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Clampless In-Situ Immobilized Branching (CLIMB) to Reconstruct the Internal Iliac Artery. LIFE (BASEL, SWITZERLAND) 2022; 12:life12111928. [PMID: 36431063 PMCID: PMC9697542 DOI: 10.3390/life12111928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/09/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Surgical reconstruction of the internal iliac artery (IIA) or its branches is sometimes demanding because of difficulty in distal clamping and suturing in the narrow pelvic space. Here we present a hybrid technique of ClampLess In-situ imMobilized Branching (CLIMB) to reconstruct IIA. METHODS in the CLIMB technique, an 8 mm artificial graft is sutured onto the surface of the common iliac artery (CIA) without clamping. Following puncture of the CIA wall, stent grafts are bridged from IIA to the graft. Finally, the graft is sutured to the ipsilateral external iliac artery (EIA). Concomitant endovascular aneurysm repair or IIA branch embolization can also be performed. We applied this technique to the patients unsuited for other IIA reconstruction. RESULTS eleven patients underwent the current technique. All but one patient underwent contralateral IIA interruption. Seven patients had a history of aorto-iliac repair before the index surgery. Iliac extender, internal iliac component, Viabahn VBX or Fluency covered stent were used for bridging the graft. Simultaneous IIA branch embolization was performed in 2 patients. Distal landing zones were IIA in 7 grafts, superior gluteal artery in 4 grafts and inferior gluteal artery (IGA) in 1 graft. Technical success was achieved in all cases. No patient complained of buttock claudication or other ischemic symptoms on the treatment side. During a mean follow-up period of 38 months, 11 out of 12 grafts were patent without any related endoleak. One IGA graft occluded at 56 months after surgery. CONCLUSIONS the CLIMB technique is a viable alternative to preserve IIA with an acceptable mid-term durability.
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Scheurig-Münkler C, Zerwes S. [Isolated iliac artery aneurysm : Clinical background and interventional treatment strategies]. Radiologe 2022; 62:607-613. [PMID: 35503119 DOI: 10.1007/s00117-022-01002-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Isolated iliac artery aneurysms are less frequent than abdominal aortic aneurysms, with the same, predominantly atherosclerotic-degenerative etiology, but patients present more frequently with symptoms or at the stage of rupture. The majority of those affected are men over the age of 65. The ideal imaging technique for diagnosis, treatment planning and follow-up is computed tomography (CT) angiography. Below a diameter of 4 cm, the risk of rupture is 6.3%, and then increases significantly with increasing diameter. Today, treatment is recommended from a size of 3.5 cm at the earliest. THERAPY Because of the lower mortality, endovascular therapy is the leading treatment for the elective and emergency situation. The quality of the landing zones, which are important for sealing, is decisive for elimination of the aneurysm. The elimination is carried out by means of stent grafts, often in combination with embolization. Due to the risk of buttock claudication and erectile dysfunction, the preservation of ipsilateral pelvic perfusion is recommended in cases of insufficient collateralization. Special iliac branch devices or various parallel endograft techniques are available for this purpose. FOLLOW-UP The main problem of endovascular treatment are endoleaks and the associated need for reintervention. Imaging control by means of CT angiography is crucial for timely endoleak detection, especially in the early phase.
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Affiliation(s)
- C Scheurig-Münkler
- Klinik für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
| | - S Zerwes
- Klinik für Gefäßchirurgie und endovaskuläre Chirurgie, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
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Masuyama S, Azuma T, Inoue T, Ichihara T. Upside-down and kissing stent graft techniques for late extravasation of a prosthetic graft implanted in the abdominal aorta. Interact Cardiovasc Thorac Surg 2020; 32:661-663. [PMID: 33221869 DOI: 10.1093/icvts/ivaa293] [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: 07/08/2020] [Revised: 09/28/2020] [Accepted: 10/24/2020] [Indexed: 11/14/2022] Open
Abstract
Extravasation of prosthetic grafts is rare. Various anatomical problems after graft replacement might make standard endovascular treatment difficult. Use of a commercially available main body requires an adequate distance of the flow divider. An 86-year-old man developed extravasation of a graft that had been implanted in the infrarenal abdominal aorta 24 years previously. Endovascular repair with upside-down and kissing stent graft techniques using the contralateral leg was successfully performed.
