Risk Factors for Early and Late Iliac Limb Occlusions of Stent Grafts Extending to the External Iliac Artery after Endovascular Abdominal Aneurysm Repair

Arterio-ureteral fistulas are relatively rare, but a potentially life-threatening condition because of the possible massive bleeding. An 82-year-old woman with a history of hysterectomy and irradiation for uterine cancer was treated with ureteric stents for recurrent bilateral ureteral stenosis. During the adjustments of the stent, removing the right ureteric stent immediately resulted in massive hematuria. Computed tomography showed that the right ureter coursed above and seemed to be connected to the right external iliac artery. From the clinical history and computed tomography findings, an arterio-ureteral fistula between the right external iliac artery and right ureter was strongly suspected. The GORE® VIABAHN® VBX Stent Graft was deployed from the common iliac artery to the external iliac artery via a 7-French femoral system, followed by post-dilatation. The patient did not develop any complications or recurrence of hematuria after the procedure during the 11-month follow-up. The VBX is a useful device, with a low- profile device and a size-adjustable balloon-expandable stent that depended on the individual vessel size for post-dilatation. However, there are several concerns, such as risk of infection, stent thrombosis/stenosis, and chronic outcome while using stent grafts for treatment. Patients with arterio-ureteral fistulas who were treated using stent grafts should be carefully followed up.

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An External Iliac Artery Pseudoaneurysm Resulting From Stent Graft Migration

Vascular and Endovascular Surgery ◽

10.1177/1538574420965735 ◽

2020 ◽

pp. 153857442096573

Author(s):

Takahiro Tokuda ◽

Yasuhiro Oba ◽

Ryoji Koshida ◽

Ai Kagase ◽

Hiroaki Matsuda ◽

...

Keyword(s):

Computed Tomography ◽

Intravascular Ultrasound ◽

Ct Angiography ◽

Stent Graft ◽

Iliac Artery ◽

External Iliac Artery ◽

Stent Grafts ◽

Artery Pseudoaneurysm ◽

Graft Migration ◽

Iliac Artery Pseudoaneurysm

The case of an 80-year-old male with claudication of his left foot who was referred to our hospital for evaluation and treatment. Computed tomography (CT) angiography revealed occlusion of left common and external iliac (EIA) arteries. Recanalization of the EIA lesion under intravascular ultrasound (IVUS) guidance and placement of 2 stent grafts was completed successfully. Nine months later, 27 × 29 mm pseudoaneurysm of the left EIA was identified that appeared to have developed secondary to migration of the original stent graft. A new stent graft was placed.

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Evolution and clinical relevance of common iliac artery seal zone after endovascular aortic aneurysm repair

Vascular ◽

10.1177/1708538119830285 ◽

2019 ◽

Vol 27 (4) ◽

pp. 363-368 ◽

Cited By ~ 1

Author(s):

Gergana T Taneva ◽

Alejandro González García ◽

Ana Begoña Arribas Díaz ◽

Yasmina Baquero Yebra ◽

Konstantinos P Donas ◽

...

Keyword(s):

Computed Tomography ◽

Iliac Artery ◽

Computed Tomography Angiography ◽

Endovascular Aneurysm Repair ◽

Aortic Aneurysms ◽

Stent Grafts ◽

Iliac Arteries ◽

Radiological Data ◽

The Mean ◽

Aneurysm Repair

Objective Data in literature suggest iliac artery dilatation and endograft retraction as complications after endovascular aneurysm repair. However, mainly older generation endografts were included. Therefore, we sought to evaluate the distal sealing zone chronological changes after endovascular aneurysm repair with newer generation stent-grafts. Methods Clinical and radiological data of patients with abdominal aortic aneurysms treated with endovascular aneurysm repair between January 2010 and December 2013 were reviewed. Measurements were made using volumetric reconstructions in the first and last available computed tomography angiography. Endpoints of the study were the presence of iliac dilatation and retraction of the endograft. Association with distal oversizing and sealing length was analyzed. Results Consecutive patients with a total of 52 common iliac arteries were included in the study (mean age 74.9 ± 6.8 years, four women (7.7%)). The mean follow-up was 3.1 years. The mean iliac diameter increased from 15.5 to 17.1 mm ( p < .001) in the first control computed tomography angiography and to 18.7 mm ( p < .001) in the last available computed tomography angiography. No endograft (Endurant by Medtronic (24/52; 46%), Excluder de Gore (23/52; 44%), Zenith by Cook (5/52; 9%)) was associated with dilatation ( p = .066) or iliac retraction ( p = .591). Two type Ib endoleaks were found (3.8%) and successfully treated with distal graft extension. An iliac branch retraction of ≥5 mm was identified in seven cases (13%). Iliac arteries treated with limbs of ≥24 mm in diameter dilated significantly more than the rest of limbs (5.37 mm versus 3.12 mm; p = .022). In the last available imaging, iliac dilatation was ≥20% in 28 cases (53.8%) and had exceeded the diameter of the implanted endograft in 20 cases (38.4%). Iliac dilatation (OR 15.11 per mm, p = .025) was identified as a risk factor for retraction ≥5 mm. Conclusion Iliac dilatation and endograft limb retraction are common findings after endovascular aneurysm repair despite the use of new generation endografts. Optimizing the iliac sealing length and meticulous computed tomography angiography surveillance are recommended especially in case of use ≥24 mm iliac stent-grafts to prevent possible complications.

