Endovascular Gamma Irradiation of the Iliac Arteries: 1-Year Results from a Clinical Safety and Feasibility Study

2003 ◽  
Vol 10 (3) ◽  
pp. 573-576 ◽  
Author(s):  
Piotr Walichiewicz ◽  
Jerzy Piecuch ◽  
Brygida Białas ◽  
Witold Orkisz ◽  
Marek Fijałkowski ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Common Iliac Artery ◽  
Balloon Dilation ◽  
Limb Ischemia ◽  
Antiplatelet Treatment ◽  
Clinical Safety ◽  
Iliac Arteries ◽  
Vascular Brachytherapy ◽  
Iridium 192

Purpose: To estimate safety and feasibility of vascular brachytherapy in iliac arteries. Methods: Fourteen patients (11 men; mean age 56.7±9.9 years, range 44–81) with occlusive disease in 15 iliac arteries (7 external, 8 common) were treated with balloon dilation followed by irradiation from an iridium 192 source (15 Gy at 3 mm from the inner surface of the artery wall) applied with a PARIS centering catheter and bilateral 10-mm margins. Patients receiving stents for suboptimal angioplasty were prescribed a 6-month course of antiplatelet treatment with ticlopidine. Angiography was routinely scheduled for 6 months after intervention. Results: There were no complications of the angioplasty procedure or EVBT treatment; 7 patients received stents for dissection or residual stenosis. Mean follow-up was 12.4±6.0 months. At 6-month angiography, 1 (6.7%) restenosis in a common iliac artery stent was found. Another patient with a common iliac artery stent developed transient lower limb ischemia at 4 months, probably due to temporary suspension of antiplatelet treatment and distal disease. Conclusions: Brachytherapy in the iliac arteries appears to be feasible and safe; longer follow-up in more patients is needed to determine its clinical utility in the prevention of restenosis.

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.

Large Iliac Arteries: A High-Risk Group for Endovascular Aortic Aneurysm Repair

2007 ◽  
Vol 14 (5) ◽  
pp. 625-629 ◽  
Author(s):  
Ciaran O. McDonnell ◽  
James B. Semmens ◽  
Yvonne B. Allen ◽  
Shirley J. Jansen ◽  
D. Mark Brooks ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Iliac Artery ◽  
High Risk Group ◽  
Consecutive Series ◽  
Type Ii ◽  
Secondary Intervention ◽  
Iliac Arteries ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair

Purpose: To examine if the presence of large iliac arteries is a potential risk factor for the development of a type Ib endoleak (iliac sealing zone) or need for iliac artery—related secondary intervention in patients undergoing endovascular abdominal aortic aneurysm repair. Methods: The medical notes and all preoperative and postoperative plain abdominal radiographs and computer tomographic scans were reviewed for a consecutive series of 100 patients (89 men; mean age 75 years, range 56–91) with large iliac arteries (mean 19.7 mm, range 16–22) who had Zenith endovascular stent-grafts inserted for management of aortoiliac aneurysmal disease from January 1999 until September 2002. Endpoints were all-cause mortality, aneurysm-related death, endoleak, secondary intervention, secondary interventions, and stent-graft migration. Results: Mean follow-up was 30.1±8.3 months; at the last follow-up, 30% of patients were dead, 3% were aneurysm-related. Seven (7%) patients developed a type Ib endoleak, with the remainder being type II (29%), type Ia (2%), type III (1%), and type V (endotension, 1%). Eight (27.5%) type II endoleaks persisted, with the remainder closing spontaneously with sac shrinkage. The iliac artery—related secondary intervention rate was 10%, and the overall secondary intervention rate was 16%. Conclusion: Iliac arteries between 16 and 22 mm in diameter may be treated with a cuff to the iliac limb with an expectation of 90% efficacy. Surveillance is required, with a high index of suspicion for type 1b endoleaks. Early secondary iliac intervention with extension to the external iliac artery is recommended if there is an increase in sac size after 6 months.

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.

