1
|
Liao H, Zhou E, Tang Y, He C. Endovascular repair of bilateral isolated common iliac artery aneurysms with unsuitable anatomy utilizing an aortic bifurcated unibody endograft and modified sandwich technique to preserve pelvic blood flow: a case series. J Cardiothorac Surg 2024; 19:210. [PMID: 38616244 PMCID: PMC11017656 DOI: 10.1186/s13019-024-02674-2] [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: 08/05/2023] [Accepted: 03/23/2024] [Indexed: 04/16/2024] Open
Abstract
Bilateral isolated common iliac artery aneurysms (CIAAs) are rare, and endovascular repair of CIAAs has emerged as an alternative to traditional open surgical repair. The primary goal of therapy is to exclude the aneurysm sac while maintaining perfusion of at least one internal iliac artery (IIA) to prevent pelvic ischemia. Although the iliac branch device (IBD) has improved the feasibility of preserving the IIA, its applicability is limited to a specific subset of aneurysm anatomy. We present a case series of three patients with bilateral isolated CIAAs in whom preoperative CT scans revealed an absence of a landing zone, the diameter of proximal CIA diameter was less than 13.0 mm, and normal diameter of the nonaneurysmal infrarenal aorta, making it challenging to use an IBD alone or a standard bifurcated aortic endograft to provide a proximal landing zone for iliac artery stenting. To overcome the small diameter of the infrarenal aorta, we implanted an aortic bifurcated unibody endograft. Then, we utilized a balloon-expandable covered stent-graft with overdilation as a modified sandwich technique to create an "eye of the tiger" configuration to prevent gutter leakage. The final angiography performed during the procedure revealed successful exclusion of the aneurysms, with blood flow to the right IIA and no type III endoleak. During the postoperative follow-up period, no patients exhibited symptoms associated with pelvic ischemia. There were no endoleaks or sac expansions on the two-year follow-up CT scans, and all external and internal iliac graft limbs were patent. This study demonstrated that a combination of an aortic bifurcated unibody endograft and a modified sandwich technique can effectively treat bilateral isolated CIAAs with certain anatomical constraints.
Collapse
Affiliation(s)
- Haodong Liao
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, CN, China
| | - Enquan Zhou
- Department of Interventional Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, CN, China
| | - Yongjiang Tang
- Department of Vascular Disease, Panzhihua Municipal Central Hospital, Panzhihua, Sichuan, CN, China
| | - Chunshui He
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, Sichuan, CN, China.
| |
Collapse
|
2
|
Ye K, Qiu P, Qin J, Peng Z, Li W, Yin M, Lu X. Internal iliac artery preservation during endovascular aortic repair using in situ laser fenestration. J Vasc Surg 2023; 77:129-135. [PMID: 35944730 DOI: 10.1016/j.jvs.2022.07.174] [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: 05/13/2022] [Revised: 07/18/2022] [Accepted: 07/27/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of the present study was to evaluate the technical and short-term clinical outcomes of internal iliac artery (IIA) reconstruction during endovascular aortic repair (EVAR) with in situ laser-assisted fenestration in cases of abdominal aortic aneurysm (AAA) in which the iliac artery is unfit for an internal branched device (IBD). METHODS In the present single-institution retrospective study, we analyzed patients with AAAs who had undergone EVAR with in situ laser-assisted fenestration for IIA reconstruction between January 2018 and April 2021. The study included patients with iliac artery anatomy unfit for the use of commercial IBDs. The primary safety end point was freedom from major adverse events and unplanned reinterventions within 30 days. The primary efficacy end point was freedom from IIA restenosis, reintervention, and symptoms due to pelvic ischemia at 1 year after the procedure. RESULTS A total of 20 patients requiring IIA reconstruction but with anatomy unfit for IBD placement were treated with in situ laser-assisted fenestration during EVAR for aortoiliac aneurysms during the study period. The mean age of our patients was 72 years, and 90% were men. The technical success rate was 100%. No patient had died within 30 days after the procedure. A suspicious IIA perforation had occurred in one patient, which was treated with an additional covered stent, for a primary safety end point of 95.0%. After a mean follow-up of 11 months, all except for one of the reconstructed IIAs were patent. Three patients reported symptoms of buttock claudication on the IIA occluded side at their 3-month follow-up after the procedure. However, these symptoms had subsided in two of these patients at 6 months. Type II endoleaks without sac expansion had occurred in two patients owing to retrograde blood flow from the inferior mesenteric artery and lumbar artery. Both patients were kept under close surveillance. The rate of freedom from major adverse events and unplanned reinterventions within 30 days (primary efficacy end point) was 86.3% at 1 year after procedure. CONCLUSIONS In situ laser-assisted fenestration was found to be a safe and effective alternative method for IIA reconstruction during EVAR for aortoiliac aneurysms in patients with anatomy unfit for IBD.
