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

Vascular ◽  
2013 ◽  
Vol 21 (2) ◽  
pp. 92-96 ◽  
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.

scholarly journals Endovascular Treatment of Isolated Iliac Artery Aneurysms with Anaconda Stent Graft Limb

2013 ◽  
Vol 2013 ◽  
pp. 1-5
Author(s):  
Christos Karathanos ◽  
Elias Kaperonis ◽  
Dimitrios Xanthopoulos ◽  
Theophanis Konstantopoulos ◽  
Maria Exarchou ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Stent Graft ◽  
Iliac Artery ◽  
Surgical Reconstruction ◽  
Type I ◽  
Stent Grafts ◽  
Internal Iliac ◽  
Feasible Alternative ◽  
Male Patients ◽  
Isolated Iliac Artery Aneurysms

Isolated aneurysms of the iliac arteries are relatively rare conditions that traditionally have been treated by surgical reconstruction. We report our experience with endovascular treatment of iliac artery aneurysms (IAAs) with Anaconda stent graft limb. Two male patients were found to have 4.5 and 3.6 cm isolated common IAAs, respectively. The endograft was successfully advanced and deployed precisely to the intended position in both cases. In one case the internal iliac artery was embolized. No type I or II endoleak was observed immediately after the procedure. In one patient postimplantation fever (>38°C) and gluteal claudication occurred. After 2 years followup both iliac endovascular stent grafts are patent and without endoleak. Endovascular treatment with Anaconda limb stent graft seems to be a safe and feasible alternative to open surgery.

scholarly journals Endovascular treatment of arterio-ureteral fistula with new-generation balloon-expandable stent graft using a 7-French system

2020 ◽  
Vol 8 ◽  
pp. 2050313X2095921
Author(s):  
Naoki Yoshioka ◽  
Kensuke Takagi ◽  
Yasuhiro Morita ◽  
Makoto Kawase ◽  
Itsuro Morishima
Keyword(s):  
Computed Tomography ◽  
Stent Graft ◽  
Iliac Artery ◽  
Uterine Cancer ◽  
External Iliac Artery ◽  
Clinical History ◽  
Massive Bleeding ◽  
Stent Grafts ◽  
Ureteral Fistula ◽  
The Right

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.

An External Iliac Artery Pseudoaneurysm Resulting From Stent Graft Migration

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.

Results From a Nationwide Registry on Scalloped Thoracic Stent-Grafts for Short Landing Zones

2016 ◽  
Vol 24 (1) ◽  
pp. 97-106 ◽  
Author(s):  
Emma van der Weijde ◽  
Olaf J. Bakker ◽  
Ignace F. J. Tielliu ◽  
Clark J. Zeebregts ◽  
Robin H. Heijmen
Keyword(s):  
Stent Graft ◽  
Innominate Artery ◽  
Celiac Trunk ◽  
Stent Grafts ◽  
Conversion To Open Surgery ◽  
Landing Zone ◽  
Early Results ◽  
Aortic Pathology ◽  
Custom Made

Purpose: To report the perioperative results and short-term follow-up of patients treated with scalloped thoracic stent-grafts. Methods: A multicenter registry in the Netherlands captured data on 30 patients (mean age 68 years; 17 men) with thoracic aortic pathology and a short (<20 mm) proximal or distal landing zone who received a custom-made scalloped stent-graft between January 2013 and February 2016. Patients were treated for saccular (n=13) aneurysms, fusiform (n=9) aneurysms, pseudoaneurysms (n=4), or chronic type B dissections (n=4). The scallop was used to preserve flow in the left subclavian artery (LSA) (n=17), left common carotid artery (n=5), innominate artery (n=1), and celiac trunk (n=7). In 7 (23%) patients, the scallop also included the adjacent artery. Results: Technical success was achieved in 28 (93%) patients. In 1 patient, a minor type Ia endoleak was observed intraoperatively, which was no longer visible on computed tomography angiography at 3 months. In another patient, the LSA was unintentionally obstructed due to migration of the stent-graft on deployment. Concomitant carotid-carotid or carotid-subclavian bypass was performed in 4 patients. There was no retrograde type A dissection or conversion to open surgery. In-hospital mortality was 3%, and the perioperative ischemic stroke rate was 3%. At a mean follow-up of 9.7 months (range <1 to 31), 29 of 30 target vessels were patent. Conclusion: The scalloped stent-graft appears to be a safe and relatively simple alternative for the treatment of thoracic aortic lesions with short landing zones. Larger patient series and long-term follow-up are required to confirm these early results.

