Impact of Stent Graft Design on External Iliac Artery Limb Occlusion Rates After Endovascular Aneurysm Repair: Post-hoc Analysis of a Japanese Multicentre Database

Purpose: To describe a modified up-and-over access technique for treatment of iliac artery aneurysms in patients with prior bifurcated stent-grafts for endovascular aneurysm repair (EVAR). Technique: This technique uses a coaxial 12-F flexible sheath that is docked with a through-and-through wire into a 7-F sheath advanced from the contralateral femoral approach. This maneuver allows both sheaths to be moved as a unit while maintaining position of the apex of the system as it loops over the flow divider, avoiding damage to or displacing the extant endograft. Once the 12-F sheath is positioned in the iliac limb of the aortic stent-graft and secured in place with the through-and-through wire, the repair is extended into the internal iliac artery using a bridging stent-graft or covered stent introduced via a coaxial sheath. Conclusion: The up-and-over technique with a flexible 12-F sheath mated with a 7-F sheath from the opposite side allows bilateral femoral access to be used for iliac branch device placement after prior aortic endograft procedures that create a higher, acutely angled bifurcation. Use of a through-and-through wire and a coaxial sheath for stent delivery creates a very stable platform for intervention.

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Impact of Insertion Technique and Iliac Artery Anatomy on Fenestrated Endovascular Aneurysm Repair

Journal of Endovascular Therapy ◽

10.1177/1526602819872499 ◽

2019 ◽

Vol 26 (6) ◽

pp. 797-804

Author(s):

Sean A. Crawford ◽

Matthew G. Doyle ◽

Cristina H. Amon ◽

Thomas L. Forbes

Keyword(s):

Stent Graft ◽

Iliac Artery ◽

Flexural Rigidity ◽

Endovascular Aneurysm Repair ◽

Patient Specific ◽

Bending Rigidity ◽

Insertion Technique ◽

3 Dimensional ◽

Aneurysm Repair

Purpose: To develop a mechanically realistic aortoiliac model to evaluate anatomic variables associated with stent-graft rotation and to assess common deployment techniques that may contribute to rotation. Materials and Methods: Idealized aortoiliac geometries were constructed either through direct 3-dimensional (3D) printing (rigid) or through casting with polyvinyl alcohol using 3D-printed molds (flexible). Flexible model bending rigidity was controlled by altering wall thickness. Three flexible patient-specific models were also created based on the preoperative computed tomography angiograms. Zenith infrarenal and fenestrated devices were used in this study. The models were pressurized to 100 mm Hg with normal saline. Deployments were performed under fluoroscopy at 37°C. Rotation was calculated by tracking the change in position of gold markers affixed to the devices. Results: In the rigid idealized models, stent-graft rotation increased with increasing torsion; torsion levels of 1.6, 2.6, and 3.6 mm−1 had mean rotations of 5.2°±0.03°, 11.2°±4.8°, and 27.6°±13.0°, respectively (p<0.001). In the flexible models, the highest rotation (58°±3.0°) was observed in models with high torsion and high rigidity (7.5 mm−1 net torsion and 254 N·m2 flexural rigidity). No rotation was observed in the absence of torsion. Applying torque to the device during insertion significantly increased stent-graft rotation by an average of 28° across all levels of torsion (p<0.01). Multiple device insertions prior to deployment did not change the observed device rotation. The patient-specific models accurately predicted the degree of rotation seen intraoperatively to within 5°. Conclusion: Insertion technique plays an important role in the degree of stent-graft rotation during deployment. Our model suggests that in vivo correction of device orientation can increase the observed rotation and supports the concept of fully removing the device, adjusting the orientation, and subsequently reinserting. Additionally, increasing iliac artery torsion in the presence of increased vessel rigidity results in stent-graft rotation.

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Self expandable stent application to prevent limb occlusion in external iliac artery during endovascular aneurysm repair

Annals of Surgical Treatment and Research ◽

10.4174/astr.2016.91.3.139 ◽

2016 ◽

Vol 91 (3) ◽

pp. 139 ◽

Cited By ~ 3

Author(s):

Jae Hoon Lee ◽

Ki Hyuk Park

Keyword(s):

Iliac Artery ◽

Endovascular Aneurysm Repair ◽

External Iliac Artery ◽

Aneurysm Repair

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Another Late Complication after Endovascular Aneurysm Repair: Aneurysmal Degeneration at the Iliac Artery Landing Site

Vascular ◽

10.2310/6670.2008.00065 ◽

2008 ◽

Vol 16 (6) ◽

pp. 316-320 ◽

Cited By ~ 6

Author(s):

Obekieze Agu ◽

Dee Boardley ◽

Mohan Adiseshiah

Keyword(s):