Collapse
Affiliation(s)
- Kaichuang Ye
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Vascular Center of Shanghai JiaoTong University, Shanghai, China
| | - Peng Qiu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Vascular Center of Shanghai JiaoTong University, Shanghai, China
| | - Jinbao Qin
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Vascular Center of Shanghai JiaoTong University, Shanghai, China
| | - Zhiyou Peng
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Vascular Center of Shanghai JiaoTong University, Shanghai, China
| | - Weimin Li
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Vascular Center of Shanghai JiaoTong University, Shanghai, China
| | - Minyi Yin
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Vascular Center of Shanghai JiaoTong University, Shanghai, China
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Vascular Center of Shanghai JiaoTong University, Shanghai, China.
| |
Collapse
|
3
|
Wang W, Wu J, Shao J, Xu F, Chen Y, Liu B, Zheng Y. Single-Center Experience in the Endovascular Management of the Combination of Isolated Common and Internal Iliac Artery Aneurysms. Front Surg 2021; 8:693233. [PMID: 34336919 PMCID: PMC8319564 DOI: 10.3389/fsurg.2021.693233] [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: 04/10/2021] [Accepted: 06/22/2021] [Indexed: 11/19/2022] Open
Abstract
Objective: The combination of isolated common and internal iliac artery aneurysms (CIIAA) are rare, life-threatening, abnormal conditions with relatively complex treatment. This study aimed to evaluate the clinical characteristics and treatment outcomes of CIIAA. Methods: We retrospectively reviewed 26 patients with CIIAA consecutively treated between January 2010 and August 2020 at Peking Union Medical College Hospital. Demographic, clinical characteristic, treatment strategy and outcome data were collected and analyzed. Results: Twenty-six patients (24 men and 2 women) with a mean age of 70 years were included. There was a total of 72 aneurysms, and the mean diameters of the common iliac artery aneurysms (CIAA) and internal iliac artery aneurysms (IIAA) were 36 and 38 mm, respectively. Ten patients (38%) presented with bilateral CIAA and unilateral IIAA, and eight (31%) had CIAA with ipsilateral IIAA. All patients were treated with endovascular repair, and the overall primary technical success rate was 100%. The surgical techniques mainly included combined bifurcated stent grafting and embolization (n = 11), combined straight stent grafting and embolization (n = 8), and internal iliac artery (IIA) reconstruction (n = 7). There were no patient deaths or reintervention during hospitalization. The mean follow-up time was 43 months, and the patency rate of the stent was 96.2%. The overall reintervention rate was 7.7%. During the follow-up period, there were no aneurysm-related deaths. Conclusions: Endovascular repair involving stent graft placement, coil embolization and IIA revascularization is a safe and effective treatment for isolated CIIAA.