Technical issues and clinical outcomes of endovascular repair of isolated iliac artery aneurysms: A single-center experience

Vascular ◽  
2018 ◽  
Vol 26 (6) ◽  
pp. 591-599
Author(s):  
Peixian Gao ◽  
Dianning Dong ◽  
Le Yang ◽  
Hai Yuan ◽  
Mo Wang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Stent Graft ◽  
Iliac Artery ◽  
Endovascular Repair ◽  
Internal Iliac Artery ◽  
Artery Aneurysm ◽  
Covered Stent ◽  
Internal Iliac ◽  
Technical Issues ◽  
Isolated Iliac Artery Aneurysms

Purpose Isolated iliac artery aneurysms are the relatively uncommon condition. This study aims to evaluate the technical issues and clinical outcomes of endovascular repair in a cohort of isolated iliac artery aneurysms treated. Methods We retrospectively reviewed 22 consecutive patients with isolated iliac artery aneurysms between December 2006 and September 2016. Iliac artery aneurysms were treated in one of the three ways: (1) standard bifurcated aortic stent graft placement with limb extension; (2) coverage of iliac artery aneurysms with covered stent grafts; and (3) embolization of the arterial branches distal to the aneurysms with coils or vascular plugs. Results Twenty-two patients (20 men) with a mean age 64.7 years underwent endovascular repair during the study period. The median diameter of the isolated iliac artery aneurysms was 5.9 ± 1.7 cm (2.9–9.0 cm). Technical success was 95.5%. Conversion to open surgery was performed in one patient with bilateral internal iliac artery aneurysms. Four patients underwent placement of a bifurcated stent graft. A covered stent graft was deployed in 16 patients, with embolization of internal iliac artery in 14 patients. Simple coil embolization of isolated internal iliac artery aneurysm was performed in one patient. There was one sudden cardiac death on day 4 after the procedure due to heart failure. During the follow-up period (range: 1–50 months, mean 19.8 months), five patients died of causes not related to isolated iliac artery aneurysms, and transient buttock claudication was observed in one patient. Conclusions Our study documents the safety and effectiveness of endovascular repair of isolated iliac artery aneurysms with low morbidity and mortality.

Emergent conversion of the Ovation Stent Graft System to aortouniiliac modification via occlusion of a unilateral internal iliac artery with a stentgraft as a bailout solution

Vascular ◽  
2015 ◽  
Vol 23 (4) ◽  
pp. 440-443 ◽  
Author(s):  
Efstratios Georgakarakos ◽  
Nikolaos Schoretsanitis ◽  
Vasileios D Souftas ◽  
Chris Argyriou ◽  
Erchan Moustafa ◽  
...  
Keyword(s):  
Stent Graft ◽  
Iliac Artery ◽  
Internal Iliac Artery ◽  
External Iliac Artery ◽  
Covered Stent ◽  
Contralateral Limb ◽  
Internal Iliac ◽  
Crossover Bypass ◽  
The Common ◽  
Femorofemoral Bypass

Purpose To present a case of inadvertent collapse of the contralateral limb gate caused by misorientation during the deployment of the Ovation Abdominal Stent Graft System in a narrow aortic lumen and the bailout conversion to aortouniiliac modification, using a covered stent to exclude the orifice of the internal iliac artery (IIA). Technique description Despite the repeated efforts from the femoral and brachial site, the collapsed/occluded contralateral limb gate could not be catheterized. In order to exclude successfully the orifice of the IIA, an oversized stentgraft was placed immediately at the common-to-external iliac artery (CIA-EIA) transition followed by peripheral ligation of the latter. The procedure was completed with crossover femorofemoral bypass. Conclusion Occlusion the IIA orifice with an oversized stentgraft in the CIA-EIA transition can be considered as a safe, simple, fast, and efficient bailout maneuver, followed by EIA ligation and crossover bypass.