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Affiliation(s)
- Shinji Masuyama
- Cardiovascular Surgery, Otakanomori Hospital, Kashiwa, Japan
| | - Takashi Azuma
- Cardiovascular Surgery, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Takehiko Inoue
- Cardiovascular Surgery, Otakanomori Hospital, Kashiwa, Japan
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Pagliariccio G, Gatta E, Schiavon S, Grilli Cicilioni C, Lattanzi S, Dimitri E, Carbonari L. Bell-bottom technique in iliac branch era: mid-term single stent graft performance. CVIR Endovasc 2020; 3:57. [PMID: 32886266 PMCID: PMC7474032 DOI: 10.1186/s42155-020-00147-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/03/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Endovascular abdominal aortic aneurysm repair (EVAR) is considered the primary option for abdominal aortic aneurysm but the management of concomitant wide or aneurysmal iliac arteries (CIAs) is still controversial. METHODS We retrospectively evaluated mid-term results of patients receiving standard EVAR combined with bell-bottom technique (BBT) using Medtronic Endurant endograft between January 2009 and December 2018. Patients were followed up by CT scan performed 1 month after the procedure and by duplex ultrasound annually (with or without contrast medium) followed by CT scan in case of evolution. RESULTS Seventy-one patients (67 males; mean age of 77,1 years) with abdominal aortic aneurysm and wide or aneurysmal common iliac artery (distal landing zone diameter up to 25 mm and length more than 20 mm) were treated with standard EVAR and BBT (107 limbs) using Endurant stent graft. The median aortic diameter was 56,1 mm (31.0-85.0). Technical success was obtained in 100%. Mean procedural time was of 100.1 min. No 30 days' mortality, renal failure or limb ischaemia occurred. The median follow-up was of 36.56 months (1-136). 5-year aneurysm related mortality was not found. At 5 years, the number of all-cause deaths was seven. The freedom from secondary intervention was 91.6% at 5 years. Three patients (4.4%) were treated for iliac related complications at 5 years: internal iliac artery aneurysm, iliac obstruction, type 1b endoleak, all successfully treated by endovascular technique. CONCLUSIONS According with this study BBT using Endurant stent graft is effective and safe with good mid-term results, with low rate of iliac related complications and no aneurysm related mortality.
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Affiliation(s)
- Gabriele Pagliariccio
- Department of Vascular Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti Ancona, Via Conca, 71, 60126, Ancona, Italy.
| | - Emanuele Gatta
- Department of Vascular Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti Ancona, Via Conca, 71, 60126, Ancona, Italy
| | - Sara Schiavon
- Department of Vascular Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti Ancona, Via Conca, 71, 60126, Ancona, Italy
| | - Carlo Grilli Cicilioni
- Department of Vascular Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti Ancona, Via Conca, 71, 60126, Ancona, Italy
| | - Simona Lattanzi
- Department of Experimental and Clinical Medicine, Clinic of Neurology, Marche Polytechnic University, Ancona, Italy
| | - Elisa Dimitri
- Department of Vascular Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti Ancona, Via Conca, 71, 60126, Ancona, Italy
| | - Luciano Carbonari
- Department of Vascular Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti Ancona, Via Conca, 71, 60126, Ancona, Italy
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Kusadokoro S, Hori D, Yuri K, Yamaguchi A. Dissected thoracoabdominal aortic aneurysm repair with modified parallel endografting. J Card Surg 2020; 35:3220-3223. [PMID: 33047314 DOI: 10.1111/jocs.14962] [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: 11/29/2022]
Abstract
A 67-year-old woman with a prior history of aortic dissection was admitted for enlarging the thoracoabdominal aortic aneurysm (TAAA). She has received multiple treatments including Bentall procedure, hemiarch replacement, and subsequent endovascular procedures for the closure of re-entry. Preoperative computed tomography revealed previously implanted thoracic endograft from distal arch to superior mesenteric artery with dissected TAAA measuring up to 70 mm in diameter. Re-entry was observed at bilateral common iliac arteries. The patient was successfully treated by endovascular treatment using a fenestrated stent graft to obtain a landing zone for parallel endograft technique to the iliac arteries for the closure of re-entry.
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Affiliation(s)
- Sho Kusadokoro
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Daijiro Hori
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Koichi Yuri
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Kato H, Kato N, Nakajima K, Higashigawa T, Ouchi T, Chino S, Tokui T, Sakuma H. Parallel Placement of Excluder Legs to Treat Abdominal Aortic Aneurysms with Aortoiliac Occlusive Lesion. Ann Vasc Dis 2020; 13:319-321. [PMID: 33384738 PMCID: PMC7751086 DOI: 10.3400/avd.cr.20-00044] [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] [Indexed: 11/13/2022] Open
Abstract
The effectiveness of endovascular aneurysm repair (EVAR) has been proven, but anatomical limitations, including narrow access route, may obstruct procedure of EVAR and cause serious complications. Parallel placement of Excluder legs (W. L. Gore & Associates, Inc., Newark, DE, USA) was established to treat patients with type IIIb endoleak or those with a narrow aorta, who could not be treated using a standard main body. In this report, we applied this technique in two patients with aortoiliac aneurysms with occlusive lesion.
