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.

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.

Pseudoaneurysm Formation at the Site of External Iliac Artery Stents: Percutaneous Stent-Graft Treatment

2001 ◽  
Vol 8 (3) ◽  
pp. 303-307 ◽  
Author(s):  
Dierk Scheinert ◽  
Josef Ludwig ◽  
Malte Schröder ◽  
Sven Bräunlich ◽  
Joern O. Balzer ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Stent Graft ◽  
Iliac Artery ◽  
External Iliac Artery ◽  
Spiral Computed ◽  
Pseudoaneurysm Formation ◽  
Contrast Enhanced ◽  
Stent Graft Repair ◽  
Palmaz Stents

Purpose: To present a patient who developed an asymptomatic large iliac pseudoaneurysm complicating stent-supported iliac artery recanalization. Case Report: The pseudoaneurysm was detected in an asymptomatic 69-year-old man during routine angiography 6 months after an uncomplicated procedure to implant 3 overlapping Palmaz stents in an occluded external iliac artery. There was no evidence of stent infection. During a second intervention, the pseudoaneurysm was successfully treated by percutaneous implantation of an EndoPro System I stent-graft. Contrast-enhanced spiral computed tomography at 6 and 12 months confirmed the durability of aneurysm exclusion and the patency of the endoprosthesis. Conclusions: Angioplasty-induced pseudoaneurysm is rare and usually asymptomatic, but elective percutaneous stent-graft repair should be considered as the first treatment option.

Emergent Endovascular Repair of Challenging Aortocaval Fistula With Hostile Anatomy

2017 ◽  
Vol 51 (5) ◽  
pp. 255-260 ◽  
Author(s):  
Yuewei Wang ◽  
Wenjuan Yu ◽  
Yongxin Li ◽  
Haofu Wang
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Iliac Artery ◽  
Endovascular Repair ◽  
Computed Tomography Angiography ◽  
External Iliac Artery ◽  
Aortocaval Fistula ◽  
The Right ◽  
Great Neck ◽  
Aortic Cuff

Aortocaval fistula (ACF) is a rare complication. Endovascular repair is an option for this fatal condition. However, endoleak and persistent fistula may occur and lead to technical failure. We performed endovascular repair for 3 cases of challenging ACF with hostile anatomy. Patient 1 was an 80-year-old man who complained of abdominal distension and lower limb edema for 15 days. He had renal and cardiac dysfunction. Computed tomography angiography (CTA) showed an ACF and extreme tortuosity of right iliac artery. The super-stiff guidewire could not pass the right iliac artery. We performed endovascular repair and an occluder was used to block the right external iliac artery. Postoperative CTA showed migration of the occluder, and we ligated the right external iliac artery. The patient survived for 5 years. Patient 2 was a 78-year-old man who complained of an acute abdominal pain for 30 hours. Computed tomography angiography showed great neck angulation (63.3°) and a huge aneurysm (9.9 cm in diameter). A type 1A endoleak occurred and an aortic cuff was deployed at the proximal seal zone. Meanwhile, a type 3 endoleak occurred because of the migration and detachment of the left iliac limb. Another stent-graft was deployed to connect the iliac limb. The patient was followed up for 1 year and remained in a good condition. Patient 3 was a 74-year-old man who experienced severe abdominal pain for 1 day. Computed tomography angiography showed great neck angulation (66°) and a huge aneurysm (10.1 cm in diameter). A type 1A endoleak occurred, and an aortic cuff was deployed at the proximal seal zone. The patient was followed up for 6 months. In conclusion, ACF is a rare but a fatal condition. Acute cases and chronic cases with instable hemodynamics need urgent diagnosis and surgical intervention. Endovascular repair is an efficacious alternative to the traditional open repair.

