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Obrand J, Jones M, Mirakhur A, Rommens K, Moore R. A hybrid approach to complex bilateral common iliac artery and internal iliac artery aneurysm repair. J Vasc Surg Cases Innov Tech 2024; 10:101410. [PMID: 38379612 PMCID: PMC10877432 DOI: 10.1016/j.jvscit.2023.101410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/14/2023] [Indexed: 02/22/2024] Open
Abstract
A case of a young patient with incidental bilateral internal iliac artery aneurysms and common iliac artery aneurysms is described. A staged hybrid surgical approach was performed to preserve pelvic perfusion, with bilateral stent grafts deployed into an ipsilateral anterior division branch and contralateral posterior division branch of the internal iliac arteries. One week later, an open infrarenal aorto-bi-iliac graft was performed with distal anastomoses to the previously deployed stent grafts. The findings from the present case add to the growing number of reported cases of hybrid repair of bilateral internal iliac and common iliac artery aneurysms with preservation of pelvic perfusion.
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Affiliation(s)
- Jeremy Obrand
- Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Melissa Jones
- Division of Vascular Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Anirudh Mirakhur
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kenton Rommens
- Division of Vascular Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Randy Moore
- Division of Vascular Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Hanif H, Clark RM, Guliani S, Rana MA. A hybrid approach to previously excluded, expanding internal iliac artery aneurysms. J Vasc Surg Cases Innov Tech 2023; 9:101313. [PMID: 37822945 PMCID: PMC10562858 DOI: 10.1016/j.jvscit.2023.101313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/14/2023] [Indexed: 10/13/2023] Open
Abstract
Previously excluded internal iliac artery (IIA) aneurysms can continue to expand and pose a risk of rupture. In this case series, we present three patients with previously excluded, expanding IIA aneurysms after endovascular stent coverage or open surgical ligation of the proximal IIA. We describe a hybrid approach to treat these patients safely and effectively.
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Affiliation(s)
- Hamza Hanif
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM
| | - Ross M. Clark
- Division of Vascular Surgery, Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM
| | - Sundeep Guliani
- Division of Vascular Surgery, Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM
| | - Muhammad Ali Rana
- Division of Vascular Surgery, Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM
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Tsuda E. Long-term results of large common iliac artery aneurysms caused by Kawasaki disease in four patients. Cardiol Young 2023; 33:1686-1690. [PMID: 36184839 DOI: 10.1017/s104795112200316x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Among Kawasaki disease patients with systemic artery aneurysms, the brachial and internal iliac arteries are the most commonly affected, and occlusions of both arteries are often found. However, the long-term fate of large common iliac artery aneurysms remains unknown, because their prevalence is very low. The long-term outcomes of common iliac artery aneurysms caused by Kawasaki disease in four patients (three females, one male) were investigated retrospectively based on their medical records and angiograms. Their ages ranged from 30 to 36 years-old. The onset age of Kawasaki disease ranged from 4 to 8 months, and the interval from the onset of Kawasaki disease to the latest angiogram ranged from 17 to 21 years. All patients had bilateral large coronary aneurysms and common iliac artery aneurysms with maximal diameters greater than 10 mm. Although all patients had multi-vessel coronary artery stenotic lesions and systemic artery aneurysms, they were asymptomatic. The three female patients underwent coronary artery bypass grafting, and the male patient underwent replacement of artificial vessels for large bilateral common iliac artery aneurysms at 3 years old of age. Over the long-term, common iliac artery aneurysms greater than 10 mm persisted as calcified aneurysms. However, they had no symptoms due to their common iliac artery aneurysms, and their ankle brachial pressure index was preserved, even if the stenosis of the common iliac artery developed as a late outcome, because the collateral arteries were well developed. The progression of stenosis of the common iliac artery after Kawasaki disease was slower.
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Affiliation(s)
- Etsuko Tsuda
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Nishi S, Arima D, Matsumoto R, Kurahashi K, Yoshimoto A, Suematsu Y. Custom-made iliac fenestrated endoprosthesis for the treatment of internal iliac artery aneurysm with preservation of the superior gluteal artery. J Vasc Surg Cases Innov Tech 2021; 7:532-535. [PMID: 34401619 PMCID: PMC8358284 DOI: 10.1016/j.jvscit.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/09/2021] [Indexed: 10/24/2022]
Abstract
A 56-year-old man with huge bilateral internal iliac artery aneurysms (IIAAs) had emergently undergone right common iliac artery replacement. Intermittent claudication was induced by 8 minutes of walking on postoperative day 16. Endovascular repair using a custom-made iliac fenestrated endoprosthesis for the treatment of the left IIAA with preservation of the superior gluteal artery was performed on postoperative day 20 without discharging the patient. The patient had no ischemic complications. When an IIAA with a short length (<55 mm) and large diameter (>21 mm) of the common iliac artery is anatomically suitable, the placement of a custom-made iliac fenestrated endoprosthesis is a feasible and effective technique.