Are There Long-Term Consequences of Iliac Artery Trauma during Endograft Implantation? Results of Serial Duplex Ultrasound Follow-up

2005 ◽  
Vol 29 (2) ◽  
pp. 71-73
Author(s):  
Bernardo Mendoza ◽  
George H. Meier ◽  
Kathleen Carter ◽  
Courtney Nelms ◽  
Dulcie Chaler ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Rare Event ◽  
Duplex Ultrasound ◽  
Abdominal Aortic Aneurysm Repair ◽  
Main Body ◽  
Iliac Arteries ◽  
Intimal Medial Thickness ◽  
Abdominal Aortic ◽  
Duration Effect

Purpose The implantation of abdominal aortic endografts requires the insertion of large devices that have the potential to traumatize the iliac arteries, particularly on the ipsilateral side, where the main body of the endograft is introduced. The consequences of this potential trauma are unknown, but the possibility for significant injury remains. For this reason, a prospective measurement of iliac intimal medial thickness by serial duplex ultrasound was undertaken to determine the effect of endograft placement on iliac arteries. Methods A total of 117 patients had duplex evaluation of their iliac arteries after aortic endograft placement at an average follow-up of 18.8 months (range, 0 to 71 months). Ancure devices were used in 89, AneuRx in 11, Endologix in 12, Vanguard in 1, and unknown devices in 4. All endografts were scanned using Philips/ ATL HDI 5000 or ATL 3000 ultrasound machines with 7–4 MHz transducers and a standard protocol, with additional iliac artery measurements performed for the specifics of this study. Of these 117 patients, bilateral intimal medial thickness (IMT) was measured with a clearly determined ipsilateral (larger diameter sheath) implantation side defined in 66 patients. In these patients the ratio of ipsilateral (main introducer) IMT to contralateral (smaller diameter sheath) IMT was determined. Results Of the 66 patients with complete data available for review, the mean ipsilateral to contralateral IMT ratio was 1.41 (range, 0.3 to 16.4). Nonetheless, when evaluated more closely, only two patients had IMT ratios exceeding 2.0 (12.0 and 16.4). When these two patients are excluded, the IMT ratio averaged 1.01, suggesting an absence of significant intimal trauma secondary to aortic endograft implantation. If we presume that the cause of this increased intimal thickness is iliac trauma secondary to endograft placement, then the maximum incidence is 2/66 (3.0%). Analysis by follow-up intervals suggests no duration effect of significance. Conclusions Iliac artery trauma resulting in intimal hyperplasia or premature atherosclerosis appears to be a rare event after endograft abdominal aortic aneurysm repair. With current devices and current clinical selection, iliac artery pathology after endograft placement is not a significant concern.

Secondary Relining With Focal Flaring of Novel-Generation Balloon-Expandable Covered Stents for Endovascular Treatment of Significant Diameter Mismatch in the Aorto-Iliac Territory

Vascular ◽  
2020 ◽  
pp. 170853812094505
Author(s):  
Mario D’Oria ◽  
Filippo Griselli ◽  
Davide Mastrorilli ◽  
Filippo Gorgatti ◽  
Silvia Bassini ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Endovascular Treatment ◽  
Stent Graft ◽  
Iliac Artery ◽  
Common Iliac Artery ◽  
Covered Stents ◽  
Abdominal Aortic ◽  
The Right

Objectives The aim of this study was to report on the safety and feasibility of secondary relining with focal flaring of novel-generation balloon-expandable covered stents for endovascular treatment of significant diameter mismatch in the aorto-iliac territory. Significant diameter mismatch was defined as >20% difference in the nominal diameter between the intended proximal and distal landing zones. Methods Patient A was an 84-year-old man with prior abdominal aortic aneurysm open repair with a straight 20 mm Dacron tube. He presented with a right common iliac artery aneurysm (Ø88 mm) with contained rupture. The Gore Viabahn endoprosthesis (9 mm × 5 cm) was inserted proximally about 15 mm above the occluded ostium of the internal iliac artery. Subsequently, the BeGraft Aortic® (16 mm × 48 mm) was inserted proximally up to the common iliac artery origin; its proximal portion was flared to 22 mm. Patient B was a 77-year-old man with prior endovascular abdominal aortic aneurysm repair with a Medtronic Endurant stent-graft. He presented with occlusion of the right limb of the aortic endoprosthesis and thrombosis that extended down to the level of the superficial femoral artery. After mechanical thrombectomy, two Gore Viabahn endoprosthesis (first one, 8 mm × 10 cm; second one, 10 mm × 15 cm) were inserted into the right iliac limb. Subsequently, the BeGraft Aortic® (12mm × 39mm) was inserted proximally up to the gate of the aortic stent-graft; its proximal portion was flared to 16 mm. Results Technical success and clinical success were achieved in both patients. Imaging follow-up (6 months for Patient A, 12 months for Patient B) showed correct placement of all stent-grafts without any graft-related adverse event. The patients remained free from new reinterventions or recurrent symptoms. Patient A died 8 months after the index procedure from acute respiratory failure after community acquired pneumonia. Conclusion Secondary relining with focal flaring of novel-generation balloon-expandable covered stents for endovascular treatment of significant diameter mismatch in the aorto-iliac territory is safe and feasible. Although mid-term results seem to be effective, longer follow-up is warranted to establish durability of the technique.

