Anatomic Suitability of Aortoiliac Aneurysms for Next Generation Branched Systems

Pearce, Benjamin J.; Varu, Vinit N.; Glocker, Roan J.; Novák, Zdeněk; Jordan, William D.; Lee, Jason T.

doi:10.1016/j.avsg.2014.08.003

Cited by 61 publications

(39 citation statements)

References 25 publications

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“…Overall CIA lengths were shorter for Japanese patients compared to American patients previously reported 18 but overall aorto-iliac lengths were similar: 56.5 ± 20.2 mm vs. 71.4 ± 23.7 (P < 0.001), 181.6 ± 27.5 mm vs. 183.6 ± 28.3 (P= 0.584), respectively. Regarding the 29 CIA segments in the 16 patients with bilateral IIA exclusion, 5 segments (17%) met IFU criteria for the Cook IBD and 8 (28%) segments met IFU criteria for the Gore IBE.…”

Section: Resultsmentioning

confidence: 48%

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Outcomes of Endovascular Repair of Aortoiliac Aneurysms and Analyses of Anatomic Suitability for Internal Iliac Artery Preserving Devices in Japanese Patients

Itoga

Fujimura

Hayashi

et al. 2017

Circ J

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Background Understanding common iliac arteries (CIA) are shorter in Asian patients, we investigated whether this anatomical difference affects clinical outcomes of internal iliac artery (IIA) exclusion during endovascular repair (EVAR) of aorto-iliac aneurysm and limits the use of IIA preserving devices in Japanese patients. Methods and Results From 2008–2014, 69 Japanese patients underwent EVAR of aorto-iliac aneurysms with 53 unilateral and 16 bilateral IIA exclusion. One patient had persistent-buttock claudication during follow-up; however colonic or spinal cord ischemia was not observed. Anatomic suitability was investigated for the iliac branch device (IBD) by Cook Medical and iliac branch endoprosthesis (IBE) by WL Gore. Eighty-seven aorto-iliac segments were analyzed: 17% meet criteria for the IBD and 25% meet criteria for the IBE with 40% meeting criteria for either. Main exclusions for the IBD were IIA diameter >9 mm or <6 mm, (47%) and CIA length <50 mm, (39%). Main exclusions for the IBE were proximal CIA diameter <17 mm, (44%) and aorto-iliac length <165 mm, (24%). Conclusions EVAR with IIA exclusions in Japanese patients showed low incidence of persistent-buttock claudication and no major pelvic complications. Aorto-iliac morphology demonstrated smaller proximal CIA diameters and shorter CIA lengths, limiting the use of IIA preserving devices.

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Section: Resultsmentioning

confidence: 48%

“…The IIA landing measurements were performed on the IIA segment before a first order branch without aneurysmal dilation or stenotic lesions suitable for stent graft placement. Previously published data at American institutions 18 were used to compare aorto-iliac aneurysm morphology in the current study.…”

Section: Methodsmentioning

confidence: 99%

Outcomes of Endovascular Repair of Aortoiliac Aneurysms and Analyses of Anatomic Suitability for Internal Iliac Artery Preserving Devices in Japanese Patients

Itoga

Fujimura

Hayashi

et al. 2017

Circ J

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“…[1–3] While these iliac artery branched graft devices are newly commercially available, 65% of patients are not candidates for such devices according to the manufacturer published inclusion and exclusion criteria. [4, 17–19] Off label use of devices to repair common iliac artery aneurysms that extend to the iliac bifurcation, such as the parallel graft and sandwich techniques, and physician modified devices have been recently described as well. [5–8, 20, 21] However, long term patency rates and outcomes of such techniques and devices are not yet known, and the overall cost of these devices may be prohibitively expensive, effectively limiting access to such technology in certain centers.…”

Section: Discussionmentioning

confidence: 99%

“…However, not all patients are candidates for branched IIA devices, and these devices have only recently become available outside of clinical trials. [1–4] In addition to branched graft technology, physician modified endografts and parallel graft techniques can maintain pelvic perfusion, but these techniques are outside the devices’ indications for use and require advanced endovascular training and skill. [5–8] Additionally, long-term patency of novel endovascular stent graft techniques is not known.…”