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Affiliation(s)
- Hiroaki Kato
- Department of Radiology, Mie University Hospital
| | | | | | | | | | - Shuji Chino
- Department of Radiology, Ise Red Cross Hospital
| | - Toshiya Tokui
- Department of Cardiovascular Surgery, Ise Red Cross Hospital
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Propensity-Matched Comparison of Endovascular versus Open Reconstruction for TASC-II C/D AortoIliac Occlusive Disease. A Ten-Year Single-Center Experience with Self-Expanding Covered Stents. Ann Vasc Surg 2020; 71:84-95. [PMID: 32927036 DOI: 10.1016/j.avsg.2020.08.139] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND To compare endovascular therapy (EVT) using kissing self-expanding covered stents, with open repair (OR) with aortobifemoral bypass (ABF), for reconstruction of the aortic bifurcation in Trans-Atlantic Inter-Society Consensus II (TASC-II) C/D aortoiliac occlusive disease (AIOD). METHODS A single-center retrospective analysis of patients treated by EVT or ABF for TASC-II C/D AIOD (2009-2018) was carried out. The perioperative risk was quantified by the Society for Vascular Surgery (SVS) and American Society of Anesthesiologists (ASA) scores. Outcomes of interest were early (30 days) mortality and complication rates, length of hospitalization, and midterm patency that were compared between EVT and OR after propensity score matching. Follow-up results were analyzed with Kaplan-Meier curves. Cox proportional hazards were used to identify predictors of patency. RESULTS Sixty-three EVT and 55 OR patients were treated; the EVT group had higher perioperative risk (ASA score, P = 0.012. SVS score, P = 0.012) and less advanced disease (TASC D lesions, 52.3% vs. 72.7%; P = 0.036. Iliac occlusion, 46.8% vs. 87.2%; P = 0.024). After propensity score matching, 148 limbs were selected (74 EVT and 74 OR), resulting in well-balanced groups regarding risk (ASA score, P = 0.514. SVS score, P = 0.373) and anatomical complexity (TASC D lesions, 60.4% vs. 63.0%; P = 0.516. Iliac occlusion, 47.3% vs. 59.5%; P = 0.187). Mortality was 0%. The EVT group showed significantly shorter hospital (4.5 ± 7.6 days vs. 9.9 ± 6.8 days; P < 0.001) and intensive care unit stay (0 ± 0.1 days vs. 1.7 ± 1.5 days; P = 0.046) and less surgical complications (4% vs. 14.8%; P = 0.046). Five-year primary patency was similar between EVT and OR (84.1% vs. 88.3%; P = 0.454); multivariate analysis showed that Rutherford category was the only predictor of primary patency (HR 4.1, P = 0.023). CONCLUSIONS The endovascular kissing self-expanding covered stent technique for TASC-II C/D AIOD presented a primary patency equal to ABF at 5 years, with the advantage of less surgical complications and shorter hospitalization. Therefore, it may be considered as a valid option for complex atherosclerotic lesions involving the aortic bifurcation.
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Mizoguchi T, Morikage N, Takeuchi Y, Nagase T, Samura M, Harada T, Suehiro K, Hamano K. Treatment Results of Endovascular Aneurysm Repair Using the Parallel Stent-Graft Double D Technique for Distal Saccular Abdominal Aortic Aneurysms and Common Iliac Aneurysms. Ann Vasc Surg 2020; 71:392-401. [PMID: 32827677 DOI: 10.1016/j.avsg.2020.07.048] [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: 04/25/2020] [Revised: 07/10/2020] [Accepted: 07/26/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Endovascular aneurysm repair (EVAR) using a bifurcated stent graft may involve technical challenges when aortic disease (aneurysm or dissection) consists of a length <70 mm between the inferior renal artery and aortic bifurcation or narrow aortic bifurcation that is common in asymmetric distal abdominal aortic aneurysms (AAAs) or iliac artery aneurysms (IAAs). We use EVAR with the double D technique (DDT-EVAR) for such cases, which involves straight type of stent grafts with same diameter in left and right that are deployed parallel to an aortic cuff that has been previously placed. In addition, DDT-EVAR can preserve the inferior mesenteric artery (IMA) for IAA. METHODS DDT-EVAR was performed for 21 of 910 (2%) cases from April 2007 to April 2019 at our institution. The median patient age was 74 years (range, 52-85). Nineteen patients (90%) were men. Six patients (all saccular; 1 rupture) had AAAs, 12 had IAAs, and 3 had chronic type B aortic dissociation (TBAD) for re-entry closure. AAA and IAA had diameters of 45 mm (range, 34-71) and 34 mm (range, 25-58), respectively. An aortic cuff was used for 19 (90%) cases. Endurant II (Medtronic, Santa Rosa, CA) was used for 12 cases. The Excluder (W.L. Gore & Associates, Inc, Flagstaff, AZ) was used for 7 cases. Endurant II was used for 20 cases, and the VBX (W.L. Gore & Associates, Inc) was used for 1 case as stent-graft limbs. RESULTS The procedural success rate was 100%. The median operative time was 146 min (range, 88-324). IMA planned for preservation was successful for all 12 cases. Type I and type III endoleaks were not observed. With TBAD, flow to the false lumen decreased or disappeared, and no complications during the hospital stay were associated with the procedure. For 2 patients whose procedure involved Endurant II stent-graft limb, limb occlusions were observed postoperatively, and reintervention was required. No other patients required additional treatment at a median follow-up of 18 months (range, 4-50). CONCLUSIONS DDT-EVAR is a safe and straightforward technique for the treatment of distal AAA, common iliac artery aneurysm, and TBAD. It may help preserve the IMA and internal iliac artery, even when it is impossible to preserve them with a bifurcated stent graft.
