scholarly journals Midterm Outcomes after Primary Stenting in Treatment of Atherosclerotic Iliac Arteries

2021 ◽  
Author(s):  
Mehmet Atay ◽  
Onur Saydam ◽  
Deniz Şerefli ◽  
Ayşen Yaprak Engin ◽  
Burçin Abud ◽  
...  
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Limb Ischemia ◽  
Lesion Length ◽  
Covered Stents ◽  
Complication Rates ◽  
Iliac Arteries ◽  
Primary Stenting ◽  
Stent Diameter ◽  
Severe Calcification

IntroductionThe purpose of this study was to report the midterm outcomes of primary stenting of iliac arteries with additional factors which affect the outcome and to compare the results between patients with simple and complex aorta iliac occlusive disease (AOID).Material and methodsFrom January 2015 and March 2018, the study consisted of 103 lesions in 93 patients with common iliac artery (CIA) and/or external iliac artery (EIA) lesions which accompanied with severe claudication or critical limb ischemia. Balloon-expandable stents (BMS), self-expandable stents (SES) and covered stents (CS) were used to treat the lesions.ResultsLesions of 93 patients that were in CIA and/or EIA and treated with ET were included to the study (n=103). Seventy-one (68.9%) lesions were classified as simple AIOD group (TASCII A-B) while 32(31.1%) were classified as complex AIOD (TASCII C-D) group. In 72.8% of the lesions only mild calcification was detected while 27.2% lesions had moderate or severe calcification. Mean stent diameter for CIA position was 8.26±0.8mm and for EIA position was 7.52±0.8mm. Mean lesion length in patients treated with BMS were 52.5±21.0mm while SES were 63.6±28.3(p=0.03). Technical success was achieved in 101(98.1%) lesions. Significant differences in primary (93% vs 63%) and secondary (98% vs 82%) patency rates at 24 months were found between patients in simple and complex AIOD group (p<0.001 p=0.001)ConclusionsConclusion: In our study, it was found that the primary stenting in patients who had AIOD had satisfactory results with high immediate success, low complication rates and acceptable midterm outcomes.

Aortobiiliac Bypass to the Distal External Iliac Artery versus Aortobifemoral Bypass: A Matched Cohort Study

2013 ◽  
Vol 79 (1) ◽  
pp. 61-66 ◽  
Author(s):  
John W. York ◽  
Brent L. Johnson ◽  
Michael Cicchillo ◽  
Spence M. Taylor ◽  
David L. Cull ◽  
...  
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Limb Ischemia ◽  
Wound Complications ◽  
Matched Cohort ◽  
Aortobifemoral Bypass ◽  
Aortoiliac Occlusive Disease ◽  
Iliac Arteries ◽  
Vascular Bypass ◽  
Bypass Patency

Vascular bypass has long been the standard surgical treatment for symptomatic aortoiliac occlusive disease (AIOD). Conventional wisdom has been that aortobifemoral bypass (ABF) be performed for AIOD because of the inevitable progression of iliac atherosclerosis leading to bypass thrombosis. However, ABF is prone to significant groin incision complications such as infection and lymphocele. The purpose of this study was to determine if aortobiiliac bypass (ABI) to the distal external iliac artery performs similarly to ABF in cases in which minimal atherosclerosis is present in the distal iliac arteries. Of patients undergoing aortic reconstruction for symptomatic AIOD between July 1998 and December 2008, 37 were found to have minimal atherosclerosis in the distal external iliac arteries and underwent ABI. These were compared with patients undergoing ABF using a retrospective matched cohort design. The indication for ABI was claudication in 86.5 per cent and critical limb ischemia in 13.5 per cent. There was no difference found in overall bypass patency. The 1-, 3-, and, 5-year patencies were 97, 92, and 79 per cent in the ABI group and 93, 85, and 76 per cent in the ABF group, respectively ( P = 0.8). The incidence of groin wound complications in the ABF group was 14.6 per cent. ABI to the distal external iliac artery achieves equivalent graft patencies to ABF without added risk of associated groin wound complications. These data suggest that ABI be preferentially considered to ABF in situations when the very distal external iliac arteries are patent and free of significant atherosclerotic disease.

