Aortobiiliac Bypass to the Distal External Iliac Artery versus Aortobifemoral Bypass: A Matched Cohort Study

2013 ◽  
Vol 79 (1) ◽  
pp. 61-66 ◽  
Author(s):  
John W. York ◽  
Brent L. Johnson ◽  
Michael Cicchillo ◽  
Spence M. Taylor ◽  
David L. Cull ◽  
...  
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Limb Ischemia ◽  
Wound Complications ◽  
Matched Cohort ◽  
Aortobifemoral Bypass ◽  
Aortoiliac Occlusive Disease ◽  
Iliac Arteries ◽  
Vascular Bypass ◽  
Bypass Patency

Vascular bypass has long been the standard surgical treatment for symptomatic aortoiliac occlusive disease (AIOD). Conventional wisdom has been that aortobifemoral bypass (ABF) be performed for AIOD because of the inevitable progression of iliac atherosclerosis leading to bypass thrombosis. However, ABF is prone to significant groin incision complications such as infection and lymphocele. The purpose of this study was to determine if aortobiiliac bypass (ABI) to the distal external iliac artery performs similarly to ABF in cases in which minimal atherosclerosis is present in the distal iliac arteries. Of patients undergoing aortic reconstruction for symptomatic AIOD between July 1998 and December 2008, 37 were found to have minimal atherosclerosis in the distal external iliac arteries and underwent ABI. These were compared with patients undergoing ABF using a retrospective matched cohort design. The indication for ABI was claudication in 86.5 per cent and critical limb ischemia in 13.5 per cent. There was no difference found in overall bypass patency. The 1-, 3-, and, 5-year patencies were 97, 92, and 79 per cent in the ABI group and 93, 85, and 76 per cent in the ABF group, respectively ( P = 0.8). The incidence of groin wound complications in the ABF group was 14.6 per cent. ABI to the distal external iliac artery achieves equivalent graft patencies to ABF without added risk of associated groin wound complications. These data suggest that ABI be preferentially considered to ABF in situations when the very distal external iliac arteries are patent and free of significant atherosclerotic disease.

scholarly journals Midterm Outcomes after Primary Stenting in Treatment of Atherosclerotic Iliac Arteries

2021 ◽  
Author(s):  
Mehmet Atay ◽  
Onur Saydam ◽  
Deniz Şerefli ◽  
Ayşen Yaprak Engin ◽  
Burçin Abud ◽  
...  
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Limb Ischemia ◽  
Lesion Length ◽  
Covered Stents ◽  
Complication Rates ◽  
Iliac Arteries ◽  
Primary Stenting ◽  
Stent Diameter ◽  
Severe Calcification

IntroductionThe purpose of this study was to report the midterm outcomes of primary stenting of iliac arteries with additional factors which affect the outcome and to compare the results between patients with simple and complex aorta iliac occlusive disease (AOID).Material and methodsFrom January 2015 and March 2018, the study consisted of 103 lesions in 93 patients with common iliac artery (CIA) and/or external iliac artery (EIA) lesions which accompanied with severe claudication or critical limb ischemia. Balloon-expandable stents (BMS), self-expandable stents (SES) and covered stents (CS) were used to treat the lesions.ResultsLesions of 93 patients that were in CIA and/or EIA and treated with ET were included to the study (n=103). Seventy-one (68.9%) lesions were classified as simple AIOD group (TASCII A-B) while 32(31.1%) were classified as complex AIOD (TASCII C-D) group. In 72.8% of the lesions only mild calcification was detected while 27.2% lesions had moderate or severe calcification. Mean stent diameter for CIA position was 8.26±0.8mm and for EIA position was 7.52±0.8mm. Mean lesion length in patients treated with BMS were 52.5±21.0mm while SES were 63.6±28.3(p=0.03). Technical success was achieved in 101(98.1%) lesions. Significant differences in primary (93% vs 63%) and secondary (98% vs 82%) patency rates at 24 months were found between patients in simple and complex AIOD group (p<0.001 p=0.001)ConclusionsConclusion: In our study, it was found that the primary stenting in patients who had AIOD had satisfactory results with high immediate success, low complication rates and acceptable midterm outcomes.