Massive Bleeding from Guidewire Perforation of an External Iliac Artery: Treatment with Hand-made Stent-Graft Placement

2015 ◽  
Vol 39 (1) ◽  
pp. 106-110 ◽  
Author(s):  
Vimal Mehta ◽  
Bhagya Narayan Pandit ◽  
Pratishtha Mehra ◽  
Arima Nigam ◽  
Aniruddha Vyas ◽  
...  
Keyword(s):  
Stent Graft ◽  
Iliac Artery ◽  
External Iliac Artery ◽  
Massive Bleeding ◽  
Graft Placement

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 Intraorbital wooden foreign body detected by computed tomography and magnetic resonance imaging

2016 ◽  
Vol 30 (1) ◽  
pp. 88-91 ◽  
Author(s):  
Alfredo Di Gaeta ◽  
Francesco Giurazza ◽  
Eugenio Capobianco ◽  
Alvaro Diano ◽  
Mario Muto
Keyword(s):  
Computed Tomography ◽  
Foreign Body ◽  
Magnetic Resonance ◽  
Delayed Diagnosis ◽  
Clinical History ◽  
Definitive Diagnosis ◽  
Double Vision ◽  
Resonance Imaging ◽  
Wooden Foreign Body ◽  
The Right

To identify and localize an intraorbital wooden foreign body is often a challenging radiological issue; delayed diagnosis can lead to serious adverse complications. Preliminary radiographic interpretations are often integrated with computed tomography and magnetic resonance, which play a crucial role in reaching the correct definitive diagnosis. We report on a 40 years old male complaining of pain in the right orbit referred to our hospital for evaluation of eyeball pain and double vision with an unclear clinical history. Computed tomography and magnetic resonance scans supposed the presence of an abscess caused by a foreign intraorbital body, confirmed by surgical findings.

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.

Evolution and clinical relevance of common iliac artery seal zone after endovascular aortic aneurysm repair

Vascular ◽  
2019 ◽  
Vol 27 (4) ◽  
pp. 363-368 ◽  
Author(s):  
Gergana T Taneva ◽  
Alejandro González García ◽  
Ana Begoña Arribas Díaz ◽  
Yasmina Baquero Yebra ◽  
Konstantinos P Donas ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Iliac Artery ◽  
Computed Tomography Angiography ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Stent Grafts ◽  
Iliac Arteries ◽  
Radiological Data ◽  
The Mean ◽  
Aneurysm Repair

Objective Data in literature suggest iliac artery dilatation and endograft retraction as complications after endovascular aneurysm repair. However, mainly older generation endografts were included. Therefore, we sought to evaluate the distal sealing zone chronological changes after endovascular aneurysm repair with newer generation stent-grafts. Methods Clinical and radiological data of patients with abdominal aortic aneurysms treated with endovascular aneurysm repair between January 2010 and December 2013 were reviewed. Measurements were made using volumetric reconstructions in the first and last available computed tomography angiography. Endpoints of the study were the presence of iliac dilatation and retraction of the endograft. Association with distal oversizing and sealing length was analyzed. Results Consecutive patients with a total of 52 common iliac arteries were included in the study (mean age 74.9 ± 6.8 years, four women (7.7%)). The mean follow-up was 3.1 years. The mean iliac diameter increased from 15.5 to 17.1 mm ( p < .001) in the first control computed tomography angiography and to 18.7 mm ( p < .001) in the last available computed tomography angiography. No endograft (Endurant by Medtronic (24/52; 46%), Excluder de Gore (23/52; 44%), Zenith by Cook (5/52; 9%)) was associated with dilatation ( p = .066) or iliac retraction ( p = .591). Two type Ib endoleaks were found (3.8%) and successfully treated with distal graft extension. An iliac branch retraction of ≥5 mm was identified in seven cases (13%). Iliac arteries treated with limbs of ≥24 mm in diameter dilated significantly more than the rest of limbs (5.37 mm versus 3.12 mm; p = .022). In the last available imaging, iliac dilatation was ≥20% in 28 cases (53.8%) and had exceeded the diameter of the implanted endograft in 20 cases (38.4%). Iliac dilatation (OR 15.11 per mm, p = .025) was identified as a risk factor for retraction ≥5 mm. Conclusion Iliac dilatation and endograft limb retraction are common findings after endovascular aneurysm repair despite the use of new generation endografts. Optimizing the iliac sealing length and meticulous computed tomography angiography surveillance are recommended especially in case of use ≥24 mm iliac stent-grafts to prevent possible complications.

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