scholarly journals Descending Thoracic Aortic Aneurysm Rupture Treated with Thoracic Endovascular Aortic Repair in a Patient with Peripheral Artery Disease

2018 ◽  
Vol 21 (2) ◽  
pp. 112 ◽  
Author(s):  
Ovidiu Stiru ◽  
Roxana Carmen Geana ◽  
Platon Pavel ◽  
Marian Croitoru ◽  
Cristian Boros ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Iliac Artery ◽  
Thoracic Aortic Aneurysm ◽  
Limb Ischemia ◽  
Aneurysm Rupture ◽  
Axillofemoral Bypass ◽  
Iliac Arteries ◽  
Descending Thoracic Aortic Aneurysm ◽  
Stent Grafting ◽  
Less Invasive

Descending thoracic aortic aneurysm rupture is a life-threatening disease associated with high rates of morbidity and mortality. Treatment in these cases is a surgical emergency. Less invasive therapies for the treatment of this pathology have been developed over time. For descending thoracic aneurysm rupture, endovascular stent grafting is less invasive, life-saving, and a unique alternative to open repair. However, this approach is subject to anatomical and logistic limitations. The purpose of the present study is to report a case of an emergency endovascular repair for a ruptured thoracic aortic aneurysm in a patient with peripheral arterial disease, and to discuss some important issues related to this approach. Severe calcifications were discovered in this patient on both iliac arteries, and the remaining circulated lumen was less than 2 to 3 mm. Unfortunately, only catheter insertion into the left iliac artery for angiography was able to determine the development of a dissection in the arterial wall. We decided to dilate both iliac arteries with partial stabilization of the dissection on the right iliac artery which allowed us to successfully continue the endovascular procedure. After 24 hours, the patient experienced right limb ischemia, and revascularization of the affected limb was achieved by performing a right axillofemoral bypass.

Successful and Unsuccessful Blind Placement of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Catheters Through Damaged Arteries: A Report of Three Cases

2018 ◽  
Vol 2 (1) ◽  
Author(s):  
Philip Joseph Wasicek ◽  
William A Teeter ◽  
Peter Hu ◽  
Deborah M Stein ◽  
Thomas M Scalea ◽  
...  
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Common Femoral Artery ◽  
Arterial Injury ◽  
Balloon Occlusion ◽  
Tactile Feedback ◽  
Balloon Inflation ◽  
Iliac Arteries ◽  
Tertiary Center ◽  
The Common

Background: Patients who receive REBOA for temporization of exsanguinating hemorrhage may have occult injuries sustained to the iliac arteries or aorta which may pose increased risks in performing REBOA. There is a paucity of literature describing the successful blind placement of wires and/or catheters for REBOA through damaged vasculature. Methods: Patients admitted between February 2013 and July 2017 at a tertiary center who had a successful or unsuccessful blind placement of a REBOA catheter or wire through a damaged iliac artery or aorta were included. Results: Three patients were identified. Two patients had successful placement of the REBOA catheter; one sustained injury to the external iliac artery, and the other sustained injury to the abdominal aorta. Confirmation of catheter placement was obtained before balloon inflation; and the damaged vessels were identified upon immediate operative intervention. One patient had unsuccessful placement of the REBOA catheter during cardiac arrest despite accurate access of the common femoral artery (CFA).  Conclusions: Emergent, blind placement of wires and catheters past arterial injuries is possible. Physical exam and/or tactile feedback should alert the surgeon to the possibility of arterial injury and imaging confirmation should precede balloon inflation if at all possible to minimize risk of further vascular injury.

scholarly journals Importance of Both Internal and External Iliac Artery Interrogation in Pelvic Trauma as Evidenced by Hemorrhage from Bilateral Corona Mortis with Unilateral Aberrant Origin off the External Iliac Artery

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Michael Herskowitz ◽  
James Walsh ◽  
Meghan Lilly ◽  
Kimberly McFarland
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Hemodynamic Instability ◽  
Pelvic Trauma ◽  
Obturator Artery ◽  
Iliac Arteries ◽  
Corona Mortis ◽  
Internal Iliac ◽  
Blunt Pelvic Trauma ◽  
Internal Iliac Arteries