Screening Algorithm for Aortoiliac Occlusive Disease Using Duplex Ultrasonography–Acquired Velocity Spectra from the Distal External Iliac Artery

Vascular ◽  
2005 ◽  
Vol 13 (3) ◽  
pp. 164-172 ◽  
Author(s):  
Juan Fontcuberta ◽  
Angel Flores ◽  
Mark Langsfeld ◽  
Antonio Orgaz ◽  
Rafael Cuena ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Predictive Value ◽  
Reverse Flow ◽  
Resistance Index ◽  
Peak Systolic Velocity ◽  
External Iliac Artery ◽  
Duplex Ultrasonography ◽  
Diagnostic Study ◽  
Aortoiliac Occlusive Disease ◽  
Aortoiliac Disease

Aortoiliac duplex scanning can be difficult to perform owing to the deep location of these vessels. We propose a new method to indirectly screen for aortoiliac disease by performing duplex examination of the distal external iliac artery (DEIA). After performing a preliminary study on 21 patients, the parameters of the Doppler waveform that best distinguish normal from diseased arteries were the presence or absence of reverse flow, peak systolic velocity, and resistance index. These values were used in a derived equation, with the value Y ≥ 0.78 predicting normal proximal inflow. We then studied 118 aortoiliac segments in 81 consecutive patients with arteriography and DEIA duplex ultrasonography. To predict moderate to severe stenosis, duplex ultrasonography had a sensitivity of 95.7%, a specificity of 84.1%, a positive predictive value of 80%, and a negative predictive value of 96.8%. Our formula thus predicted significant disease in 55 of the 118 aortoiliac segments (47%), with these segments needing further arteriographic evaluation. The other 63 limbs can be safely considered as having normal aortoiliac inflow. Our method accurately screens for aortoiliac disease and is excellent for predicting normal inflow. This information can be used to better plan the intraoperative diagnostic study and intervention.

scholarly journals Descending Thoracic Aortic Aneurysm Rupture Treated with Thoracic Endovascular Aortic Repair in a Patient with Peripheral Artery Disease

2018 ◽  
Vol 21 (2) ◽  
pp. 112 ◽  
Author(s):  
Ovidiu Stiru ◽  
Roxana Carmen Geana ◽  
Platon Pavel ◽  
Marian Croitoru ◽  
Cristian Boros ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Iliac Artery ◽  
Thoracic Aortic Aneurysm ◽  
Limb Ischemia ◽  
Aneurysm Rupture ◽  
Axillofemoral Bypass ◽  
Iliac Arteries ◽  
Descending Thoracic Aortic Aneurysm ◽  
Stent Grafting ◽  
Less Invasive

Descending thoracic aortic aneurysm rupture is a life-threatening disease associated with high rates of morbidity and mortality. Treatment in these cases is a surgical emergency. Less invasive therapies for the treatment of this pathology have been developed over time. For descending thoracic aneurysm rupture, endovascular stent grafting is less invasive, life-saving, and a unique alternative to open repair. However, this approach is subject to anatomical and logistic limitations. The purpose of the present study is to report a case of an emergency endovascular repair for a ruptured thoracic aortic aneurysm in a patient with peripheral arterial disease, and to discuss some important issues related to this approach. Severe calcifications were discovered in this patient on both iliac arteries, and the remaining circulated lumen was less than 2 to 3 mm. Unfortunately, only catheter insertion into the left iliac artery for angiography was able to determine the development of a dissection in the arterial wall. We decided to dilate both iliac arteries with partial stabilization of the dissection on the right iliac artery which allowed us to successfully continue the endovascular procedure. After 24 hours, the patient experienced right limb ischemia, and revascularization of the affected limb was achieved by performing a right axillofemoral bypass.

