Surgeon Custom-Made Iliac Branch Device to Salvage Hypogastric Artery during Endovascular Aneurysm Repair

Background Acute endovascular aneurysm repair with stent grafts (thoracic endovascular aortic repair [TEVAR]) is safe and feasible. Case Description A 64-year-old female presented with a perforated aortic aneurysm of the thoracic descending aorta. Primary TEVAR resulted in good management of the perforation but a type Ib endoleakage remained postoperatively. To place another stent, abdominal debranching with saphenous vein bypass to the celiac trunk was required. In the same session, another endograft was inserted successfully. Conclusion Abdominal debranching is a safe alternative to open aortic repair in acute thoracic and abdominal aneurysms, instead of waiting for a custom-made device.

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Buttock Claudication After Interventional Occlusion of the Hypogastric Artery—A Mid-Term Follow-Up

Vascular and Endovascular Surgery ◽

10.1177/1538574411436329 ◽

2012 ◽

Vol 46 (3) ◽

pp. 236-241 ◽

Cited By ~ 20

Author(s):

Daphne Pavlidis ◽

M. Hörmann ◽

M. Libicher ◽

M. Gawenda ◽

J. Brunkwall

Keyword(s):

Retrospective Analysis ◽

Endovascular Aneurysm Repair ◽

Hypogastric Artery ◽

Iliac Arteries ◽

Frequent Complication ◽

Buttock Claudication ◽

Ischemic Complication ◽

Pelvic Perfusion ◽

Aneurysm Repair

Background. Interventional occlusion of the hypogastric artery (HA) can be used for endovascular aneurysm repair (EVAR) in the iliac arteries. Most frequent ischemic complication is buttock claudication (BC). Aim. To investigate the frequency and progression of BC after interventional occlusion of the HA prior to EVAR. Methods. A retrospective analysis was performed in patients with EVAR and occlusion of the HA between September 2004 and August 2010. Acute and persistent BC symptoms were assessed. Results. Fifty-four catheter occlusions of the HA were performed. In 10 cases, claudication could not be evaluated. During a mean follow-up of 17 months, 23 occlusions (52.3%) of the HA showed BC, in 52% symptoms were persistent. Of the 5 patients, 3 patients who underwent bilateral occlusion had BC and in 2 cases, persistent in the follow-up. Conclusion. Buttock claudication after occlusion of the HA prior to EVAR is a frequent complication, which often persists during follow-up. Alternatives that maintain pelvic perfusion should be considered.

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Preservation of Hypogastric Artery Blood Flow During Endovascular Aneurysm Repair of an Abdominal Aortic Aneurysm With Bilateral Common and Internal Iliac Artery Involvement: Utilization of Off-the-Shelf Stent-Graft Components

Annals of Vascular Surgery ◽

10.1016/j.avsg.2011.10.004 ◽

2012 ◽

Vol 26 (1) ◽

pp. 109.e1-109.e5 ◽

Cited By ~ 9

Author(s):

Paul J. Riesenman ◽

Joseph J. Ricotta ◽

Ravi K. Veeraswamy

Keyword(s):

Blood Flow ◽

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Internal Iliac Artery ◽

Endovascular Aneurysm Repair ◽

Artery Blood Flow ◽

Hypogastric Artery ◽

Abdominal Aortic ◽

Internal Iliac ◽

Aneurysm Repair

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Parallel-Stenting Technique in a Sandwich Configuration for Hypogastric Artery Preservation during Endovascular Aneurysm Repair: An In Vitro Study

Annals of Vascular Surgery ◽

10.1016/j.avsg.2017.03.202 ◽

2017 ◽

Vol 44 ◽

pp. 221-228 ◽

Cited By ~ 1

Author(s):

Xavier Yugueros ◽

Gaspar Mestres ◽

Savino Pasquadibisceglie ◽

Xavier Alomar ◽

Ana Apodaka ◽

...

Keyword(s):

Endovascular Aneurysm Repair ◽

In Vitro Study ◽

Vitro Study ◽

Hypogastric Artery ◽

Sandwich Configuration ◽

Aneurysm Repair

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Endovascular Aneurysm Repair Complicated with Type Ia Endoleak and Presumable Infection Treated with a Fenestrated Endograft

Aorta ◽

10.1055/s-0039-1681067 ◽

2018 ◽

Vol 06 (04) ◽

pp. 102-106

Author(s):

Arne de Niet ◽

Paul van Schaik ◽

Ben Saleem ◽

Clark Zeebregts ◽

Ignace Tielliu

Keyword(s):

Listeria Monocytogenes ◽

Antibiotic Therapy ◽

Endovascular Treatment ◽

Endovascular Aneurysm Repair ◽

Suppressive Therapy ◽

Graft Material ◽

Custom Made ◽

Type Ia ◽

Fenestrated Endograft ◽

Aneurysm Repair

AbstractAn 81-year-old patient presented to the emergency room 5 years after infrarenal endovascular aneurysm repair, with a Type Ia endoleak and a presumable infection of the graft material with Listeria monocytogenes. He was treated with a custom-made fenestrated endograft to seal the endoleak and lifelong antibiotic therapy to suppress the infection. Full explantation of graft material is not always preferable, and endovascular treatment combined with antibiotic suppressive therapy is in some cases an appropriate alternative.