Collapse
Affiliation(s)
- Wei Wang
- Department of Vascular Surgery, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianqiang Wu
- Department of Vascular Surgery, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiang Shao
- Department of Vascular Surgery, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fang Xu
- Department of Vascular Surgery, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuexin Chen
- Department of Vascular Surgery, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bao Liu
- Department of Vascular Surgery, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuehong Zheng
- Department of Vascular Surgery, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
4
|
Experimental in vitro study of parallel stent technique in endovascular repair of complex abdominal aortic aneurysms. ANGIOLOGIA 2021. [DOI: 10.20960/angiologia.00269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
5
|
Frenzel F, Fries P, Shayesteh-Kheslat R, Buecker A, Massmann A. Single Angio-Seal vascular closure device for transfemoral access exceeding 8F. J Cardiol 2020; 76:211-216. [PMID: 32402666 DOI: 10.1016/j.jjcc.2020.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/07/2020] [Accepted: 02/18/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND This was a retrospective single-center evaluation for off-label use of a single Angio-Seal-VIP 8F vascular closure device (VCD) (Terumo Interventional Systems, Somerset, NJ, USA) for retrograde transfemoral arterial access exceeding 8F. METHODS Between 2010 and 2018, in 32 consecutive patients (3 females; mean age 67±9; range 46-86 years) retrograde femoral access was performed in 48 groins for aortoiliac stent or stent graft implantations using 9-14F sheaths. For vascular closure, one single Angio-Seal™-VIP 8F was used. Procedural success, closure-related complications, and risk factors were retrospectively evaluated using patient characteristics, duplex-ultrasound, and contrast-enhanced computed tomography angiography (CTA). Receiver-operating-characteristics were used for statistical analysis. RESULTS Technical success for deployment of VCD was 100%. Visual inspection and duplex-ultrasound confirmed immediate hemostasis in 100%. Postinterventional CTA depicted major vascular access site complications in 6.3% (3/48 groins) requiring surgical treatment. A subgroup of 13 patients underwent surgical cut-down one day after VCD deployment as part of a two-staged complex endovascular aortic aneurysm repair procedure, allowing for visual assessment of prior used undersized Angio-SealTM. Patient's height (p=0.028) and severe access site calcifications (p=0.028) proved as predictors for one vessel occlusion and two pseudoaneurysms. Low body-mass-index (BMI) showed a non-significant trend. Sheath-size, common femoral artery depth, or body weight were not indicative for occurrence of complications. CONCLUSIONS In selected cases, without availability of appropriate VCDs, a single Angio-SealTM-VIP 8F served as a feasible option to achieve sufficient hemostasis of transfemoral access exceeding 8F without relevant bleeding complications. Very low BMI, tall body-height, and severe atherosclerosis were identified to predispose to access site complications.
Collapse
Affiliation(s)
- Felix Frenzel
- Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Peter Fries
- Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Roushanak Shayesteh-Kheslat
- Clinic for General, Abdominal and Vascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Arno Buecker
- Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Alexander Massmann
- Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany.
| |
Collapse
|
6
|
Massmann A, Fries P, Shayesteh-Kheslat R, Buecker A, Stöckle M, Niklas C. Life-threatening arterioureteral fistula treatment by endovascular complete anatomic iliac artery bifurcation reconstruction. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:199-204. [PMID: 32322776 PMCID: PMC7160530 DOI: 10.1016/j.jvscit.2020.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/26/2020] [Indexed: 11/16/2022]
Abstract
We present an endovascular approach for anatomic reconstruction of the iliac bifurcation in life-threatening arterioureteral fistula without sacrificing the pelvic arterial vascular supply. Five consecutive patients suffering from acute onset of significant gross hematuria caused by iliac-ureteral fistula resulting from previous oncologic surgery and radiation therapy were treated by transfemoral stent graft implantation in a double-barrel technique. Iliac-ureteral pseudoaneurysm coverage succeeded in an iliac neobifurcation with preservation of pelvic perfusion. Follow-up ranging from 9 to 37 months confirmed cessation of hematuria. One patient experienced stent graft thrombosis of the external iliac artery as a result of large cervical cancer invasion treated by crossover bypass. In all other patients, stent grafts were patent.