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Affiliation(s)
- Takahiro Mizoguchi
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Noriyasu Morikage
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
| | - Yuriko Takeuchi
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Takashi Nagase
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Makoto Samura
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Takasuke Harada
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Kotaro Suehiro
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Kimikazu Hamano
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
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Kato H, Kato N, Nakajima K, Higashigawa T, Ouchi T, Chino S, Sakuma H. Parallel Placement of Excluder Legs for the Treatment of a Type IIIb Endoleak Using AFX2. Ann Vasc Dis 2020; 13:180-182. [PMID: 32595796 PMCID: PMC7315243 DOI: 10.3400/avd.cr.19-00110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Endoleak is a major complication of endovascular aneurysm repair (EVAR). Type IIIb endoleaks, which are caused by endograft fabric disruption, are relatively rare. Although relining of the previously placed endograft with another main endograft is considered an ideal approach, it is sometimes difficult. The efficacy of parallel placement of Excluder legs has been reported in various settings. Here, we report the successful treatment of a type IIIb endoleak with parallel placement of Excluder legs during EVAR by using an AFX2 device.
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Affiliation(s)
- Hiroaki Kato
- Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
| | - Noriyuki Kato
- Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
| | - Ken Nakajima
- Department of Radiology, Ise Red Cross Hospital, Ise, Mie, Japan
| | | | - Takafumi Ouchi
- Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
| | - Shuji Chino
- Department of Radiology, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
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Yao C, Ning J, Li Z, Wang M, Wu R, Wang S, Chang G. Parallel Covered Stents Technique in the Treatment of Abdominal Aortic Diseases. J Vasc Interv Radiol 2020; 31:771-777. [PMID: 32127313 DOI: 10.1016/j.jvir.2019.09.022] [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: 04/18/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To investigate the safety and efficacy of the parallel covered stents technique in the treatment of anatomically challenging aortic aneurysms, pseudoaneurysms, and dissections. MATERIALS AND METHODS Data were retrospectively collected from 16 patients with abdominal aortic diseases who were treated with parallel covered stents (Gore Excluder, n = 14; Medtronic Endurant, n = 2) between January 2016 and July 2018. Patients were treated with this technique if they were unsuitable for either open repair or standard endovascular aortic repair with bifurcated stents. Such unfavorable anatomy included narrow aortic necks (≤18 mm), small vascular access (occluded or ≤6.0 mm), or compressed aortic lumens (≤18 mm). All patients were male, with a mean age of 64.7 ± 13.3 years. For true aneurysms (n = 4) and pseudoaneurysms (n = 4), the mean diameter and length of the proximal necks were 17.5 ± 2.6 mm (range, 14-21 mm) and 51.0 ± 12.5 mm (range, 39-75 mm), respectively. The minimal diameter of true lumen in cases with aortic dissection and penetrating ulcers (n = 8) was 14.8 ± 3.1 mm. Small or occluded femoral access was found in 3 patients. RESULTS Technical success was 100%. Minor type I endoleaks, which were seen on completion angiography in 5 patients, had all resolved within 3 months. There were no perioperative deaths. Postoperative complications included supraventricular tachycardia in 1 patient and pneumonia combined with heart failure in 1 patient. Patency of all stents was observed at a mean follow-up of 21.8 ± 10.1 months. CONCLUSIONS The parallel covered stents technique appears to offer a feasible solution for abdominal aortic diseases with unfavorable anatomy. Long-term follow-up is needed to further evaluate the safety and efficacy of this technique.
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Affiliation(s)
- Chen Yao
- Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Junjie Ning
- Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Zilun Li
- Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Mian Wang
- Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Ridong Wu
- Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Shenming Wang
- Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Guangqi Chang
- Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China.
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Pfabe FP. [The Treatment of Aneurysms of the Extremities Arteries - a Systematic Overview - New Therapies for Isolated Iliac Artery Aneurysm Employing a New Classification]. Zentralbl Chir 2020; 145:456-466. [PMID: 31931546 DOI: 10.1055/a-1027-7164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aneurysms of arteries in the extremities have a low incidence and are often manifest through complications. The most serious complications are rupture and extremity-threatening ischemia. Both usually lead to the diagnosis. Absolute indications for therapy are symptomatic aneurysms and asymptomatic aneurysms of 2 cm diameter or more. The extrailiacal gold standard is interponat or bypass with venous graft material. Endovascular methods are reserved for inoperable patients and clinical decisions on special cases. In contrast, complex endovascular techniques have been established in isolated iliac aneurysms and have significantly improved treatment options. Their implementation is bound to the existence of a suitable landing zone. This is the basis for a new classification of isolated iliac artery aneurysm. With the help of morphological subtypes, this classification permits standardised procedure planning for perfusion preservation of the internal iliac artery. The present article gives an overview of the current treatment strategy for aneurysms of extremities arteries. Similarities and regional differences in therapy are discussed.