Distribution of Air Embolization During TEVAR Depends on Landing Zone: Insights From a Pulsatile Flow Model

2019 ◽  
Vol 26 (4) ◽  
pp. 448-455 ◽  
Author(s):  
Vladimir Makaloski ◽  
Fiona Rohlffs ◽  
Constantin Trepte ◽  
E. Sebastian Debus ◽  
Bent Øhlenschlaeger ◽  
...  
Keyword(s):  
Stent Graft ◽  
Flow Model ◽  
Aortic Flow ◽  
Type I ◽  
Stent Grafts ◽  
Descending Aorta ◽  
Landing Zone ◽  
The Mean ◽  
The Right ◽  
Common Carotid Arteries

Purpose: To analyze the distribution of air bubbles in the supra-aortic vessels during thoracic stent-graft deployment in zones 2 and 3 in an aortic flow model. Materials and Methods: Ten identical, investigational, tubular, thoracic stent-grafts were deployed in a glass aortic flow model with a type I arch: 5 in zone 2 and 5 in zone 3. A pulsatile pump generated a flow of 5 L/min with systolic and diastolic pressures (±5%) of 105 and 70 mm Hg, respectively. The flow rates (±5%) were 300 mL/min in the subclavian arteries, 220 mL/min in the vertebral arteries, and 400 mL/min in the common carotid arteries (CCAs). The total amounts of air released in each supra-aortic branch and in the aorta were recorded. Results: The mean amounts of air measured were 0.82±0.23 mL in the zone-2 group and 0.94±0.28 mL in the zone-3 group (p=0.49). In the zone-2 group compared with zone 3, the amounts of released air were greater in the right subclavian artery (0.07±0.02 vs 0.02±0.02 mL, p<0.01) and right CCA (0.30±0.8 vs 0.18±07 mL, p=0.04). There were no differences between the groups concerning the mean amounts of air measured in the right vertebral and all left-side supra-aortic branches. The amount of air released in the descending aorta was significantly higher in the zone-3 group vs the zone-2 group (0.48±0.12 vs 0.13±0.08 mL, p<0.01). Small bubbles were observed continuously during deployment, whereas large bubbles appeared more commonly during deployment of the proximal stent-graft end and after proximal release of the stent-graft. Conclusion: Air is released into all supra-aortic branches and the descending aorta during deployment of tubular thoracic stent-grafts in zones 2 and 3 in an aortic flow model. Higher amounts of air were observed in right-side supra-aortic branches during deployment in zone 2, whereas significantly greater amounts of air were observed in the descending aorta during deployment in zone 3.

Prospective study of the E-liac Stent Graft System in patients with common iliac artery aneurysms: 30-Day results

Vascular ◽  
2018 ◽  
Vol 26 (6) ◽  
pp. 647-656 ◽  
Author(s):  
Jan Brunkwall ◽  
Carlos Vaquero Puerta ◽  
Joerg Heckenkamp ◽  
Jose Maria Egaña Barrenechea ◽  
Piotr Szopinski ◽  
...  
Keyword(s):  
Stent Graft ◽  
Iliac Artery ◽  
Common Iliac Artery ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
External Iliac Artery ◽  
Aortic Stent Graft ◽  
Type Ia ◽  
Internal Iliac

Objectives To study the safety and feasibility of the E-liac Stent Graft System® in patients with aorto/iliac aneurysms. Methods A prospective multicentric European registry of patients receiving the E-liac Stent Graft System® was conducted. Endpoints of the study included the technical success as well as periprocedural events and 30-day endoleaks, reinterventions, internal and external iliac artery patency and mortality. Results Between July 2014 and June 2016, a total of 45 patients (93% men, mean age 72 years, range 53–90 years) were enrolled at 11 sites in four European countries. Five patients received an isolated iliac treatment. Thirty-seven patients were treated with a combination of an abdominal stent graft and a unilateral E-liac and three in combination with bilateral E-liac. All E-liac Stent Grafts (48) were implanted in the intended position and the internal iliac arteries were successfully bridged. Two patients did not receive clinical success, due to endoleak type Ia of the aortic stent graft. At 30-day follow-up, clinical success rate was 96%. Three successful endovascular reinterventions were performed within the 30-day follow-up: one due to a type Ia endoleak in the common iliac artery, one due to type Ia endoleak of the aortic stent graft, and one due to bilateral lower limb claudication provoked by stent graft limb stenosis. At 30-day, a 100% survival rate and complete absence of pelvic or buttock ischemia/claudication were reported. Primary patency at 30 days was 100% for the internal iliac artery and 98% for the external iliac artery with an assisted patency of 100% in the latter. Conclusions The high clinical success rate, low rates of device-related reinterventions (2%), and excellent patency rate demonstrate the safety and feasibility of the E-liac Stent Graft System. Long-term results are awaited to state efficacy and durability. Clinical Trials.gov. Identifier no. NCT02209194.

