Endovascular reconstruction of iliac artery bifurcation atherosclerotic disease with the kissing technique

A 71-year-old male patient with severe left buttock and lower-extremity claudication due to iliac artery bifurcation stenoses was referred to our institution for endovascular treatment. A ‘kissing’ technique was used in order to dilate the proximal parts of both internal and external iliac arteries and avoid compromization of the internal iliac artery during proximal external iliac artery stenting. A balloon expandable stent was inserted via a left ipsilateral retrograde access to the narrowed origin of the left external iliacartery and a balloon catheter via a right contralateral access inside the origin of the left internal iliac artery. Simultaneous balloons inflation restored full patency of both vessels. Twelve months later the patient is doing well, free of buttock or lower-extremity claudication symptoms. For iliac artery bifurcation atherosclerotic disease, endovascular repair with the ‘kissing’ technique can achieve a complete bifurcation reconstruction offering significant clinical benefit in selected patients.

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Common to Internal Iliac Artery Stent to Increase Collateral Flow to Lower Extremity in Context of Occluded External Iliac Artery

Annals of Vascular Surgery ◽

10.1016/j.avsg.2018.07.025 ◽

2018 ◽

Vol 52 ◽

pp. 13-14

Author(s):

Edward C. Oh ◽

Mila H. Ju

Keyword(s):

Lower Extremity ◽

Iliac Artery ◽

Internal Iliac Artery ◽

External Iliac Artery ◽

Collateral Flow ◽

Internal Iliac

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Rare origin of the obturator artery from the external iliac artery with two obturator veins

Jornal Vascular Brasileiro ◽

10.1590/1677-5449.005116 ◽

2016 ◽

Vol 15 (3) ◽

pp. 250-253 ◽

Cited By ~ 2

Author(s):

Kiyoshi Goke ◽

Lucas Alves Sarmento Pires ◽

Tulio Fabiano de Oliveira Leite ◽

Carlos Alberto Araujo Chagas

Keyword(s):

Iliac Artery ◽

Internal Iliac Artery ◽

External Iliac Artery ◽

Lateral Wall ◽

Iliac Vein ◽

Obturator Foramen ◽

Obturator Artery ◽

Iliac Arteries ◽

Internal Iliac ◽

The Common

Abstract The obturator artery is a branch of the internal iliac artery, although there are reports documenting variations, with origin from neighboring vessels such as the common iliac and external iliac arteries or from any branch of the internal iliac artery. It normally runs anteroinferiorly along the lateral wall of the pelvis to the upper part of the obturator foramen where it exits the pelvis by passing through said foramen. Along its course, the artery is accompanied by the obturator nerve and one obturator vein. It supplies the muscles of the medial compartment of the thigh and anastomoses with branches of the femoral artery on the hip joint. We report a rare arterial variation in a Brazilian cadaver in which the obturator artery arose from the external iliac artery, passing beyond the external iliac vein toward the obturator foramen, and was accompanied by two obturator veins with distinct paths. We also discuss its clinical significance.

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Surgical and Endovascular Management of Isolated Internal Iliac Artery Aneurysms: A Systematic Review and Meta-Analysis

Vascular and Endovascular Surgery ◽

10.1177/1538574420981812 ◽

2020 ◽

pp. 153857442098181

Author(s):

Paolo Perini ◽

Erica Mariani ◽

Mara Fanelli ◽

Alessandro Ucci ◽

Giulia Rossi ◽

...

Keyword(s):

Systematic Review ◽

Iliac Artery ◽

Endovascular Repair ◽

Open Surgery ◽

Internal Iliac Artery ◽

Cochrane Library ◽

Hypogastric Artery ◽

Stent Grafting ◽

Buttock Claudication ◽

Internal Iliac

Objectives: The purpose of this paper is to report the different modalities for the treatment of isolated internal iliac artery aneurysms (IIIAA), as well as their outcomes. Methods: We performed a systematic review of the literature (database searched: PubMed, Web of Science, Scopus, Cochrane Library; last search: April 2020). We included articles reporting on the outcomes for IIIAA interventions comprising at least 5 patients. Studies were included when presenting extractable outcome data regarding intraoperative and/or early results. We performed meta-analyses of proportions for different outcomes, using random effects model. Results: Thirteen non-randomized studies were included (192 patients with 202 IIIAA). IIIAA were symptomatic in the 18.1% (95%CI 9.3-26.9; I2 54.46%, P = .019). Estimated mean IIIAA diameter was 46.28 mm (95%CI 39.72-52.85; I2 88.85%, P < .001). Open repair was performed in 21/202 cases. Endovascular treatments were: embolization (81/181), embolization and hypogastric artery coverage (79/181), hypogastric artery coverage by stent-grafting (15/181), stent-grafting in the hypogastric artery (6/181). Overall estimated technical success (TS) rate was 91.6% (95% CI 86.8-95.5; I2 45.82%, P = .031). TS rate was 94.5% for open surgery (95%CI 85.3-100; I2 0%, P = .907), and 89.7% for endovascular repair (95%CI 83.8-95.6; I2 55.43%, P = .006). Estimated overall 30-day mortality was 3.1% (95%CI 0.8-5.4; I2 0%, P = .969). Mortality rates after open surgery and endovascular repair were 8.2% (95%CI 3.4-19.8; I2 0%, P = .545) and 2.8% (95%CI 0.5-5.1; I2 0%, P = .994), respectively. Estimated mean follow-up was 32.63 months (95%CI 21.74-43.53; I2 94.45%, P < .001). During this timeframe, IIIAA exclusion was preserved in 92.8% of the patients (95%CI 89.3-96.2; I2 0%, P = .797). Buttock claudication occurred in 13.9% of the patients (95%CI 8.7-19.2; I2 0%, P = .622). Conclusions: IIIAA are frequently large, and symptomatic at presentation. Several treatments are proposed in literature, open and endovascular, both with good results. The endovascular treatment is the preferred method of treatment in literature, since it offers good short- to mid-term results and low early mortality. Buttock claudication after hypogastric artery exclusion is a common complication.

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