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Affiliation(s)
- Frank-Peter Pfabe
- Klinik für Gefäßmedizin, Asklepios Klinikum Uckermark GmbH, Schwedt, Deutschland
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12
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Xu H, Mei Y, Han X, Wei J, Watton PN, Jia W, Li A, Chen D, Xiong J. Optimization schemes for endovascular repair with parallel technique based on hemodynamic analyses. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2019; 35:e3197. [PMID: 30838798 DOI: 10.1002/cnm.3197] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/24/2019] [Accepted: 03/03/2019] [Indexed: 06/09/2023]
Abstract
Endovascular repair with parallel stent-grafts (SG) is a challenging technique that reconstructs the luminal flow pathways by implanting parallel-placed SGs into the vessel. After treatment, occlusion and shifting of the parallel SGs are sometimes reported, which could be fatal and difficult to be re-operated. These issues are highly related to the local hemodynamic conditions in the stented region. In this study, a patient case treated by the octopus endograft technique (a head-SG with three limb-SGs) and experienced limb-SG occlusion is studied. 3-D models are established based on computed tomography (CT) angiography datasets pretreatment and posttreatment as well as during follow-ups. Hemodynamic quantities such as pressure drop, wall shear stress-related parameters, and flow division in limb-SGs and visceral arteries are quantitatively investigated. Optimizations on the length of the head-SG and diameter of the limb-SGs are analyzed based on various scenarios. The results indicate that when reconstructing the flow pathways via octopus stenting, it is important to ensure the flow distribution as physiologically required with this new morphology. Position (or length) of the head-SG and diameter of the limb-SGs play an important role in controlling flow division, and high time average wall shear stress (TAWSS) around the head-SG acts as a main factor for graft immigration. This study, by proposing optimization suggestions with hemodynamic analyses for a specific case, implicates that pretreatment SG scenarios may assist in wise selection and placement of the device and thus may improve long-term effectiveness of this kind of challenging endovascular repair techniques.
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Affiliation(s)
- Huanming Xu
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Yuqian Mei
- Department of Computer Science and INSIGNEO Institute, University of Sheffield, Sheffield, UK
| | - Xiaofeng Han
- Department of Diagnostic and Interventional Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jianyong Wei
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Paul N Watton
- Department of Computer Science and INSIGNEO Institute, University of Sheffield, Sheffield, UK
| | - Wan Jia
- Department of Vascular Surgery, The Second People's Hospital of Yunnan Province, Kunming, China
| | - Anqiang Li
- Department of Vascular Surgery, Gansu Provincial People's Hospital, Lanzhou, China
| | - Duanduan Chen
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Jiang Xiong
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
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Early and Late Outcome of Common Iliac Aneurysms Treated by Flared Limbs or Iliac Branch Devices during Endovascular Aortic Repair. J Vasc Interv Radiol 2019; 30:503-510. [DOI: 10.1016/j.jvir.2018.10.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/18/2018] [Accepted: 10/22/2018] [Indexed: 11/17/2022] Open
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Current Status of Endovascular Preservation of the Internal Iliac Artery with Iliac Branch Devices (IBD). Cardiovasc Intervent Radiol 2019; 42:935-948. [DOI: 10.1007/s00270-019-02199-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/06/2019] [Indexed: 02/06/2023]
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15
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Schiro BJ, Gandhi RT, Peña CS, Geronemus AR, Powell A, Benenati JF. Endovascular management of iliac aneurysmal disease with hypogastric artery preservation. Cardiovasc Diagn Ther 2018; 8:S168-S174. [PMID: 29850428 DOI: 10.21037/cdt.2017.09.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Common iliac artery aneurysms (CIAAs) pose a challenge in endovascular aneurysm repair. Aneurysm repair of CIAA traditionally requires embolization of the ipsilateral hypogastric artery (HA). Symptoms of buttock claudication and more feared complications of pelvic ischemia make HA preservation an appealing addition to aneurysm repair. In this review, we discuss various methods of CIAA repair with devices specifically designed for aneurysm repair and other custom techniques of HA preservation.