Collapse
Affiliation(s)
- Alexander Massmann
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Peter Fries
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | | | - Arno Buecker
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Michael Stöckle
- Clinic for General, Abdominal and Vascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Christina Niklas
- Clinic for General, Abdominal and Vascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Abstract
CLINICAL/METHODICAL ISSUE New technical developments in endovascular aortic repair (EVAR) have broadened the range of patients eligible for minimally invasive aneurysm treatment. Optimization of delivery sheaths and catheters by considerable downsizing of diameters, increase of pushability and stability combined with flexibility are important parameters. PERFORMANCE Especially patients characterized by small and tortuous iliac access vessels can nowadays be treated by EVAR. Ease and effectiveness of applicability guarantee safety and quality improvement, which results in better treatment of patients. Progress in stent-graft design with integrated options for repositioning, active positioning and aneurysm sealing facilitate treatment of angulated vessel segments or hitherto unsuitable sealing zones. PRACTICAL RECOMMENDATIONS Interventionalists have to be familiar with all available stent-graft materials and techniques. Profound knowledge helps to choose the best material for a patient's individual anatomy, confident application and long-term satisfactory results.
Collapse
|
9
|
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]
|
10
|
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]
|
11
|
Pang H, Chen Y, He X, Zeng Q, Ye P. Selection of Stents by Calculation of Arterial Cross-sectional Area in Modified Sandwich Technique for Complex Aortoiliac Arterial Lesions. Ann Vasc Surg 2019; 58:108-114. [PMID: 30731228 DOI: 10.1016/j.avsg.2018.10.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/08/2018] [Accepted: 10/16/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND We prospectively evaluated the modified sandwich technique for treatment of complex aortoiliac arterial lesions using commercial stent grafts selected according to the arterial cross-sectional area. The primary outcomes were technical feasibility and mid-term follow-up results. METHODS We prospectively enrolled 13 patients (mean age 63.85 ± 6.12 years) with aortoiliac arterial lesions (5 infrarenal abdominal aortic dissections, 1 lower abdominal aortic occlusion, 5 iliac artery aneurysms, 1 external iliac arterial pseudoaneurysm, and 1 type IB endoleak following endovascular aneurysm repair) for endovascular repair with the modified sandwich technique. All lesions were complex and unsuitable for routine endovascular treatment. The bifurcated stent-graft diameters were determined by calculating the arterial cross-sectional area. Success and complication rates were recorded. Patients were followed for 20.69 ± 6.51 (range 6-31) months and stent patency determined by contrast-enhanced ultrasound and computed tomography 1, 3, and 6 months post-operatively and every 12 months thereafter. RESULTS The initial technical success rate was 100%, and no surgical complications occurred. The primary patency of the stent grafts was 100% during follow-up. Post-procedural type I "gutter" endoleaks occurred in 4 patients (30.8%) after 1 month. At 3 months, the endoleaks in 3 of the 4 patients had disappeared without treatment, and the remaining endoleak resolved after coil embolization. CONCLUSIONS The sandwich technique is a safe and effective therapy for complex aortoiliac arterial lesions. Stent-graft sizes based on the arterial cross-sectional area can ensure technical success and reduce the rate of "gutter" endoleaks.
Collapse
Affiliation(s)
- Huajin Pang
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Yong Chen
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China.
| | - Xiaofeng He
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Qingle Zeng
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Peng Ye
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| |
Collapse
|
12
|
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]
|
13
|
Massmann A, Shayesteh-Kheslat R, Fries P, Buecker A. Endovascular Aortic Repair with the Use of Low-Profile Altura and Covera Stent Graft for Accessory Renal Artery Chimney. J Vasc Interv Radiol 2018; 29:1285-1288. [PMID: 30146197 DOI: 10.1016/j.jvir.2018.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Alexander Massmann
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Straße, Geb. 50.1, 66421 Homburg, Germany
| | | | - Peter Fries
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Straße, Geb. 50.1, 66421 Homburg, Germany
| | - Arno Buecker
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Straße, Geb. 50.1, 66421 Homburg, Germany
| |
Collapse
|
14
|