Successful and Unsuccessful Blind Placement of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Catheters Through Damaged Arteries: A Report of Three Cases

2018 ◽  
Vol 2 (1) ◽  
Author(s):  
Philip Joseph Wasicek ◽  
William A Teeter ◽  
Peter Hu ◽  
Deborah M Stein ◽  
Thomas M Scalea ◽  
...  
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Common Femoral Artery ◽  
Arterial Injury ◽  
Balloon Occlusion ◽  
Tactile Feedback ◽  
Balloon Inflation ◽  
Iliac Arteries ◽  
Tertiary Center ◽  
The Common

Background: Patients who receive REBOA for temporization of exsanguinating hemorrhage may have occult injuries sustained to the iliac arteries or aorta which may pose increased risks in performing REBOA. There is a paucity of literature describing the successful blind placement of wires and/or catheters for REBOA through damaged vasculature. Methods: Patients admitted between February 2013 and July 2017 at a tertiary center who had a successful or unsuccessful blind placement of a REBOA catheter or wire through a damaged iliac artery or aorta were included. Results: Three patients were identified. Two patients had successful placement of the REBOA catheter; one sustained injury to the external iliac artery, and the other sustained injury to the abdominal aorta. Confirmation of catheter placement was obtained before balloon inflation; and the damaged vessels were identified upon immediate operative intervention. One patient had unsuccessful placement of the REBOA catheter during cardiac arrest despite accurate access of the common femoral artery (CFA).  Conclusions: Emergent, blind placement of wires and catheters past arterial injuries is possible. Physical exam and/or tactile feedback should alert the surgeon to the possibility of arterial injury and imaging confirmation should precede balloon inflation if at all possible to minimize risk of further vascular injury.

scholarly journals Importance of Both Internal and External Iliac Artery Interrogation in Pelvic Trauma as Evidenced by Hemorrhage from Bilateral Corona Mortis with Unilateral Aberrant Origin off the External Iliac Artery

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Michael Herskowitz ◽  
James Walsh ◽  
Meghan Lilly ◽  
Kimberly McFarland
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Hemodynamic Instability ◽  
Pelvic Trauma ◽  
Obturator Artery ◽  
Iliac Arteries ◽  
Corona Mortis ◽  
Internal Iliac ◽  
Blunt Pelvic Trauma ◽  
Internal Iliac Arteries

Transcatheter angiography and embolization has long been recognized as the gold standard for patients with hemodynamic instability secondary to blunt pelvic trauma. While often the bleeding source can be readily localized based on the distribution of extravasation on preprocedural Computed Tomographic Angiography, one should be cautious in assessment for aberrant anatomy. A variant obturator artery originating from the inferior epigastric branch of the external iliac artery is commonly referred to as the corona mortis. We present a case of blunt pelvic trauma in which a patient demonstrated extravasation in the anterior distributions of both internal iliac arteries. Following embolization of bilateral internal iliac arteries, identification and embolization of bilateral corona mortis branches was crucial to achieving hemodynamic stability in this patient.

scholarly journals Iliac artery myointimal hyperplasia in rabbits submitted to angioplasty and treated with Moringa oleifera

2016 ◽  
Vol 43 (1) ◽  
pp. 28-34
Author(s):  
Jânio Cipriano Rolim ◽  
Manoel Ricardo Sena Nogueira ◽  
Paulo Roberto da Silva Lima ◽  
Francisco Chavier Vieira Bandeira ◽  
Mizael Armando Abrantes Pordeus ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Moringa Oleifera ◽  
External Iliac Artery ◽  
Laboratory Animals ◽  
Iliac Arteries ◽  
Significance Level ◽  
Hypercholesterolemic Diet ◽  
Significant Difference ◽  
Moringa Oleifera Leaves ◽  
Student’S T

