CT Study of the Relationship Between the Common Iliac Artery and Vein and Their Juxtaposition: Implications for Conduit Construction Prior to Endosvascular Stent-Graft Repair of Aortic Aneurysms

We retrospectively reviewed 41 patients with isolated iliac artery aneurysms presenting over a 21-year period. The mean age was 72 years. Mean aneurysmal diameter was 6.0 cm (range, 3.2–13 cm). The aneurysms were located in the common iliac artery in 31 patients, internal iliac artery in 7, and both arteries in 3. Rupture occurred in 20 patients (49%). The frequency of rupture of isolated iliac artery aneurysms was significantly higher than that of abdominal aortic aneurysms (8%) during the same period. The 30-day mortality was 9.8%; death in all 4 patients was due to rupture of the aneurysm. The surgical procedure was aneurysmectomy and replacement with a bifurcated prosthetic graft in 24 patients (59%), closure of the common iliac artery with a femorofemoral crossover in 7, minilaparotomy in 3, thromboexclusion in 6, and endoluminal stent-graft repair in one. In contrast to abdominal aortic aneurysms, isolated iliac artery aneurysms can be treated by various methods other than replacement with a bifurcated prosthetic graft. When selecting a strategy for such aneurysms, it is important to choose an approach appropriate to the location and risk, because of the frequency of rupture.

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Endovascular Stent-Graft Repair of Common Iliac Artery–to–Inferior Vena Cava Fistula

Journal of Vascular and Interventional Radiology ◽

10.1016/s1051-0443(95)71190-3 ◽

1995 ◽

Vol 6 (5) ◽

pp. 803-806 ◽

Cited By ~ 35

Author(s):

Albert B. Zajko ◽

Andrew F. Little ◽

David L. Steed ◽

Edward I. Curtiss

Keyword(s):

Inferior Vena Cava ◽

Stent Graft ◽

Iliac Artery ◽

Inferior Vena ◽

Common Iliac Artery ◽

Vena Cava ◽

Endovascular Stent ◽

Endovascular Stent Graft ◽

Stent Graft Repair ◽

Endovascular Stent Graft Repair

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Use of a Steerable Sheath for Retrograde Access to Antegrade Branches in Branched Stent-Graft Repair of Complex Aortic Aneurysms

Journal of Endovascular Therapy ◽

10.1177/1526602818794965 ◽

2018 ◽

Vol 25 (5) ◽

pp. 566-570 ◽

Cited By ~ 22

Author(s):

Vladimir Makaloski ◽

Nikolaos Tsilimparis ◽

Fiona Rohlffs ◽

Konstantinos Spanos ◽

E. Sebastian Debus ◽

...

Keyword(s):

Upper Extremity ◽

Stent Graft ◽

Femoral Artery ◽

Common Femoral Artery ◽

Aortic Aneurysms ◽

Femoral Access ◽

Aortic Stent Graft ◽

Stent Graft Repair ◽

The Common ◽

Steerable Sheath

Purpose: To describe how to use a steerable sheath from a femoral access to catheterize antegrade branches in a branched aortic stent-graft. Technique: Following femoral cutdown, a stent-graft with antegrade branches destined for renovisceral target vessels was deployed in the desired position. A steerable sheath with a tip that rotates up to 180° was introduced from the common femoral artery and navigated to the antegrade branches for consecutive catheterization of the target vessels and deployment of one or more bridging stents per branch. The technique is demonstrated in 4 patients who underwent successful complex abdominal and thoracoabdominal branched endovascular repairs with 1, 2, and 4 antegrade branches. Conclusion: Retrograde access for complex aortic endografts with antegrade branches using a steerable sheath appears feasible and effective and may serve as an alternative to upper extremity access.

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Iliac artery deformation during EVAR

Vascular ◽

10.1177/1708538119840565 ◽

2019 ◽

Vol 27 (5) ◽

pp. 511-517 ◽

Cited By ~ 1

Author(s):

Giasemi Koutouzi ◽

Marcus Pfister ◽

Katharina Breininger ◽

Mikael Hellström ◽

Håkan Roos ◽

...

Keyword(s):

Stent Graft ◽

Iliac Artery ◽

Common Iliac Artery ◽

Delivery Systems ◽

Data Sets ◽

Aortic Bifurcation ◽

Iliac Arteries ◽

The Common ◽

Common Iliac Arteries ◽

Iliac Bifurcation

Objectives To quantify the deformation of the common iliac artery caused by stiff guide wires and delivery systems during abdominal endovascular aortic repair (EVAR). Methods Twenty-two patients treated with abdominal EVAR were included. The following three image data-sets were acquired for each patient: (1) a preoperative computed tomography angiography (CTA), (2) an intraoperative contrast-enhanced cone beam CT (CBCT) obtained after the main trunk of the bifurcated stent graft was released and both iliac limbs were engaged with stiff guide wires, and (3) the first postoperative CTA. These data-sets were merged and compared in an image analysis work station. The length and the tortuosity index of the common iliac artery, the Euclidian displacement of the aortic and the iliac bifurcations, and the optimal C-arm angulation for projection of the iliac bifurcation were computed. Results The common iliac artery was on average 6.4 mm shorter ( p < 0.001) and tortuosity index was lower ( p = 0.003) in the intraoperative images compared to preoperative. Some of the foreshortening was reversed postoperatively, remaining mean length difference was 2.9 mm ( p = 0.007) compared to preoperative. Intraoperatively, the aortic bifurcation was mostly displaced in a cranial direction (100%) and the iliac bifurcation in a ventral direction (93%). The optimal lateral C-arm angulation for projection of the iliac bifurcation changed. Anterior contralateral angle increased from median 42° (IQR, 27–63) in the preoperative CTA to 62 (49–74) in the intraoperative CBCT ( p = 0.02). Optimal cranio-caudal angulation did not change. Conclusion Stiff guide wires and delivery systems cause significant deformation of the common iliac arteries during EVAR. The aortic bifurcation is more cranial, the common iliac arteries are shorter, and optimal C-arm angulation is more contralateral oblique when the iliac limbs are to be deployed compared to baseline measurements from preoperative CTA. This affects image fusion accuracy and stent graft selection.

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Managing Unilateral or Bilateral Common Iliac Artery Aneurysms with Preservation of the Hypogastric Artery

10.1093/med/9780199986071.003.0007 ◽

2018 ◽

Author(s):

S. Lowell Kahn

Keyword(s):

Stent Graft ◽

Iliac Artery ◽

Common Iliac Artery ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Hypogastric Artery ◽

Stent Grafts ◽

Abdominal Aortic ◽

Clinically Significant

Isolated common iliac artery aneurysms are uncommon, occurring in 0.03% of the population, and are responsible for less than 2% of clinically significant aneurysm disease. However, the incidence of iliac artery aneurysms is much higher in patients with abdominal aortic aneurysms, with an incidence close to 40% in this population. The presence of bilateral iliac aneurysms in this population is common. This chapter describes two techniques to manage unilateral or bilateral common iliac artery aneurysms with preservation of the hypogastric artery: use of an Endologix AFX stent graft with snorkel placement and use of two bifurcated Gore Excluder stent grafts.

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