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Endovascular treatment of isolated iliac artery aneurysms using a custom-made stent graft with proximal barb fixation: early outcome

Vascular ◽

10.1177/1708538113478720 ◽

2013 ◽

Vol 21 (2) ◽

pp. 92-96 ◽

Cited By ~ 3

Author(s):

D L H Baird ◽

K Mani ◽

T Sabharwal ◽

P R Taylor ◽

H A Zayed

Keyword(s):

Stent Graft ◽

Iliac Artery ◽

Perioperative Complications ◽

External Iliac Artery ◽

Stent Grafts ◽

Landing Zone ◽

Custom Made ◽

Internal Iliac ◽

The Mean ◽

Isolated Iliac Artery Aneurysms

Current endovascular treatments for isolated iliac artery aneurysms (IIAAs) include the use of aortoiliac stent grafts with coverage of the distal aorta or stent grafts confined to the iliac artery without active proximal fixation. We report our experience in the use of custom-made Cook Zenith™ iliac limb stent grafts with proximal barb fixation. Patients treated from July 2009 to February 2011 were included. All imaging and patient records were assessed for perioperative and early outcomes. Nine IIAAs (seven patients) were treated. The mean patient age was 80 years (range 58-91 years). The mean aneurysm size was 48 mm (35-80 mm), and the mean length of the proximal landing zone (PLZ) was 29 mm (10-50 mm). The distal landing zone was in the external iliac artery after coil embolization of the internal iliac artery. The Mean diameter of the PLZ was 21 mm (20-24 mm). Technical success was achieved in eight cases. Perioperative complications included reoperation in one patient for groin bleeding and ischemia. On follow-up (mean 12 months, range 1-26), all aneurysms were successfully excluded from the circulation and there was no stent graft migration or thrombosis. Use of custom-made stent grafts with proximal barb fixation in treatment of IIAAs is a feasible option which may reduce the risk of migration when compared with stent grafts with lack of proximal fixation.

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Oversizing of Aortic Stent Grafts for Abdominal Aneurysm Repair: A Systematic Review of the Benefits and Risks

Journal of Vascular Surgery ◽

10.1016/j.jvs.2009.05.033 ◽

2009 ◽

Vol 50 (1) ◽

pp. 236

Author(s):

J. van Prehn ◽

F.J.V. Schlösser ◽

B.E. Muhs ◽

H.J.M. Verhagen ◽

F.L. Moll ◽

...

Keyword(s):

Systematic Review ◽

Stent Grafts ◽

Abdominal Aneurysm ◽

Aneurysm Repair

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External iliac artery endofibrosis in an elite female endurance cyclist

Jornal Vascular Brasileiro ◽

10.1590/1677-5449.200122 ◽

2021 ◽

Vol 20 ◽

Author(s):

Victor Bilman ◽

Enrico Rinaldi ◽

Francesca Sanvito ◽

Germano Melissano ◽

Roberto Chiesa

Keyword(s):

Risk Factors ◽

Iliac Artery ◽

Young Patients ◽

External Iliac Artery ◽

Endurance Athletes ◽

Best Management ◽

High Level ◽

Maximal Effort ◽

Atherosclerotic Risk Factors

Abstract External iliac artery endofibrosis is a rare pathology that affects high-level endurance athletes, especially cyclists. Classical symptoms include pain, loss of power, and/or cramp in the affected limb while training at maximal effort. The patient’s lack of atherosclerotic risk factors makes clinical suspicion of arteriopathy challenging. Moreover, the best management of such patients is still a subject of discussion. We report the case of a 36-year-old professional female endurance cyclist who presented with lower extremity pain during training. Right external iliac artery endofibrosis was diagnosed and the patient underwent surgical treatment. At two-months follow-up, she reported significant improvement in symptoms. This case highlights the importance of diagnosing peripheral vascular disease in young patients and athletes, who do not fit the ordinary profile of patients with atherosclerotic risk factors.

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