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.

Surgical Reconstruction of the Iliac Arteries Prior to Endovascular Aortic Aneurysm Repair

1997 ◽  
Vol 4 (3) ◽  
pp. 307-311 ◽  
Author(s):  
Timothy A.M. Chuter ◽  
Linda M. Reilly
Keyword(s):  
Aortic Aneurysm ◽  
Stent Graft ◽  
Iliac Artery ◽  
Surgical Techniques ◽  
Surgical Reconstruction ◽  
Common Trunk ◽  
Aortic Blood Flow ◽  
Iliac Arteries ◽  
The Right

Purpose: To explore a method of combined endovascular/conventional treatment of abdominal aortic aneurysm (AAA), in which the iliac arteries are reconstructed by conventional surgical techniques to provide the anatomic substrate for subsequent endovascular repair of the aortic aneurysm. Method: A 77-year-old patient with severe cardiac disease was found to have a 6.5-cm AAA, bilateral common iliac artery (CIA) aneurysms, and diffusely narrowed, tortuous external iliac arteries. The left internal iliac artery was occluded. At operation, the right CIA was exposed through a transverse retroperitoneal incision under epidural anesthesia. An iliobifemoral bypass was constructed using a preformed bifurcated graft. A stent-graft was delivered through the right limb of the bifurcated iliobifemoral graft. The proximal end of the stent-graft was implanted in the neck of the aneurysm, and the distal end was deployed in the common trunk of the iliobifemoral graft, thereby excluding the AAA and both native iliac arteries from prograde arterial flow. Results: Completion angiography and follow-up contrast computed tomography showed the aneurysm to be excluded from the circulation. The patient was not intubated, was never hemodynamically unstable, and had aortic blood flow interrupted for no more than 20 seconds. In addition, he was able to resume his usual diet on the first postoperative day. He continues to be well and without evidence of endoleak at 6-month follow-up. Conclusions: This case demonstrates that iliac artery stenosis, tortuosity, and aneurysmal dilatation are not impediments to endovascular AAA exclusion. Any necessary surgical modifications of pelvic arterial anatomy can be performed before stent-graft insertion to minimize aortic occlusion time.

Single-Center Experience and 1-Year Follow-up Results of “Sandwich Technique” in the Management of Common Iliac Artery Aneurysms During EVAR

2012 ◽  
Vol 35 (5) ◽  
pp. 1195-1200 ◽  
Author(s):  
Carmelo Ricci ◽  
Claudio Ceccherini ◽  
Marco Cini ◽  
Francesco Vigni ◽  
Sara Leonini ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Common Iliac Artery ◽  
Single Center ◽  
Sandwich Technique ◽  
Single Center Experience

scholarly journals Midterm results of endovascular treatment of iliac artery lesions: analysis of 59 cases

2013 ◽  
Vol 12 (2) ◽  
pp. 91-101
Author(s):  
Leonardo Ghizoni Bez
Keyword(s):  
Endovascular Treatment ◽  
Iliac Artery ◽  
Peripheral Arterial Occlusive Disease ◽  
Ankle Brachial Index ◽  
Arterial Occlusive Disease ◽  
Occlusive Disease ◽  
Secondary Patency ◽  
Iliac Arteries ◽  
Peripheral Arterial

BACKGROUND: Endovascular treatment of peripheral arterial occlusive disease has become increasingly frequent in the past few years. Because it is a less invasive procedure, lower morbidity and mortality rates are associated with this form of treatment. OBJECTIVES: To describe the endovascular procedures performed in iliac arteries for the treatment of peripheral arterial occlusive disease. METHODS: This retrospective study assesses 59 cases of iliac artery angioplasty performed according to a specific protocol from January 2004 to February 2010. RESULTS: Mean age of patients was 62 years (minimum: 42, maximum: 89). Thirty seven were male (62.72%) and 22 female (37.28%). The main indications for treatment were moderate to severe intermittent claudication in 30 cases (50.84%) and rest pain or trophic lesions (critical ischemia) in 29 cases (49.15%). Postoperative follow-up included ankle-brachial index measurements and a duplex ultrasound at 30 days, 3 months, 6 months, 12 months, and every 6 months thereafter. Minimum follow-up time was 3 months, and maximum, 72 months (6 years), with primary and secondary patency rates of 91.37 and 94.82%, respectively. CONCLUSIONS: The results of this case series, combined with literature review results, allow to conclude that the endovascular approach is an effective and safe option to treat peripheral arterial occlusive disease in iliac arteries.

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