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Affiliation(s)
- Brian J Schiro
- Miami Cardiac & Vascular Institute, Baptist Hospital of Miami, Miami, FL, USA
| | - Ripal T Gandhi
- Miami Cardiac & Vascular Institute, Baptist Hospital of Miami, Miami, FL, USA
| | - Constantino S Peña
- Miami Cardiac & Vascular Institute, Baptist Hospital of Miami, Miami, FL, USA
| | - Adam R Geronemus
- Miami Cardiac & Vascular Institute, Baptist Hospital of Miami, Miami, FL, USA
| | - Alex Powell
- Miami Cardiac & Vascular Institute, Baptist Hospital of Miami, Miami, FL, USA
| | - James F Benenati
- Miami Cardiac & Vascular Institute, Baptist Hospital of Miami, Miami, FL, USA
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Giaquinta A, Ardita V, Ferrer C, Beggs CB, Veroux M, Barbante M, Orrico M, Cao P, Veroux P. Isolated Common Iliac Artery Aneurysms Treated Solely With Iliac Branch Stent-Grafts: Midterm Results of a Multicenter Registry. J Endovasc Ther 2018; 25:169-177. [PMID: 30141378 DOI: 10.1177/1526602818754862] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess early and midterm outcomes of iliac branch device (IBD) implantation without an aortic stent-graft for the treatment of isolated common iliac artery aneurysm (CIAA). METHODS From December 2006 to June 2016, 49 isolated CIAAs in 46 patients were treated solely with an IBD at 7 vascular centers. Five patients were lost to follow-up, leaving 41 male patients (mean age 72.5±7.8 years) for analysis. Mean CIAA diameter was 39.1±10.5 mm (range 25-65). Thirty-two patients (2 with bilateral CIAAs) were treated with a Cook Zenith iliac branch device; 9 patients (1 bilateral) received a Gore Excluder iliac branch endoprosthesis. Primary endpoints were technical success, survival, aneurysm exclusion, device patency, and freedom from reintervention at 1 and 5 years. Freedom from major adverse events and aneurysm shrinkage at 1 year were also assessed. RESULTS Thirty-day mortality and the IBD occlusion rate were 2.4% and 2.3%, respectively. At a mean follow-up of 40.2±33.9 months, no patient presented buttock claudication, erectile dysfunction, or bowel or spinal cord ischemia. Three patients died within 6 months after the procedure. Estimates of cumulative survival, device patency, and freedom from reintervention were 90.2%, 95.2%, and 95.7%, respectively, at 1 and 5 years. At 1 year, CIAA shrinkage ≥5 mm was recorded in 21 of 38 survivors. No evidence of endoleak, device migration, or disconnection was found on imaging follow-up. CONCLUSION The use of IBDs without an aortic stent-graft for isolated CIAAs resulted in excellent patency, with low morbidity and mortality. This, in conjunction with no endoleak or migration and a low reintervention rate, supports the use of isolated IBDs as a stable and durable means of endovascular reconstruction in cases with suitable anatomy. Longer follow-up and a larger cohort are needed to validate these results.
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Affiliation(s)
- Alessia Giaquinta
- 1 Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Italy
| | - Vincenzo Ardita
- 1 Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Italy
| | - Ciro Ferrer
- 2 Department of Surgery "Pietro Valdoni," "Sapienza" University, Rome, Italy
| | - Clive B Beggs
- 3 Research Institute for Sport, Physical Activity and Leisure, Carnegie Faculty, Leeds Beckett University, Leeds, UK
| | - Massimiliano Veroux
- 1 Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Italy
| | - Matteo Barbante
- 4 Vascular Surgery Unit, Department of Biomedicine and Prevention, University of Rome "Tor Vergata," Rome, Italy
| | - Matteo Orrico
- 5 Department of Vascular Surgery, San Filippo Neri Hospital, Rome, Italy
| | - Piergiorgio Cao
- 6 Division of Vascular Surgery, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Piefrancesco Veroux
- 1 Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Italy
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Hashimoto T, Kato N, Tokui T, Miyake Y, Nasu M, Nakajima K, Higashigawa T, Chino S. Parallel placement of Excluder legs for treatment of type IIIb endoleaks caused by fabric tear after endovascular aneurysm repair. J Vasc Surg 2017; 66:1285-1289. [PMID: 28705593 DOI: 10.1016/j.jvs.2017.06.072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 06/15/2017] [Indexed: 11/19/2022]
Abstract
A total of 576 patients underwent endovascular aneurysm repair using main body devices for treatment of abdominal aortic aneurysms or iliac artery aneurysms. During follow-up, type IIIb endoleaks caused by fabric tear occurred in six patients (1.0% [6/576]). The device used was Zenith (Cook Medical, Bloomington, Ind) in five cases and Talent (Medtronic, Santa Rosa, Calif) in one case. All endoleaks were close to the flow divider of the main body devices. The distance between the lower renal artery and the top end of the contralateral leg was 53 ± 14 mm. Bell-bottom-shaped Excluder (W. L. Gore & Associates, Flagstaff, Ariz) legs were placed parallel from the top of the main body device through both legs to treat these endoleaks. In two patients, coil embolization was required to treat gutter endoleaks. Postoperative computed tomography showed the obliteration of type IIIb endoleaks in all patients. Our technique may be an acceptable method for treatment of type IIIb endoleaks, especially when they occur near the flow divider.