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Affiliation(s)
- Satoshi Nishi
- Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Ibaraki, Japan
| | - Daisuke Arima
- Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Ibaraki, Japan
| | - Ryumon Matsumoto
- Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Ibaraki, Japan.,Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kanan Kurahashi
- Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Ibaraki, Japan
| | - Akihiro Yoshimoto
- Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Ibaraki, Japan
| | - Yoshihiro Suematsu
- Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Ibaraki, Japan
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Kim YJ, Rabei R, Connolly K, Pallav Kolli K, Lehrman E. Percutaneous approach options for embolization of endoleak after iliac artery aneurysm repair: stick the sac or stick the gluteal artery. Radiol Case Rep 2021; 16:1447-1450. [PMID: 33912261 PMCID: PMC8065193 DOI: 10.1016/j.radcr.2021.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/20/2021] [Indexed: 11/30/2022] Open
Abstract
Internal iliac artery aneurysms (IIAAs), isolated or associated with abdominal aortic aneurysms, are at rupture risk with growth. Treatment is recommended when symptomatic or greater than 3 cm. Surgical or endovascular therapy should exclude the arterial origin and outflow branches. If all outflow branches are not completely embolized, an endoleak can develop, pressurizing the sac leading to growth and rupture. Accessing the arteries involved can be technically challenging and understanding potential targets is critical. We describe two percutaneous approaches for treatment: percutaneously accessing the sac from an anterior trans-iliopsoas approach and percutaneously accessing the gluteal artery from a posterior approach.
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Affiliation(s)
- Yoon-Jin Kim
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Avenue, 2nd Floor, Room S-257, San Francisco, CA 94143 USA
| | - Rana Rabei
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Avenue, 2nd Floor, Room S-257, San Francisco, CA 94143 USA
| | - Kevin Connolly
- Radiology Associates of San Luis Obispo, PO Box 2920, Atascadero, CA 93423 USA
| | - K Pallav Kolli
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, M-361, San Francisco, CA 94143 USA
| | - Evan Lehrman
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, M-361, San Francisco, CA 94143 USA
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Giordano G, Meo D, Magnano San Lio V. Internal iliac artery aneurysm embolization with direct percutaneous puncture and thrombin injection. Radiol Case Rep 2020; 15:210-3. [PMID: 31890070 DOI: 10.1016/j.radcr.2019.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/21/2019] [Accepted: 11/24/2019] [Indexed: 11/23/2022] Open
Abstract
Endoleak it is the most common complication after endovascular abdominal aortic aneurysm repair and it represents the failure of endovascular treatment. In particular type 2 endoleak is associated with retrograde flow in the aneurysm sac from one or more arterial branches. We describe a reperfusion of the aortic aneurysm sac with slow-flow type II endoleak from the right internal iliac artery aneurysm through the posterior door previously closed with coils, and treatment with direct puncture of the internal iliac artery aneurysm with infixion of human thrombin under ultrasound guidance, not previously described in the literature. In this case the direct puncture of the aneurysm sac was the faster and safer way to treat this patient just because the back door was closed by coils and the entry by the iliac graft. Thrombin reduces significantly the presence of artifacts and give to us the exact extension of thrombosis into the aneurysm sac and the echo-guided offers the advantage of being able to monitor the progression of the thrombotic process induced by thrombin injection in real time.
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Kliewer M, Plimon M, Taher F, Walter C, Hirsch K, Falkensammer J, Assadian A. Endovascular treatment of hypogastric artery aneurysms. J Vasc Surg 2019; 70:1107-14. [PMID: 31147136 DOI: 10.1016/j.jvs.2018.12.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 12/18/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Internal iliac artery aneurysm (IIAA) is a rare entity. Its treatment can be technically challenging. The aim of this study was to evaluate the treatment possibilities in an era of advanced endovascular techniques and their potential to preserve iliac blood flow while reliably excluding the aneurysm. METHODS A retrospective analysis of 46 consecutive patients with endovascularly treated IIAA was performed. Data were collected from a single-institution aortoiliac database. The following end points were recorded: technique of aneurysm exclusion, technical success rates, perioperative morbidity and mortality, primary patency, and midterm follow-up. RESULTS Between September 2009 and May 2016, a total of 46 patients with 55 IIAAs were identified. The majority of patients (n = 39 [84.8%]) had aortoiliac aneurysms and seven had isolated IIAAs (15.2%). The following surgical techniques were used: implantation of iliac branch devices (IBDs; n = 29), occlusion of the internal iliac artery (IIA) by ostium coverage with or without prior coil embolization (n = 23), and other endovascular techniques (n = 3). Primary assisted technical success was achieved in 93.1% of IBD implantations and in 100% of occlusions by ostium coverage and other techniques. Overall 30-day mortality was 4.3% (n = 2) and 0% in electively treated patients. Assisted midterm patency after IBD implantation was 93.1%. Gluteal claudication occurred in seven patients (15.2%) who had undergone intentional or accidental occlusion of the IIA or the superior gluteal artery. Reintervention rates within the midterm follow-up were 13.8% (n = 4) after IBD implantation and 4.3% (n = 1) after coverage of the IIA ostium. No ruptures were observed during follow-up, and no complications occurred during reinterventions. CONCLUSIONS Implantation of IBD devices for the treatment of hypogastric artery aneurysms shows good technical results with a high primary patency and a low rate of perioperative complications. Although successful aneurysm exclusion while preserving pelvic blood flow is associated with a higher rate of reinterventions during midterm follow-up, it should be taken into consideration, especially in complex endovascular aortoiliac aneurysm repair.