Transcatheter angiography and embolization has long been recognized as the gold standard for patients with hemodynamic instability secondary to blunt pelvic trauma. While often the bleeding source can be readily localized based on the distribution of extravasation on preprocedural Computed Tomographic Angiography, one should be cautious in assessment for aberrant anatomy. A variant obturator artery originating from the inferior epigastric branch of the external iliac artery is commonly referred to as the corona mortis. We present a case of blunt pelvic trauma in which a patient demonstrated extravasation in the anterior distributions of both internal iliac arteries. Following embolization of bilateral internal iliac arteries, identification and embolization of bilateral corona mortis branches was crucial to achieving hemodynamic stability in this patient.

scholarly journals Iliac artery myointimal hyperplasia in rabbits submitted to angioplasty and treated with Moringa oleifera

2016 ◽  
Vol 43 (1) ◽  
pp. 28-34
Author(s):  
Jânio Cipriano Rolim ◽  
Manoel Ricardo Sena Nogueira ◽  
Paulo Roberto da Silva Lima ◽  
Francisco Chavier Vieira Bandeira ◽  
Mizael Armando Abrantes Pordeus ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Moringa Oleifera ◽  
External Iliac Artery ◽  
Laboratory Animals ◽  
Iliac Arteries ◽  
Significance Level ◽  
Hypercholesterolemic Diet ◽  
Significant Difference ◽  
Moringa Oleifera Leaves ◽  
Student’S T

Objective: to assess post-angioplasty myointimal hyperplasia in iliac artery of rabbits treated with extract of Moringa oleifera leaves. Methods : we conducted a randomized trial in laboratory animals for five weeks of follow-up, developed in the Vivarium of Pharmaceutical Technology Laboratory of the Universidade Federal da Paraíba. We used rabbits from the New Zealand breed, subjected to a hypercholesterolemic diet and angioplasty of the external iliac artery, randomized into two groups: M200 Group (n=10) - rabbits treated with 200mg/kg/day of Moringa oleifera leaves extract orally; SF group (n=10) - rabbits treated with 0.9% saline orally. After five weeks, the animals were euthanized and the iliac arteries prepared for histology. Histological sections were analyzed by digital morphometry. Statistical analysis was performed using the Student's t test. The significance level was 0.05. Results : there was no significant difference in myointimal hyperplasia between M200 and SF groups when comparing the iliac arteries submitted to angioplasty. Conclusion : there was no difference of myointimal hyperplasia between groups treated with saline and Moringa oleifera after angioplasty.

Endovascular Gamma Irradiation of the Iliac Arteries: 1-Year Results from a Clinical Safety and Feasibility Study

2003 ◽  
Vol 10 (3) ◽  
pp. 573-576 ◽  
Author(s):  
Piotr Walichiewicz ◽  
Jerzy Piecuch ◽  
Brygida Białas ◽  
Witold Orkisz ◽  
Marek Fijałkowski ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Common Iliac Artery ◽  
Balloon Dilation ◽  
Limb Ischemia ◽  
Antiplatelet Treatment ◽  
Clinical Safety ◽  
Iliac Arteries ◽  
Vascular Brachytherapy ◽  
Iridium 192

Purpose: To estimate safety and feasibility of vascular brachytherapy in iliac arteries. Methods: Fourteen patients (11 men; mean age 56.7±9.9 years, range 44–81) with occlusive disease in 15 iliac arteries (7 external, 8 common) were treated with balloon dilation followed by irradiation from an iridium 192 source (15 Gy at 3 mm from the inner surface of the artery wall) applied with a PARIS centering catheter and bilateral 10-mm margins. Patients receiving stents for suboptimal angioplasty were prescribed a 6-month course of antiplatelet treatment with ticlopidine. Angiography was routinely scheduled for 6 months after intervention. Results: There were no complications of the angioplasty procedure or EVBT treatment; 7 patients received stents for dissection or residual stenosis. Mean follow-up was 12.4±6.0 months. At 6-month angiography, 1 (6.7%) restenosis in a common iliac artery stent was found. Another patient with a common iliac artery stent developed transient lower limb ischemia at 4 months, probably due to temporary suspension of antiplatelet treatment and distal disease. Conclusions: Brachytherapy in the iliac arteries appears to be feasible and safe; longer follow-up in more patients is needed to determine its clinical utility in the prevention of restenosis.

