Andrea University Hospital, Rome, Italy
| | | | | | | | - Marcello A Tipaldi
- Department of Diagnostic and Interventional Radiology, Sant'Andrea University Hospital, Rome, Italy
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Circolo Hospital, Varese, Italy
| | - Gian F Veraldi
- Department of Vascular Surgery, University Hospital of Verona, Verona, Italy
| | - Antonio Vizzuso
- Department of Diagnostic and Interventional Radiology, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Sara Allievi
- Department of Vascular Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Luca Attisani
- Department of Vascular Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Gianluigi Fino
- Department of Vascular Surgery, S. Maria della Misericordia Hospital, Perugia, Italy
| | | | - Paola Manzo
- Department of Vascular Surgery, Umberto I Mauriziano Hospital, Turin, Italy
| | - Mattia Migliari
- Department of Vascular Surgery, Baggiovara Hospital, Modena, Italy
| | - Stephanie Steidler
- Department of Diagnostic and Interventional Radiology, San Raffaele Hospital, Milan, Italy
| | - Vittorio Miele
- Department of Diagnostic and Interventional Radiology, Careggi University Hospital, Florence, Italy
| | - Maurizio Taurino
- Department of Vascular Surgery, Sant'Andrea University Hospital, Rome, Italy
| | - Massimiliano Orso
- Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche, Perugia, Italy
| | - Maurizio Cariati
- Department of Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, Milan, Italy
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Chen X, Zhao J, Huang B, Yuan D, Yang Y. Giant Hypogastric Aneurysm Induced by Type-II Endoleak Presenting 4 Years after Endovascular Repair: A Case Report. Ann Vasc Surg 2020; 63:458.e7-458.e11. [PMID: 31622754 DOI: 10.1016/j.avsg.2019.08.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/22/2019] [Accepted: 08/22/2019] [Indexed: 02/05/2023]
Abstract
Bilateral isolated hypogastric aneurysm (HA) is a rare type of abdominal aneurysm. Endovascular repair has become predominant compared with surgical repair because of its minimal invasiveness. However, type-II endoleak after procedure may lead to continuous enlargement of HA and rupture. Herein, we report a rare case involving a very large HA induced by type-II endoleak after endovascular repair. A 68-year-old male patient underwent endovascular repair of bilateral isolated HAs 4 years ago. Stent grafts were used to block the orifices of bilateral HAs, and main distal outflows were embolized with coils. In the absence of a 4-year follow-up, he returned to the clinic with symptoms of lower abdominal pain and frequent urination. Computer tomography angiography revealed a giant left HA with a maximum diameter of 18 cm combined with the enlargement of the left common iliac artery (CIA) induced by type-II endoleak. The right isolated HA decreased from 5.5 cm to 3 cm. Angiography was performed, and multiple arteries from the middle sacral and external iliac arteries were detected as the sources of type-II endoleak. Considering the compression effect, surgical repair of the left giant HA was performed. Thrombus was removed from the giant aneurysm, and the distal outflows of HA were sutured. As the left CIA was enlarged, a prosthetic graft was interposed through the inner side of the previous cover stent to revascularize the external iliac artery. The patient had an uneventful postoperative clinical course and was discharged from the hospital 7 days after operation. Treatments of HA induced by type-II endoleak require regular patient follow-ups to monitor specific conditions, particularly the embolization of distal outflows. Surgical repair remains the first choice for HA with compression symptoms.
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Affiliation(s)
- Xiyang Chen
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jichun Zhao
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Bin Huang
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
| | - Ding Yuan
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yi Yang
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Pirvu A, Gallet N, Perou S, Thony F, Magne JL. Midterm results of internal iliac artery aneurysm embolization. JOURNAL DE MÉDECINE VASCULAIRE 2017; 42:157-161. [PMID: 28705404 DOI: 10.1016/j.jdmv.2017.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 02/28/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We describe the immediate and midterm results of endovascular treatment of isolated internal iliac artery aneurysms (IIAA). METHODS This was a retrospective single center study. From 2005 to 2014, data from 20 consecutive patients who had an embolisation for an isolated atherosclerotic internal iliac artery aneurysm underwent an endovascular treatment. We retrospectively evaluated the technical aspects and outcomes. RESULTS The mean aneurysm diameter was 42mm (range 30-97mm). No perioperative deaths or treatment failures occurred. No endoleaks or secondary aneurysm ruptures were observed during the follow-up. Three patients experienced disabling buttock claudication, which was spontaneously remissive in two cases. No relationship was found between buttock claudication and the patency of the contralateral internal iliac artery and the deep femoral artery. Six patients (30%) died during follow-up. Among these, three patients died due to cardiovascular events. The mean follow-up interval was 24 months (range 6-96 months). CONCLUSION The endovascular treatment of isolated internal iliac artery aneurysm is safe in the short-term and could prevent secondary aneurysm rupture at midterm.
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Affiliation(s)
- A Pirvu
- Department of Vascular and Surgery, Grenoble University Hospital, BP 217, 38043 Grenoble cedex 09, France.
| | - N Gallet
- Department of Vascular and Surgery, Grenoble University Hospital, BP 217, 38043 Grenoble cedex 09, France
| | - S Perou
- Department of Vascular and Surgery, Grenoble University Hospital, BP 217, 38043 Grenoble cedex 09, France
| | - F Thony
- Department of Radiology, Grenoble University Hospital, BP 217, 38043 Grenoble cedex 09, France
| | - J-L Magne
- Department of Vascular and Surgery, Grenoble University Hospital, BP 217, 38043 Grenoble cedex 09, France
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