Section: Introductionmentioning

confidence: 99%

Hybrid Endovascular Aortic Aneurysm Repair: Preservation of Pelvic Perfusion with External to Internal Iliac Artery Bypass

Mansukhani

Havelka

Helenowski

et al. 2017

Annals of Vascular Surgery

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Introduction Diminished pelvic arterial flow as a result of intentional coverage/embolization of internal iliac arteries (IIA) during isolated endovascular common iliac artery aneurysm (CIAA) repair or endovascular repair of abdominal aortic aneurysms (EVAR) may result in symptomatic pelvic ischemia. While generally well tolerated, in severe cases pelvic ischemia may manifest as recalcitrant buttock claudication, vasculogenic impotence, or perineal, vesicle, rectal, and/or spinal cord ischemia. Branched graft technology has recently become available; however, many patients are not candidates for endovascular repair with these devices. Therefore, techniques to preserve pelvic arterial flow are needed. We reviewed our outcomes of isolated endovascular common iliac artery aneurysm repair or EVAR in conjunction with unilateral external-internal iliac artery bypass. Methods Single center, retrospective review of 10 consecutive patients who underwent hybrid endovascular abdominal aortic aneurysm (AAA) or common iliac artery aneurysm (CIAA) repair with concomitant external-internal iliac artery bypass between 2006 and 2015. Demographics, index procedural details, post-operative symptoms, hospital length of stay (LOS), follow-up imaging, and bypass patency were recorded. Results The cohort of 10 patients was all men with a mean age of 71 years (range of 56–84). Hybrid repair consisted of contralateral IIA coil embolization followed by EVAR with external iliac artery- internal iliac artery (EIA-IIA) bypass. All EIA-IIA bypasses were performed via a standard lower quadrant retroperitoneal approach with a prosthetic bypass graft. Technical success was 100% and there were no peri-operative deaths. One patient developed transient paraplegia, one patient had buttock claudication on the side of his hypogastric embolization contra-lateral to his iliac bypass, and one developed post-operative impotence. 20% of patients sustained long term complications (buttock claudication and post-operative impotence). Mean LOS was 2.8 days (range 1–9 days). Post-operative imaging was obtained in 90% of patients and mean follow-up was 10.8 months (range 0.5–36 months). All bypasses remained patent. Conclusion While branched graft technology continues to evolve, strategies to maintain adequate pelvic circulation are necessary in order to avoid the devastating complications of pelvic ischemia. We have demonstrated that a hybrid approach combining EVAR or isolated endovascular common iliac artery exclusion with a unilateral external-internal iliac bypass via a retroperitoneal approach is well tolerated with a short LOS and excellent patency rates.

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“…Due to the limitations associated with IBDs, only 35% of patients have anatomy suitable for repair (29). When CIAA fall outside the instructions for use (IFU) of the above devices, several creative methods of endovascular aneurysm repair have been developed.…”

Section: Snorkels Periscopes and Sandwichesmentioning

confidence: 99%

Endovascular management of iliac aneurysmal disease with hypogastric artery preservation

Schiro

Gandhi

Peña

et al. 2018

Cardiovasc. Diagn. Ther.

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Common iliac artery aneurysms (CIAAs) pose a challenge in endovascular aneurysm repair.Aneurysm repair of CIAA traditionally requires embolization of the ipsilateral hypogastric artery (HA).Symptoms of buttock claudication and more feared complications of pelvic ischemia make HA preservation an appealing addition to aneurysm repair. In this review, we discuss various methods of CIAA repair with devices specifically designed for aneurysm repair and other custom techniques of HA preservation.

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Anatomic Suitability of Aortoiliac Aneurysms for Next Generation Branched Systems

Cited by 61 publications

References 25 publications

Outcomes of Endovascular Repair of Aortoiliac Aneurysms and Analyses of Anatomic Suitability for Internal Iliac Artery Preserving Devices in Japanese Patients

Outcomes of Endovascular Repair of Aortoiliac Aneurysms and Analyses of Anatomic Suitability for Internal Iliac Artery Preserving Devices in Japanese Patients

Hybrid Endovascular Aortic Aneurysm Repair: Preservation of Pelvic Perfusion with External to Internal Iliac Artery Bypass

Endovascular management of iliac aneurysmal disease with hypogastric artery preservation

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