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Affiliation(s)
| | - Noriyuki Kato
- Department of Radiology, Mie University Hospital, Tsu, Japan
| | - Toshiya Tokui
- Department of Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Japan
| | - Yoichiro Miyake
- Department of Cardiovascular Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Michihiro Nasu
- Department of Cardiovascular Surgery, Toyooka Public Hospital, Toyooka, Japan
| | - Ken Nakajima
- Department of Radiology, Mie University Hospital, Tsu, Japan
| | | | - Shuji Chino
- Department of Radiology, Mie University Hospital, Tsu, Japan
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18
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Reyes Valdivia A, Santos AD, Guaita JO, Gandarias C. Hypogastric Chimney Patency in Aortic Monoiliacal Endograft Thrombosis: A Life Saved by Collateral Pelvic Circulation. Int J Angiol 2017; 27:46-49. [PMID: 29483767 DOI: 10.1055/s-0037-1602373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Background To report a case of a high-risk patient treated with hypogastric chimney and aortic endograft for a native infrarenal aorta aneurysmal degeneration, 20 years after an aortobifemoral bypass procedure for severe iliac occlusive disease. Methods A two-stage procedure was planned. The first stage was right internal iliac artery (IIA) embolization and simple angioplasty of left IIA. The second stage consisted of aortouniiliac endograft with femoral crossover and left IIA chimney. Results Femoral crossover complicated with early thrombosis, but a decision on conservative medical treatment with anticoagulation was made based on no rest pain or severe claudication. After 3 months the patient presented with moderate claudication alone. Scheduled computed tomography scan showed femoral crossover graft and aortic endograft thrombosis with left IIA patency. The axillofemoral bypass was scheduled a week later, and the patient discharged home. Conclusion Preservation of pelvic circulation is mandatory to avoid life-threatening complications. The chimney technique demonstrates good patency and should be considered in the endovascular approach armamentarium for hypogastric artery revascularization.
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Affiliation(s)
- Andrés Reyes Valdivia
- Department of Vascular and Endovascular Surgery, Ramón y Cajaĺs University Hospital, Madrid, Spain
| | - Africa Duque Santos
- Department of Vascular and Endovascular Surgery, Ramón y Cajaĺs University Hospital, Madrid, Spain
| | - Julia Ocaña Guaita
- Department of Vascular and Endovascular Surgery, Ramón y Cajaĺs University Hospital, Madrid, Spain
| | - Claudio Gandarias
- Department of Vascular and Endovascular Surgery, Ramón y Cajaĺs University Hospital, Madrid, Spain
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Mansukhani NA, Havelka GE, Helenowski IB, Rodriguez HE, Hoel AW, Eskandari MK. Hybrid Endovascular Aortic Aneurysm Repair: Preservation of Pelvic Perfusion with External to Internal Iliac Artery Bypass. Ann Vasc Surg 2017; 42:162-168. [PMID: 28286187 DOI: 10.1016/j.avsg.2016.10.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/02/2016] [Accepted: 10/19/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Diminished pelvic arterial flow as a result of intentional coverage/embolization of internal iliac arteries (IIA) during isolated endovascular common iliac artery aneurysm (CIAA) repair or endovascular repair of abdominal aortic aneurysms (EVAR) may result in symptomatic pelvic ischemia. Although generally well tolerated, in severe cases, pelvic ischemia may manifest as recalcitrant buttock claudication, vasculogenic impotence, or perineal, vesicle, rectal, and/or spinal cord ischemia. Branched graft technology has recently become available; however, many patients are not candidates for endovascular repair with these devices. Therefore, techniques to preserve pelvic arterial flow are needed. We reviewed our outcomes of isolated endovascular CIAA repair or EVAR in conjunction with unilateral external-internal iliac artery bypass. METHODS Single-center, retrospective review of 10 consecutive patients who underwent hybrid endovascular abdominal aortic aneurysm (AAA) or CIAA repair with concomitant external-internal iliac artery bypass between 2006 and 2015. Demographics, index procedural details, postoperative symptoms, hospital length of stay (LOS), follow-up imaging, and bypass patency were recorded. RESULTS The cohort of 10 patients was all men with a mean age of 71 years (range: 56-84). Hybrid repair consisted of contralateral IIA coil embolization followed by EVAR with external iliac artery-internal iliac artery (EIA-IIA) bypass. All EIA-IIA bypasses were performed via a standard lower quadrant retroperitoneal approach with a prosthetic bypass graft. Technical success was 100%, and there were no perioperative deaths. One patient developed transient paraplegia, 1 patient had buttock claudication on the side of his hypogastric embolization contralateral to his iliac bypass, and 1 developed postoperative impotence. 20% of patients sustained long-term complications (buttock claudication and postoperative impotence). Mean LOS was 2.8 days (range: 1-9 days). Postoperative imaging was obtained in 90% of patients, and mean follow-up was 10.8 months (range: 0.5-36 months). All bypasses remained patent. CONCLUSIONS Although branched graft technology continues to evolve, strategies to maintain adequate pelvic circulation are necessary to avoid the devastating complications of pelvic ischemia. We have demonstrated that a hybrid approach combining EVAR or isolated endovascular common iliac artery exclusion with a unilateral external-internal iliac bypass via a retroperitoneal approach is well tolerated with a short LOS and excellent patency rates.
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Affiliation(s)
- Neel A Mansukhani
- Division of Vascular Surgery, Department of Surgery, Northwestern University, Chicago, IL
| | - George E Havelka
- Division of Vascular Surgery, Department of Surgery, Northwestern University, Chicago, IL
| | | | - Heron E Rodriguez
- Division of Vascular Surgery, Department of Surgery, Northwestern University, Chicago, IL
| | - Andrew W Hoel
- Division of Vascular Surgery, Department of Surgery, Northwestern University, Chicago, IL
| | - Mark K Eskandari
- Division of Vascular Surgery, Department of Surgery, Northwestern University, Chicago, IL.
