Successful treatment of type I endoleak of common iliac artery with balloon expandable stent (Palmaz XL stent) during endovascular aneurysm repair

Purpose: To evaluate the efficacy, feasibility, and long-term outcomes of the Zenith ZBIS iliac branch device (IBD) to preserve internal iliac artery (IIA) perfusion in a large Dutch multicenter cohort. Methods: Between September 2004 and August 2015, 140 patients (mean age 70.9±7.4 years; 130 men) with 162 IBD implantations were identified in 7 vascular centers. The indication for IBD implantation was an abdominal aortic aneurysm >55 mm with a concomitant common iliac artery (CIA) aneurysm >20 mm (n=40), a CIA aneurysm with a diameter >30 mm (n=89), or revision of a type Ib endoleak after endovascular aneurysm repair (n=11). Results: Technical success (aneurysm exclusion, no type I or III endoleak, and a patent IIA) was obtained in 157 (96.9%) of 162 IBD implantations. Six (4.3%) patients developed major complications; 2 (1.4%) died. Mean follow-up was 26.6±24.1 months, during which 17 (12.1%) IBD-associated secondary interventions were performed. Including technical failures and intentional IIA embolizations, 15 (9.3%) IIA branch occlusions were identified; buttock claudication developed in 6 of these patients. The freedom from secondary intervention estimate was 75.9% (95% confidence interval 59.7 to 86.3) at 5 years. Conclusion: CIA aneurysms can be treated safely and effectively by IBDs with preservation of antegrade flow to the IIA. Secondary interventions are indicated in >10% of patients during follow-up but can be performed endovascularly in most.

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First successful treatment of endoleak type I with E-XL stent after thoracic endovascular aneurysm repair

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0029-1246740 ◽

2010 ◽

Vol 58 (S 01) ◽

Author(s):

S Buz ◽

B Zipfel ◽

B Tutkun ◽

R Hetzer

Keyword(s):

Successful Treatment ◽

Endovascular Aneurysm Repair ◽

Type I ◽

Thoracic Endovascular Aneurysm Repair ◽

Aneurysm Repair

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Abdominal Aortic Disease: A Multicase Review

Journal for Vascular Ultrasound ◽

10.1177/1544316719829602 ◽

2019 ◽

Vol 43 (1) ◽

pp. 18-24

Author(s):

Joshua D. Lee ◽

Courtney Webb ◽

Mark W. Fugate

Keyword(s):

Patient Care ◽

Iliac Artery ◽

Endovascular Aneurysm Repair ◽

Artery Aneurysm ◽

Disease Diagnosis ◽

Aortic Disease ◽

Type I ◽

Abdominal Aortic ◽

Type I Endoleak ◽

Vascular Laboratory

Abdominal aortic disease affects more than 3 million people per year. For vascular sonographers, imaging aortic disease can become routine. Therefore, it is necessary to expand the knowledge that we have of aortic disease, diagnosis, and treatment. We present 4 cases with new or worsening conditions diagnosed by duplex ultrasound (DUS). Our first case is a 79-year-old woman returning for surveillance of an endovascular aneurysm repair (EVAR). The DUS findings reveal an increasing abdominal aortic aneurysm (AAA) sac, with evidence of flow originating from an incomplete seal at the attachment suggesting type I endoleak. Next, is a 56-year-old man returning 1 month after type A dissection repair, now presenting with unilateral claudication. The DUS findings of the left lower extremity demonstrated an early systolic deceleration waveform, suggesting more proximal disease. Upon further imaging, an abdominal aortic dissection was identified terminating into the left internal iliac artery, causing the true lumen to be compressed. The third case was a 75-year-old man returning for follow-up of an EVAR and iliac repair. The DUS findings show an increase in iliac artery sac size and anechoic area that was filled with color Doppler flow. These findings are suggestive of type I endoleak involving the distal attachment. The last case is a 56-year-old man returning for EVAR and iliac artery repair surveillance. The common iliac artery aneurysm sac had increased in diameter and length. The distal attachment of the left iliac extension cuff terminated within the aneurysm sac, causing a type I endoleak. Accurate DUS diagnosis of aortic disease is crucial for patient care. Meticulous analysis of the vessels and surrounding structures can make a difference in diagnostic outcomes. Vascular sonographers should continually review and revise vascular laboratory protocols to increase their diagnostic accuracy and improve patient care. It is important to extend the vascular laboratory protocols when complex cases arise to better demonstrate complicated diagnoses and challenging anatomy.

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Type I Endoleak Post-Endovascular Aneurysm Repair, Successfully Treated With Excluder Cuff and Fixation Screws

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2017.10.043 ◽

2018 ◽

Vol 11 (1) ◽

pp. e5-e6 ◽

Cited By ~ 1

Author(s):

Omar A. Ayah ◽

Jordan Klein ◽

Muhammad Raza ◽

Daniel J. McCormick

Keyword(s):

Endovascular Aneurysm Repair ◽

Type I ◽

Type I Endoleak ◽

Aneurysm Repair

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Fate of Aneurysmal Common Iliac Artery Landing Zones Used for Endovascular Aneurysm Repair

Journal of Endovascular Therapy ◽

10.1177/1526602815602121 ◽

2015 ◽

Vol 22 (5) ◽

pp. 748-759 ◽

Cited By ~ 15

Author(s):

Claire L. Griffin ◽

Salvatore T. Scali ◽

Robert J. Feezor ◽

Catherine K. Chang ◽

Kristina A. Giles ◽

...