scholarly journals Management of a Spontaneous Dissection of the Right External Artery

2021 ◽  
Vol 4 (5) ◽  
pp. 01-04
Author(s):  
Majdi Gueldich ◽  
Héla Ben Jemâa ◽  
Saif Hadhri ◽  
Nawel Hchaichi ◽  
Aymen Damak ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Open Repair ◽  
Rare Event ◽  
Vascular Diseases ◽  
External Iliac Artery ◽  
Limb Ischemia ◽  
Artery Dissection ◽  
History Of ◽  
The Right ◽  
Spontaneous Dissection

Introduction: Isolated spontaneous iliac artery dissection is a rare event that is usually linked to connective disorders. There is no established consensus yet on treatment modality. Case report: we report the case of a 44 years old patient with no history of vascular diseases or trauma who was admitted in our institution for a spontaneous dissection of the right external iliac artery. Conclusion: management of spontaneous iliac artery dissection is not well defined. In fact, patients could be safely managed with medical therapy in the absence of signs of complications. Endovascular and open repair are reserved for patients with complications like limb ischemia or imminent artery rupture.

Chronic Total Occlusion Crossing Approach Based on Plaque Cap Morphology: The CTOP Classification

2018 ◽  
Vol 25 (3) ◽  
pp. 284-291 ◽  
Author(s):  
Fadi Saab ◽  
Michael R. Jaff ◽  
Larry J. Diaz-Sandoval ◽  
Gwennan D. Engen ◽  
Theresa N. McGoff ◽  
...  
Keyword(s):  
Chronic Total Occlusion ◽  
Limb Ischemia ◽  
Lesion Length ◽  
Type I ◽  
Type Ii ◽  
Convex Shape ◽  
Total Occlusion ◽  
Endovascular Interventions ◽  
Type Iv ◽  
Severe Calcification

Purpose: To present the chronic total occlusion (CTO) crossing approach based on plaque cap morphology (CTOP) classification system and assess its ability to predict successful lesion crossing. Methods: A retrospective analysis was conducted of imaging and procedure data from 114 consecutive symptomatic patients (mean age 69±11 years; 84 men) with claudication (Rutherford category 3) or critical limb ischemia (Rutherford category 4–6) who underwent endovascular interventions for 142 CTOs. CTO cap morphology was determined from a review of angiography and duplex ultrasonography and classified into 4 types (I, II, III, or IV) based on the concave or convex shape of the proximal and distal caps. Results: Statistically significant differences among groups were found in patients with rest pain, lesion length, and severe calcification. CTOP type II CTOs were most common and type III lesions the least common. Type I CTOs were most likely to be crossed antegrade and had a lower incidence of severe calcification. Type IV lesions were more likely to be crossed retrograde from a tibiopedal approach. CTOP type IV was least likely to be crossed in an antegrade fashion. Access conversion, or need for an alternate access, was commonly seen in types II, III, and IV lesions. Distinctive predictors of access conversion were CTO types II and III, lesion length, and severe calcification. Conclusion: CTOP type I lesions were easiest to cross in antegrade fashion and type IV the most difficult. Lesion length >10 cm, severe calcification, and CTO types II, III, and IV benefited from the addition of retrograde tibiopedal access.

scholarly journals Results From the VISIBILITY Iliac Study: Primary and Cohort Outcomes at 9 Months

2017 ◽  
Vol 24 (3) ◽  
pp. 342-348 ◽  
Author(s):  
John H. Rundback ◽  
Patrick Peeters ◽  
Jon C. George ◽  
Michael R. Jaff ◽  
Peter L. Faries
Keyword(s):  
Iliac Artery ◽  
Ankle Brachial Index ◽  
External Iliac Artery ◽  
Patient Characteristics ◽  
The United States ◽  
Target Lesion ◽  
Primary Patency ◽  
Specific Patient ◽  
Target Vessel Revascularization ◽  
Primary Stenting