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Outcome after hypogastric artery bypass and embolization during endovascular aneurysm repair

Yearbook of Vascular Surgery ◽

10.1016/s0749-4041(08)70757-7 ◽

2008 ◽

Vol 2008 ◽

pp. 146-148

Author(s):

G.L. Moneta

Keyword(s):

Artery Bypass ◽

Endovascular Aneurysm Repair ◽

Hypogastric Artery ◽

Aneurysm Repair

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Long-Term Renal Function following Endovascular Aneurysm Repair with Infrarenal and Suprarenal Aortic Stent-Grafts

Journal of Endovascular Therapy ◽

10.1177/152660280301000301 ◽

2003 ◽

Vol 10 (3) ◽

pp. 397-405 ◽

Cited By ~ 47

Author(s):

Pierre Alric ◽

Robert J. Hinchliffe ◽

Marie-Christine Picot ◽

Bruce D. Braithwaite ◽

Shane T.R. MacSweeney ◽

...

Keyword(s):

Renal Function ◽

Serum Creatinine ◽

Stent Graft ◽

Endovascular Aneurysm Repair ◽

Stent Grafts ◽

Abdominal Aortic ◽

Custom Made ◽

Aneurysm Repair ◽

The Impact

Purpose: To determine in a retrospective analysis the incidence of renal impairment (RI) following endovascular repair (EVR) of abdominal aortic aneurysm (AAA), to assess the morbidity and mortality in endograft patients with preoperative RI, and to examine the impact of suprarenal stent-grafts on renal function. Methods: From March 1994 to October 2001, 315 AAA patients (289 men; mean age 72.4±7.0 years) undergoing EVR were entered prospectively into a vascular registry. The patients received either an in-house custom-made stent-graft or one of several commercially made devices implanted with infrarenal or suprarenal fixation. Renal function was monitored by serum creatinine measurements prior to discharge and at 3, 6, and 12 months and annually thereafter. Preoperative RI was defined as a serum creatinine > 130 μmol/L and/or long-term dialysis. Postoperative RI referred to a >20% increase in the serum creatinine over baseline. Additional deterioration of renal function in patients with preoperative RI was referred to as postoperatively worsened RI. Results: Of the 315 patients treated, 220 (69.8%) were considered high risk (ruptured AAA or ASA grade III or IV). Sixty-nine (21.9%) patients had preoperative RI (6 [1.9%] on preoperative dialysis). A suprarenal stent-graft was used in 169 (53.7%) patients and infrarenal stent-graft in the remaining 146 (46.3%). The mean follow-up was 30.1 ±22.7 months. Postoperative RI occurred in 53 (16.8%) patients (24 [7.6%] transient, 29 [9.2%] persistent). Patients with preoperative RI had a significantly higher incidence of postoperatively worsened RI (37.7% versus 11.0%, p<0.0001) and a higher mortality related to RI (7.2% versus 1.6%, p=0.02). Suprarenal fixation had no influence on the incidence of RI, on perioperative mortality, or on mortality related to RI. The only significant predictive factor of postoperative RI was preoperative RI (risk ratio 5.09, 95% CI 2.38 to 10.87, p=0.0001). Conclusions: Endovascular AAA repair may lead to persistent postoperative RI in nearly 10% of cases, especially in patients with preoperative RI. Suprarenal stent-graft fixation does not seem to have any deleterious effect on renal function. Further long-term studies are required to confirm the innocuous nature of transrenal stent placement.

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Clinical impact of hypogastric artery occlusion in endovascular aneurysm repair

Vascular ◽

10.1177/1708538114560462 ◽

2014 ◽

Vol 23 (6) ◽

pp. 575-579 ◽

Cited By ~ 9

Author(s):

Manfred Kalteis ◽

Odo Gangl ◽

Florian Huber ◽

Peter Adelsgruber ◽

Manfred Kastner ◽

...

Keyword(s):

Iliac Artery ◽

Endovascular Aneurysm Repair ◽

External Iliac Artery ◽

Artery Occlusion ◽

Long Term Results ◽

Hypogastric Artery ◽

Artery Embolization ◽

Baseline Characteristics ◽

Aneurysm Repair

Purpose To report the long-term results for patients treated with endovascular aneurysm repair and additional embolization and coverage of the hypogastric artery compared with patients treated with simple endovascular aneurysm repair. Methods A database of our endovascular aneurysm repair patient cohort was reviewed to find patients with iliac artery aneurysms. The baseline characteristics, the procedural data and the results for patients treated with endovascular aneurysm repair and concomitant hypogastric artery embolization were compared with those for patients treated with simple endovascular aneurysm repair. The results were analyzed for significant differences. Results Of 106 endovascular aneurysm repair patients treated at our vascular unit from 2001 to 2010, 24 had undergone additional hypogastric artery embolization. The complication rate was significantly increased in this group (12.5% vs. 2.4%; p = 0.041), and the long-term results were significantly poorer. Additional hypogastric artery embolization resulted in late rupture (1.2% vs. 12.5%; p = 0.036), buttock claudication (8.6% vs. 43.8%; p = 0.001) and new onset erectile dysfunction (17.3% vs. 42.9%; p = 0.043). Conclusion Endovascular aneurysm repair with extension of the stent graft to the external iliac artery and embolization of the hypogastric artery was associated with more complications and worse long-term results compared with simple endovascular aneurysm repair.

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