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Ardita V, Giaquinta A, Veroux M, Sanfiorenzo A, Virgilio C, D’Arrigo G, Veroux P. Endovascular repair of bilateral common iliac artery aneurysms using GORE Excluder iliac branch endoprosthesis without aortobi-iliac stent graft conjunction: A case report. Medicine (Baltimore) 2017; 96:e5977. [PMID: 28207510 PMCID: PMC5319499 DOI: 10.1097/md.0000000000005977] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Bilateral common iliac artery (CIA) aneurysm (CIAA) is a rare entity. In the past decade, different endovascular approaches have been adopted for patients with several comorbidities or unfit for open repair (OR). Recently, the use of iliac branch stent graft has been proposed, resulting in satisfactory patency rates and decrease in morbidity. Currently, according to instruction for use, the iliac branch stent graft is to be used with aortobi-iliac stent graft conjunction. We describe a case of a successful endovascular repair of bilateral CIAAs using the GORE Excluder iliac branch endoprosthesis (IBEs) without aortobi-iliac stent graft conjunction. CASE PRESENTATION An 83-year-old man was admitted with abdominal pain and presence of pulsatile mass in the right and left iliac fossa. Computed tomographic (CT) angiography showed the presence of large bilateral CIAAs (right CIA = 66 mm; left CIA = 38 mm), without concomitant thoracic or abdominal aorta aneurysm. Moreover, CT scan demonstrated the presence of bilateral lower accessory renal artery close to the aortic bifurcation. Due to the high operative risk, the patient was scheduled for endovascular repair with bilateral IBEs, without the aortobi-iliac stent graft conjunction to avoid the renal ischemia as a consequence of renal arteries covering. The procedure was completed without complications and duplex ultrasound demonstrated the complete exclusion of both aneurysms without any type of endoleaks at 1 month of follow-up. CONCLUSIONS GORE IBEs without aortobi-iliac stent graft conjunction seem to be a feasible and effective procedure for the treatment of isolated CIAAs in patients with highly selected anatomical conditions.
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Affiliation(s)
- Vincenzo Ardita
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Via Santa Sofia, Catania
- Vascular Surgery Unit, Guzzardi Hospital of Vittoria, Via Papa Giovanni XXIII, Vittoria
| | - Alessia Giaquinta
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Via Santa Sofia, Catania
| | - Massimiliano Veroux
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Via Santa Sofia, Catania
- Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Via Santa Sofia, Catania
| | - Angelo Sanfiorenzo
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Via Santa Sofia, Catania
| | - Carla Virgilio
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Via Santa Sofia, Catania
| | - Giuseppe D’Arrigo
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Via Santa Sofia, Catania
| | - Pierfrancesco Veroux
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Via Santa Sofia, Catania
- Department of Surgical Specialties, University Hospital of Catania, Via Santa Sofia, Catania, Italy
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Youssef M, Zerwes S, Jakob R, Dünschede F, Dorweiler B, Vahl CF. Treating iliac aneurysm using the Nellix Endovascular Sac Sealing System. Semin Vasc Surg 2016; 29:114-119. [DOI: 10.1053/j.semvascsurg.2016.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rückert RI, Hanack U, Aronés-Gomez S, Yousefi S. [Aneurysms of the abdominal aorta and iliac arteries: paradigm shift - operative therapy, if possible endovascular?]. Chirurg 2014; 85:782-90. [PMID: 25200628 DOI: 10.1007/s00104-014-2718-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Therapy of abdominal aortic aneurysms (AAA) is currently based on a high level of evidence. This is not true in the same manner for iliac artery aneurysms (IAA) which are frequently associated with AAAs and occur only rarely as isolated lesions. The therapeutic principles apply in the same way to both aneurysm locations. OBJECTIVES New findings, improved perioperative care and the rapid development of minimally invasive techniques require a constant update which is the aim of this article concerning the therapy of AAAs and IAAs. MATERIAL AND METHODS A systematic literature review was performed in PubMed and Medline and priority was given to recent publications with a high level of evidence. RESULTS Endovascular aneurysm repair (EVAR) and open aneurysm repair (OAR) result in a similar long-term survival. The perioperative survival advantage with EVAR persists only during medium-term postoperative courses. The reintervention rate after EVAR is substantially higher compared to OAR. For older patients and those who are considered unfit for OAR the expected benefits from EVAR has not been proven to date. Aneurysmal ruptures after EVAR demonstrate that a life-long surveillance of these patients is necessary. CONCLUSION Therapy of AAAs and IAAs is increasingly being performed by EVAR. Even the majority of complex aneurysms are amenable to minimally invasive treatment. Nevertheless, indications for OAR continue to exist. Screening for AAAs results in a decrease of aneurysmal ruptures for which EVAR is also gaining importance.
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Affiliation(s)
- R I Rückert
- Klinik für Gefäß- und endovaskuläre Chirurgie, Allgemein- und Viszeralchirurgie Franziskus-Krankenhaus, Akademisches Lehrkrankenhaus der Charité, Universitätsmedizin Berlin, Budapester Str. 15-19, 10787, Berlin, Deutschland,
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