Stent Graft ◽

Iliac Artery ◽

Late Complication ◽

Endovascular Aneurysm Repair ◽

Artery Aneurysm ◽

Landing Site ◽

Iliac Artery Aneurysm ◽

Aneurysm Formation ◽

Impending Rupture ◽

Aneurysm Repair

The purpose of this article is to describe a hitherto underreported late complication of infrarenal endovascular aneurysm repair (EVAR), namely type Ib endoleakage resulting from aneurysmal degeneration at the iliac artery landing site. In a prospectively recorded audit, between 1994 and 2007, 297 patients underwent EVAR. All cases that developed iliac artery aneurysm (IAA) were studied. Ten cases of IAA in seven patients (2.4% of the cohort) developed 5 to 9 years after EVAR. Eight of the 10 involved the lower landing site of the stent graft. Landing site diameter before EVAR was 12 mm (range 10–15 mm). Three IAAs presented as emergencies with rapidly expanding sacs and impending rupture. All cases underwent further endovascular intervention with no < 30-day mortality. Iliac artery landing site aneurysm formation after EVAR occurs uncommonly after 5 or more years. It should be regarded as an indication for intervention prior to type Ib endoleakage development. The need for lifelong surveillance is highlighted.

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Clinical impact of hypogastric artery occlusion in endovascular aneurysm repair

Vascular ◽

10.1177/1708538114560462 ◽

2014 ◽

Vol 23 (6) ◽

pp. 575-579 ◽

Cited By ~ 9

Author(s):

Manfred Kalteis ◽

Odo Gangl ◽

Florian Huber ◽

Peter Adelsgruber ◽

Manfred Kastner ◽

...

Keyword(s):

Iliac Artery ◽

Endovascular Aneurysm Repair ◽

External Iliac Artery ◽

Artery Occlusion ◽

Long Term Results ◽

Hypogastric Artery ◽

Artery Embolization ◽

Baseline Characteristics ◽

Aneurysm Repair

Purpose To report the long-term results for patients treated with endovascular aneurysm repair and additional embolization and coverage of the hypogastric artery compared with patients treated with simple endovascular aneurysm repair. Methods A database of our endovascular aneurysm repair patient cohort was reviewed to find patients with iliac artery aneurysms. The baseline characteristics, the procedural data and the results for patients treated with endovascular aneurysm repair and concomitant hypogastric artery embolization were compared with those for patients treated with simple endovascular aneurysm repair. The results were analyzed for significant differences. Results Of 106 endovascular aneurysm repair patients treated at our vascular unit from 2001 to 2010, 24 had undergone additional hypogastric artery embolization. The complication rate was significantly increased in this group (12.5% vs. 2.4%; p = 0.041), and the long-term results were significantly poorer. Additional hypogastric artery embolization resulted in late rupture (1.2% vs. 12.5%; p = 0.036), buttock claudication (8.6% vs. 43.8%; p = 0.001) and new onset erectile dysfunction (17.3% vs. 42.9%; p = 0.043). Conclusion Endovascular aneurysm repair with extension of the stent graft to the external iliac artery and embolization of the hypogastric artery was associated with more complications and worse long-term results compared with simple endovascular aneurysm repair.

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Modification of a Bifurcated Stent Graft for Aortouniiliac Endovascular Aneurysm Repair in a Renal Transplant Patient

Vascular and Endovascular Surgery ◽

10.1177/1538574412449077 ◽

2012 ◽

Vol 46 (5) ◽

pp. 405-409 ◽

Cited By ~ 2

Author(s):

Henrietta Poon ◽

Martin J. Duddy ◽

Alok Tiwari ◽

Jonathan D. Hopkins

Keyword(s):

Renal Transplant ◽

Aortic Aneurysm ◽

Stent Graft ◽

Endovascular Aneurysm Repair ◽

External Iliac Artery ◽

Stent Migration ◽

Modular System ◽

Main Body ◽

Abdominal Aortic ◽

Aneurysm Repair

Introduction. We describe a case of aortouniiliac (AUI) endovascular aortic aneurysm repair (EVAR) using combined iliac limb and bifurcated body stent graft modular system. Case report. This technique is demonstrated in a 58-year-old man with a 6-cm abdominal aortic aneurysm suitable for EVAR. The patient has a functioning cadaveric renal transplant anastamosed to the mid right external iliac artery, an occluded left iliac system and stenosed right iliac system. The renal allograft was protected with minimal passage across the transplant artery origin using this modified approach. The patient was successfully treated with a bifurcated main body deployed within a contralateral limb endoprosthesis. Subsequent scans confirmed no endoleaks or stent migration. Conclusions. The AUI conversion from existing Gore excluder stent graft system is safe and should be considered when faced with challenging anatomy of a pelvic renal transplant, slender access, and contralateral iliac occlusion.

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