Use of flow-diverting stents to treat para-anastomotic iliac artery aneurysms after previous open aortic prosthetic reconstruction

Common Iliac Artery Aneurysm Repair Using a Sac-Anchoring Endograft to Preserve the Internal Iliac Artery

PURPOSE

To report the application of the Nellix endovascular aneurysm sealing system to successfully treat a unilateral common iliac aneurysm and preserve the internal iliac artery.

CASE REPORT

An 85-year-old man presented with right-sided necrosis of the third and fourth toe. Computed tomography angiography (CTA) showed a right 40-mm popliteal aneurysm and a 38-mm left fusiform common iliac artery aneurysm. After endovascular exclusion of the popliteal aneurysm, the Nellix device was positioned to exclude the common iliac artery aneurysm while preserving the internal iliac artery. Postoperative CTA showed no endoleak and a patent internal iliac artery. At 1 year, duplex ultrasound documented a common iliac aneurysm diameter of 32 mm without complications.

CONCLUSION

Endovascular sealing using the Nellix device can be applied to exclude selected common iliac artery aneurysms with an adequate length and a minimal distal neck, with preservation of the internal iliac artery. The endobag can be positioned such that the aneurysm is completely excluded while the orifice of the side branch is not endangered.

Multiple overlapping uncovered stents as an alternative flow-diverting strategy in the management of peripheral and visceral aneurysms

OBJECTIVE

In this study we aimed to report on the midterm outcome of multiple overlapping uncovered stents in the treatment of peripheral and visceral aneurysms, and analyze the possible factors affecting the treatment efficacy.

METHODS

Data of patients who were regularly followed up over 24 months were retrospectively reviewed. Descriptive statistics were applied to present aneurysm thrombosis process and diameter change at each follow-up point, and a comparison with the baseline level was performed. Patients were divided into a totally thrombosed (TT) group and a residual perfusion (RP) group according to the sac thrombosis ratio (thrombus volume to sac volume ratio) at 3, 6, and 12 months of follow-up. Aneurysm shrinkage in the two groups was compared to explore the effect of the initial RP on the treatment outcome. Patients were also grouped based on their aneurysm morphology (saccular/fusiform). The aneurysm sac thrombosis speed (time to thrombosis) and diameter decrease (DD) ratio (percentage of DD) were compared between the two groups to understand the influence of aneurysm shape on the treatment efficacy.

RESULTS

Of the 64 patients treated, the initial 37 patients (25 male; average age, 55.5 ± 13.0 years) were enrolled into this study. Technical success rate was 100%. All patients were regularly followed up. At 24 months, 94.6% aneurysms (35/37) were TT, and the maximum aneurysm diameter decreased from 36.5 ± 9.7 mm preoperatively to 23.6 ± 7.7 mm (P < .001). Overall clinical success rate (complete thrombosis and shrinkage/stabilization of the aneurysm without aneurysm-related mortality) reached 94.6% in the study cohort. Most side branches (31/33) covered by the bare stent stayed patent during follow-up. Initial sac RP at 3, 6, and 12 months might not fully affect the final aneurysm DD ratio (TT group: 0.37 ± 0.09, 0.35 ± 0.09, and 0.35 ± 0.09; compared with the RP group: 0.33 ± 0.09, 0.36 ± 0.11, and 0.36 ± 0.13; P = .153, .964, and .418, respectively). At 3 and 6 months follow-up, saccular aneurysms (n = 29) seemed to have a faster thrombosis speed compared with fusiform aneurysms (78.1 ± 26.8% and 83.9 ± 21.8% vs 47.0 ± 24.4% and 63.9 ± 22.6%; P = .004 and .013, respectively), but there was no significant difference in aneurysm shrinkage ratio at 24 months between the two groups (0.36 ± 0.10 vs 0.33 ± 0.06; P = .357).

CONCLUSIONS

Multiple overlapping uncovered stents could be a feasible option for the endovascular treatment of peripheral and visceral aneurysms. Neither the aneurysm shape nor the initial sac RP would affect the midterm treatment outcome. Further validation of this technique is required to substantiate these results.