Objective: to assess post-angioplasty myointimal hyperplasia in iliac artery of rabbits treated with extract of Moringa oleifera leaves. Methods : we conducted a randomized trial in laboratory animals for five weeks of follow-up, developed in the Vivarium of Pharmaceutical Technology Laboratory of the Universidade Federal da Paraíba. We used rabbits from the New Zealand breed, subjected to a hypercholesterolemic diet and angioplasty of the external iliac artery, randomized into two groups: M200 Group (n=10) - rabbits treated with 200mg/kg/day of Moringa oleifera leaves extract orally; SF group (n=10) - rabbits treated with 0.9% saline orally. After five weeks, the animals were euthanized and the iliac arteries prepared for histology. Histological sections were analyzed by digital morphometry. Statistical analysis was performed using the Student's t test. The significance level was 0.05. Results : there was no significant difference in myointimal hyperplasia between M200 and SF groups when comparing the iliac arteries submitted to angioplasty. Conclusion : there was no difference of myointimal hyperplasia between groups treated with saline and Moringa oleifera after angioplasty.

Contemporary Outcomes of Iliofemoral Bypass Grafting for Unilateral Aortoiliac Occlusive Disease: A 10-Year Experience

2008 ◽  
Vol 74 (6) ◽  
pp. 555-560 ◽  
Author(s):  
Christopher G. Carsten ◽  
Corey A. Kalbaugh ◽  
Eugene M. Langan ◽  
Anna L. Cass ◽  
David L. Cull ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Functional Independence ◽  
Occlusive Disease ◽  
Secondary Patency ◽  
Aortobifemoral Bypass ◽  
Aortoiliac Occlusive Disease ◽  
Symptom Resolution ◽  
Acceptable Alternative

Current treatment of complex aortoiliac occlusive disease (AIOD) includes the aortobifemoral bypass or the femoral-femoral bypass. However, because of bilateral groin exposure and associated risks, there is a significant morbidity associated with these procedures. In appropriate patients with unilateral AIOD, the iliofemoral bypass graft (IFBPG) via a lower abdominal retro-peritoneal incision can be an acceptable alternative. The purpose of this study is to review the safety and efficacy as well as long-term outcomes of IFBPG in patients with unilateral AIOD. From July 1997 through June 2006, 40 patients (64.3 ± 11.2-years-old, range 41–89-years-old, 57.5% critical limb ischemia, 70% male, 95% smokers) with unilateral AIOD were treated with IFBPG. Perioperative complications and symptom resolution were measured and Kaplan-Meier life table analysis was used to analyze outcomes of primary and secondary patency, survival, limb salvage, contralateral intervention, and maintenance of ambulation and independent living status. The perioperative complication rate was 12.5 per cent (n = 5) including one patient who developed atrial-fibrillation and one who developed acute renal failure. Both patients experienced resolution of these symptoms before discharge. Other complications included one limb thrombosis and two wound infections. There were no perioperative deaths. Secondary patency was 97.5 per cent and 93.3 per cent at 1 and 5 years. Limb salvage in patients with critical limb ischemia (CLI) was 85.1 per cent and 79.1 per cent at 1 and 5 years. Limb amputation occurred due to infection (n = 2), or failed IFBPG (n = 2). Thirty-one patients (77.5%) experienced symptom resolution including 15 (88.2%) of the patients treated for claudication. Two patients (5%) required contralateral iliac intervention. Patient survival was 97.5 per cent and 64.5 per cent at 1 and 5 years. Greater than 90 per cent of patients maintained their functional independence at 5 years. IFBPG achieved excellent technical and functional outcomes, particularly in patients treated for vasculogenic claudication. This procedure is relatively safe and efficacious in a population of patients with complex unilateral AIOD and can be an acceptable alternative to the aortobifemoral bypass or fem-fem procedure.

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