A Modular Multi-Branched System for Endovascular Repair of Bilateral Common Iliac Artery Aneurysms

2003 ◽  
Vol 10 (2) ◽  
pp. 203-207 ◽  
Author(s):  
Cherrie Z. Abraham ◽  
Linda M. Reilly ◽  
Darren B. Schneider ◽  
Shelley Dwyer ◽  
Rajiv Sawhney ◽  
...  
Keyword(s):  
Stent Graft ◽  
Iliac Artery ◽  
Endovascular Repair ◽  
External Iliac Artery ◽  
Modular System ◽  
Iliac Aneurysm ◽  
Short Limb ◽  
Aortic Stent Graft ◽  
Internal Iliac ◽  
The Right

Purpose: To describe a modular stent-graft for cases of bilateral common iliac aneurysm. Technique: The aortic aneurysm is repaired using a standard bifurcated modular system (Zenith). A modified bifurcated component is deployed with its trunk in one limb of the original aortic stent-graft, its long limb in the external iliac artery, and its short limb in the iliac aneurysm just above the internal iliac orifice. A flexible extension is introduced from the right brachial artery and used to bridge the gap between the short limb of the modified bifurcated component and the left internal iliac artery. Conclusions: Endovascular repair of bilateral iliac aneurysm is feasible using a modular stent-graft with separate branches to the internal and external iliac arteries.

scholarly journals Application of a Novel Common-Iliac-Artery Skirt Technology (CST) in Treating Challenge Aorto-Iliac or Isolated Iliac Artery Aneurysms

2021 ◽  
Vol 8 ◽  
Author(s):  
Lunchang Wang ◽  
Chang Shu ◽  
Quanming Li ◽  
Ming Li ◽  
Hao He ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Common Iliac Artery ◽  
Endovascular Aneurysm Repair ◽  
Landing Zone ◽  
Maximal Diameter ◽  
Internal Iliac ◽  
Aneurysm Repair ◽  
Isolated Iliac Artery Aneurysms ◽  
Potential Use

Purpose: To report a novel common-iliac-artery skirt technology (CST) in treating challenge iliac artery aneurysms.Methods: When required healthy landing zone of common iliac artery (CIA) is not available, CST is a strategy to exclude the internal iliac artery (IIA) and prevent IIA reflux without need of embolization. Patients who received endovascular aneurysm repair (EVAR) in our center from 2014 to 2020 were retrospectively screened, and patients treated with CST or with IIA embolization (IIAE) were enrolled.Results: After retrospective screen of 524 EVAR patients, 39 CST patients, 26 IIAE patients, and 7 CST + IIAE patients were enrolled in this study. CST group suggested to have more aged, hyperlipemia, and smoking patients than IIAE group. Two groups had comparable maximal diameter of abdominal aorta (AA), CIA, EIA, but larger diameter of IIA (CST 19.82 ± 2.281 vs. IIAE 27.82 ± 3.401, p = 0.048), and CIA bifurcation (CST 25.01 ± 1.316 vs. IIAE 29.76 ± 2.775, p = 0.087) was found in IIAE group. Anatomy of 79.5% of CST patients and 92.3% of IIAE patients (p = 0.293) was not suitable for potential use of iliac branch device. CST group had significant shorter surgery time (CST 97.42 ± 3.891 vs. IIAE 141.0 ± 8.010, p &lt; 0.001), shorter hospital stay (CST 15.35 ± 0.873 vs. IIAE 19.32 ± 1.067, p = 0.009), lower in-hospital [CST 0% (0/39) vs. IIAE 11.5% (3/26), p = 0.059] and 1-year follow-up stent related MAEs [CST 6.7% (2/30) vs. IIAE 28.6% (6/21), p = 0.052], but comparable mortality and stent related MAEs for all-cohort follow-up analysis comparing to IIAE group. In our study, a lower in-hospital buttock claudication (BC) rate for CST (CST 20.5% vs. IIAE 46.2%, p = 0.053) and a comparable erectile dysfunction (ED) rate (CST 10.3% vs. IIAE 23.1%, p = 0.352) were found between CST and IIAE groups. After 1 year, both groups had about one third relief of BC symptoms [CST 33.3% (4/12) vs. IIAE 30.7% (4/13), p = 1.000]. Subgroup analysis of 14 patents concomitant with IIA aneurysm in CST group and the 7 CST + IIAE patients were carried out, and no difference was found in mortality, stent MAEs, sac dilation, or reintervention rate. Last, illustration of seven typical CST cases was presented.Conclusion: In selected cases, the CST is a safe, feasible-and-effective choose in treating challenge iliac artery aneurysms and preventing IIA endoleak.

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