Wu ZY, Chen ZG, Diao YP, Sun R, Liu CW, Chen YX, Zheng YH, Liu B, Li YJ. Endovascular Repair of Complex Aortoiliac Aneurysm with the Sandwich Technique in Sixteen Patients. Ann Vasc Surg 2018; 54:233-239. [PMID: 30053551 DOI: 10.1016/j.avsg.2018.05.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 04/10/2018] [Accepted: 05/04/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND This study aimed to evaluate the safety and efficiency of the sandwich technique in endovascular repair of complex aortoiliac aneurysm. METHODS Sixteen patients (mean age 69.6 years, ranging from 58 to 78 years) with complex aortoiliac aneurysm were studied retrospectively from October 2013 to September 2017 in two vascular centers of teaching hospitals. Computed tomography angiography (CTA) was performed to make individual therapy. They were all performed endovascular repair with sandwich technique, including one with the sandwich, chimney, and fenestrated techniques during the same procedure. All patients were followed up at 1 month, 3 months, 6 months, 12 months, and yearly thereafter with X-ray, ultrasound, and/or CTA. RESULTS The initial technical success was 81.25%, and the assisted technical success was 100%. At final angiography, little flow of a type I and a type III endoleak was found in two patients with observation. Two type II endoleaks were also detected. During the perioperative period, two patients suffered myocardial infarction. One pulmonary infection and one urinary infection happened. No death or cerebrovascular events occurred. During the follow-up (mean 18 months, ranging from 2 to 45 months), three stent occlusions were detected. One case got reintervened for his external iliac artery stent thrombosis in the first month postoperatively. The other two were under observation. A readmission happened to one man for his right brachial artery pseudoaneurysm in the third month postoperatively. One patient died of nonaneurysmal related reason in the eighth month. No aneurysmal related death, rupture, or new endoleak was found. No paralysis, claudication, or bowel ischemia was complained of. The primary patency of the preserved branches were 94.7%, 92.0%, 92.0%, 92.0%, 92.0% separately in first, sixth, 12th, 24th, and 36th month. CONCLUSIONS For patients who are not candidates for open surgery or conventional endovascular repair with complex aortoiliac aneurysm, the sandwich technique is a feasible alternative to management.
Collapse
Affiliation(s)
- Zhi-Yuan Wu
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China; Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zuo-Guan Chen
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China; Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yong-Peng Diao
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China; Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Rui Sun
- Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Chang-Wei Liu
- Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yue-Xin Chen
- Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yue-Hong Zheng
- Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Bao Liu
- Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yong-Jun Li
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China; Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
| |
Collapse
|
15
|
Kim D, Chung JK, Park HS, Jung IM, Lee T. Early Experiences of Sandwich Technique to Preserve Pelvic Circulation during Endovascular Aneurysm Repair. Vasc Specialist Int 2017; 33:72-80. [PMID: 28690999 PMCID: PMC5493190 DOI: 10.5758/vsi.2017.33.2.72] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 05/18/2017] [Accepted: 05/19/2017] [Indexed: 11/20/2022] Open
Abstract
Purpose To report experiences of the sandwich technique (ST) for preservation of pelvic flow during endovascular repair of complex aortic or aortoiliac aneurysms. Materials and Methods Eight patients underwent elective endovascular aneurysm repair (EVAR) using the ST between March 2013 and February 2017. The anatomic indications for the ST were complex aortoiliac aneurysms (5 cases), abdominal aortic aneurysms (AAA) with non-diseased short common iliac arteries (2 cases) and AAA with unilateral occluded iliac artery (1 case). The ST was performed through both femoral and brachial approach. Patient clinical and radiologic data were collected and analyzed. Results Eight patients (7 male; mean age, 73.4 years) were followed over a mean period of 277 days (range, 9–1,106 days). The technical success rate was 100%. The primary patency rate of the iliac stent-grafts was 88% (14/16 cases). One internal iliac and 1 external iliac stent-graft occlusion was observed during the early postoperative period. There was 1 gutter endoleak which disappeared spontaneously within 4 days, and there were 2 type II endoleaks: one treated by coil embolization after 13 months, and the other observed without treatment. There were no cases of sac growth or aneurysm-related deaths, and no cases of buttock claudication or impotence. Conclusion The ST is a safe and feasible technique to preserve pelvic circulation during endovascular treatment of complex aortoiliac aneurysms. The need to expand the indications for complex EVARs with adjunctive procedures, such as the ST is highlighted in situations where branched/fenestrated device availability is limited.
Collapse
Affiliation(s)
- Daehwan Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Kee Chung
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung Sub Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - In Mok Jung
- Department of Surgery, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Taeseung Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|