Keyword(s):

Iliac Artery ◽

Common Iliac Artery ◽

Endovascular Aneurysm Repair ◽

Aneurysm Repair

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Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm, Bilateral Common Iliac Artery Aneurysm, and Left Hypogastric Aneurysm with Right Iliac Branch EXCLUDER® Device

Challenging Arterial Reconstructions ◽

10.1007/978-3-030-44135-7_66 ◽

2020 ◽

pp. 291-294

Author(s):

Sachinder Singh Hans

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Iliac Artery ◽

Common Iliac Artery ◽

Endovascular Aneurysm Repair ◽

Artery Aneurysm ◽

Iliac Artery Aneurysm ◽

Abdominal Aortic ◽

Common Iliac Artery Aneurysm ◽

Aneurysm Repair

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Initial Clinical Experience Using the Low-Profile Altura Endograft System With Double D-Shaped Proximal Stents for Endovascular Aneurysm Repair

Journal of Endovascular Therapy ◽

10.1177/1526602818771973 ◽

2018 ◽

Vol 25 (3) ◽

pp. 379-386 ◽

Cited By ~ 6

Author(s):

Dainis Krievins ◽

Albrecht Krämer ◽

Janis Savlovskis ◽

Georgij Oszkinis ◽

E. Sebastian Debus ◽

...

Keyword(s):

Clinical Investigation ◽

Clinical Success ◽

Endovascular Aneurysm Repair ◽

Clinical Results ◽

Type I ◽

Midterm Outcome ◽

Early Results ◽

Low Profile ◽

Type I Endoleak ◽

Aneurysm Repair

Purpose: To report the initial clinical results of endovascular aneurysm repair (EVAR) using the low-profile (14-F) Altura Endograft System, which features a double “D-shaped” stent design with suprarenal fixation and modular iliac components that are deployed from distal to proximal. Methods: From 2011 to 2015, 90 patients (mean age 72.8±8.3 years; 79 men) with abdominal aortic aneurysm (AAA; mean diameter 53.8±5.7 mm) were treated at 10 clinical sites in 2 prospective, controlled clinical studies using the Altura endograft. Outcomes evaluated included mortality, major adverse events (MAEs: all-cause death, stroke, paraplegia, myocardial infarction, respiratory failure, bowel ischemia, and blood loss ≥1000 mL), and clinical success (freedom from procedure-related death, type I/III endoleak, migration, thrombosis, and reintervention). Results: Endografts were successfully implanted in 89 (99%) patients; the single failure was due to delivery system malfunction before insertion in the early-generation device. One (1%) patient died and 4 patients underwent reinterventions (1 type I endoleak, 2 iliac limb stenoses, and 1 endograft occlusion) within the first 30 days. During a median follow-up of 12.5 months (range 11.5–50.9), there were no aneurysm ruptures, surgical conversions, or AAA-related deaths. The cumulative MAE rates were 3% (3/89) at 6 months and 7% (6/89) at 1 year. Two patients underwent coil embolization of type II endoleaks at 6.5 months and 2.2 years, respectively. Clinical success was 94% (84/89) at 30 days, 98% (85/87) at 6 months, and 99% (82/83) at 1 year. Conclusion: Early results suggest that properly selected AAA patients can be safely treated using the Altura Endograft System with favorable midterm outcome. Thus, further clinical investigation is warranted to evaluate the role of this device in the treatment of AAA.

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Type IIIb Endoleak After Endovascular Aneurysm Repair Using the Zenith Stent Graft

Vascular and Endovascular Surgery ◽

10.1177/1538574419858824 ◽

2019 ◽

Vol 53 (6) ◽

pp. 515-519

Author(s):

Toshiya Nishibe ◽

Toru Iwahashi ◽

Kentaro Kamiya ◽

Masaki Kano ◽

Keita Maruno ◽

...

Keyword(s):

Stent Graft ◽

Endovascular Aneurysm Repair ◽

Aneurysm Rupture ◽

Type I ◽

Stent Grafts ◽

System Type ◽

Type Iiib ◽

Type I Endoleak ◽

Aneurysm Repair

We present 3 cases of type IIIb endoleak after endovascular aneurysm repair (EVAR) using the Zenith stent graft system. Type III endoleak, like type I endoleak, is a high-pressure, high-risk leak that increases sac pressure up to or even above arterial pressure, and is associated with an increased frequency of open conversions or risk of aneurysm rupture. Type IIIb endoleak is rare but there is much concern that the incidence of type IIIb endoleak is likely to increase hereafter; the mechanism of type IIIb endoleak is deterioration of graft fabric in conjunction with stent sutures. Type IIIb endoleak is difficult to diagnose before rupture. The possibility of type IIIb endoleak should be highly suspected when the continued growth of an excluded aneurysm sac without direct radiologic evidence is observed during follow-up. Type IIIb endoleak can be repaired by relining of the stent graft with additional stent grafts.

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