Purpose: To evaluate the safety and effectiveness of primary stenting of the common (CIA) or external iliac artery (EIA) using the Visi-Pro Balloon-Expandable Peripheral Stent System for treatment of stenotic, restenotic, or occluded lesions. Methods: Between 2011 and 2012, 75 patients (mean age 64.2±8.9 years; 46 men) with Rutherford category 2–4 ischemia and atherosclerotic lesions ≤10 cm in length underwent iliac artery stenting at 17 centers in the United States and Europe. The primary outcome of the study was the major adverse event (MAE) rate at 9 months postprocedure [composite of periprocedural death, in-hospital myocardial infarction, clinically driven target lesion revascularization (CD-TLR), and amputation of the treated limb]. Secondary outcomes included 30-day MAE rate, 9-month primary patency, changes in ankle-brachial index (ABI) and the Walking Impairment Questionnaire at 30 days and 9 months postprocedure, device success, and clinically driven target vessel revascularization (CD-TVR) at 30 days and 9 months. Outcomes in specific patient cohorts (ie, gender, stent location, calcification severity, and lesion grade) were analyzed. Results: Eighty-one stents were implanted in 61 CIA and 15 EIA lesions (41 with moderate/severe calcification). The mean lesion treated length was 29.3±13.9 mm. All devices were successfully deployed. MAE occurred in 3 (4.0%) of 75 subjects at 9 months. Primary patency and freedom from CD-TVR at 9 months were both 95.8%. ABI improved from 0.67±0.14 at baseline to 0.94±0.14 and 0.96±0.16 at 30 days and 9-month follow-up, respectively (p<0.001 for both). There were no differences with respect to any of the analyzed patient characteristics, including gender. Conclusion: Nine-month results of the VISIBILITY Iliac stent study ( ClinicalTrials.gov identifier NCT01402700) demonstrated safety and effectiveness for the treatment of atherosclerotic CIA and EIA lesions with the Visi-Pro stent across all treated cohorts.

scholarly journals Paclitaxel-Coated Balloon Angioplasty for the Treatment of Infrainguinal Arteries: 24-Month Outcomes in the Full Cohort of BIOLUX P-III Global Registry

2020 ◽  
Author(s):  
Gunnar Tepe ◽  
Thomas Zeller ◽  
Matej Moscovic ◽  
Jean-Marc Corpataux ◽  
Johnny Kent Christensen ◽  
...  
Keyword(s):  
Real World ◽  
Large Population ◽  
Limb Ischemia ◽  
Target Lesion ◽  
Lesion Length ◽  
Complication Rates ◽  
Full Cohort ◽  
Infrainguinal Arteries ◽  
And Performance

Abstract Purpose After promising small randomized trials, the aim of BIOLUX P-III was to further investigate the safety and performance of the Passeo-18 lx drug-coated balloon in infrainguinal arteries under real-world conditions. Methods BIOLUX P-III is a global prospective single-arm study with follow-up at 6, 12 and 24 months. The primary safety endpoint was freedom from major adverse events (MAE) within 6 months. The primary performance endpoint was freedom from clinically driven target lesion revascularization (TLR) within 12 months. Results 877 patients/1084 lesions were enrolled. Diabetes mellitus was present in 47.7%, and 42.1% had critical limb ischemia (CLI). The mean lesion length was 89.0 mm with 76.1% of calcified lesions, and 24.9% occluded. At 24 months, freedom from MAE was 83.1% in the full cohort; 84.9% in the femoropopliteal population (592 patients, 691 lesions); 77.7% for long lesions (187 subjects/192 lesions); and 72.5% in the in-stent restenosis (ISR) subgroup (103 subjects/116 lesions). Twenty-four-month freedom from clinically driven TLR was 88.1% in the full cohort; 88.9% in the femoropopliteal population; 80.3% for the long lesions; and 78.4% for ISR. Twenty-four-month all-cause mortality was 12.0% in the full cohort, 10.2% in the femoropopliteal population, 14.8% for the long lesions and 12.0% for ISR. There was no device- or procedure-related death up to 24-month follow-up. Conclusion The BIOLUX P-III 24-month outcomes confirm the safety and performance of Passeo-18 lx in infrainguinal arteries in a large population treated under real-world conditions with low complication rates and good clinical outcomes (NCT02276313).

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