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Iwafuchi Y, Oyama Y, Narita I. Huge internal iliac artery aneurysm and post-renal AKI. Clin Exp Nephrol 2019; 23:1087-1088. [PMID: 31093823 DOI: 10.1007/s10157-019-01745-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 05/03/2019] [Indexed: 11/24/2022]
Abstract
We report a rare case of a huge internal iliac artery aneurysm (IAA) complicated by post-renal acute kidney injury. Huge internal IAA should be considered for one of differential diagnoses for post-renal acute kidney injury.
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Affiliation(s)
- Yoichi Iwafuchi
- Department of Internal Medicine, Koseiren Sanjo General Hospital, 5-1-62 Tsukanome, Sanjo, 955-0055, Japan.
| | - Yuko Oyama
- Department of Internal Medicine, Koseiren Sanjo General Hospital, 5-1-62 Tsukanome, Sanjo, 955-0055, Japan
| | - Ichiei Narita
- Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-754 Asahimachi-Dori, Chuo-ku, Niigata, 951-8510, Japan
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Png CYM, Cornwall JW, Faries PL, Marin ML, Tadros RO. Bilateral GORE Iliac Branch Endoprosthesis with prior open abdominal aortic aneurysm repair. J Vasc Surg Cases Innov Tech 2019; 5:84-87. [PMID: 31193367 PMCID: PMC6529588 DOI: 10.1016/j.jvscit.2018.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 08/13/2018] [Indexed: 11/26/2022]
Abstract
The GORE Iliac Branch Endoprosthesis (W. L. Gore & Associates, Flagstaff, Ariz) has been approved by the Food and Drug Administration for use in the treatment of aortoiliac and common iliac aneurysms, with promising results to date. The efficacy of using the device to overlap with a Dacron graft has yet to be elucidated. We present the case of a patient with prior open abdominal aortic aneurysm repair who we treated with bilateral iliac branch endoprostheses.
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Affiliation(s)
- C Y Maximilian Png
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - James W Cornwall
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Peter L Faries
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael L Marin
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rami O Tadros
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
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Nenezic D, Tanaskovic S, Gajin P, Ilijevski N, Novakovic A, Radak D. A rare case of large isolated internal iliac artery aneurysm with ureteral obstruction and hydronephrosis: Compression symptoms are limitation for endovascular procedures. Vascular 2014; 23:170-5. [PMID: 24821682 DOI: 10.1177/1708538114533963] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION In this report, we aim to present a rare case of isolated internal iliac artery aneurysm with associated left ureteric obstruction and consequent hydronephrosis. CASE REPORT A 66-year-old male patient was admitted for occasional pain in the lower back that appeared one month earlier. CT arteriography revealed isolated internal iliac artery (diameter 99 mm) with ureteral obstruction, hydroureter and left kidney hydronephrosis occurrence. Aneurysm was resected, after six months the patient was doing well. Bearing in mind that 77% of the patients with isolated internal iliac artery have symptoms caused by aneurysmal compression on adjacent organs, we wanted to highlight that despite the amazing expansion of endovascular procedures in the last decades, its therapeutic effect in isolated internal iliac artery's treatment is to a great extent limited since compression symptoms cannot be solved. CONCLUSION Open surgery remains the gold standard for isolated internal iliac artery's treatment considering significant limitations of endovascular procedures due to the inability to eliminate problems caused by compression.
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Affiliation(s)
- Dragoslav Nenezic
- Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Serbia Faculty of Medicine, University of Belgrade, Serbia
| | | | - Predrag Gajin
- Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Serbia Faculty of Medicine, University of Belgrade, Serbia
| | - Nenad Ilijevski
- Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Serbia Faculty of Medicine, University of Belgrade, Serbia
| | | | - Djordje Radak
- Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Serbia Faculty of Medicine, University of Belgrade, Serbia
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