Common Iliac Artery Aneurysm Repair with Hypogastric Preservation via Balloon-Expandable Covered Stents Using the Eyelet Technique—Iliac Branched Devices Still Inappropriate in Many Patients

Jensen, Rachel; Lane, John S.; Owens, Erik L.; Bandyk, Dennis F.; Malas, Mahmoud B.; Covarrubias, Antonio; Levine, Michael J.; Barleben, Andrew

doi:10.1016/j.avsg.2020.09.016

Cited by 2 publications

(4 citation statements)

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“…There is a consensus that isolated CIAAs in patients at average risk should be repaired to exclude the aneurysm sac and preserve internal iliac artery perfusion [ 1 , 7 ]. The literature on EVAR for the treatment of bilateral isolated CIAA is infrequent and varies according to surgeon preference, patient anatomical characteristics, and device availability [ 14 , 15 ]. This case series demonstrated the efficacy and applicability of implementing an aortic bifurcated unibody endograft and modified sandwich technique as an alternative treatment option for bilateral isolated CIAAs while preserving pelvic flow.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, there are specific anatomical prerequisites for IBD treatment. Several analysts have suggested that strictly following the manufacturer’s IFU would limit the eligibility of patients to only approximately one-third of the total population [ 9 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…This technique reduces the gutter between parallel grafts and enhances sealing effectiveness. Several authors have proposed the utilization of balloon-expandable stents instead of self-expandable stents for the application of this modified technique [ 14 , 36 ]. This approach offers the advantage of facilitating sizing and enables the balloon-expandable nature of the IIA stent to fully fill the gutters in a standard sandwich technique.…”

Section: Discussionmentioning

confidence: 99%

“…The Fluency™ stent was deployed first, and then the Lifestream™ stent was inflated and deployed. Remodeling with a standard noncompliant 10 mm balloon placed inside the Fluency™ stent and the Lifestream™ stent separately to create an eyelet or “eye of the tiger” shape [ 13 , 14 ] (Figs. 1 E, 2 E and 3 D; white arrow) of the Lifestream™ stent at the overlapping zone utilizing the kiss-ballooning technique (Figs.…”

Section: Case Seriesmentioning

confidence: 99%

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Endovascular repair of bilateral isolated common iliac artery aneurysms with unsuitable anatomy utilizing an aortic bifurcated unibody endograft and modified sandwich technique to preserve pelvic blood flow: a case series

Liao,

Zhou,

Tang

et al. 2024

J Cardiothorac Surg

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Bilateral isolated common iliac artery aneurysms (CIAAs) are rare, and endovascular repair of CIAAs has emerged as an alternative to traditional open surgical repair. The primary goal of therapy is to exclude the aneurysm sac while maintaining perfusion of at least one internal iliac artery (IIA) to prevent pelvic ischemia. Although the iliac branch device (IBD) has improved the feasibility of preserving the IIA, its applicability is limited to a specific subset of aneurysm anatomy. We present a case series of three patients with bilateral isolated CIAAs in whom preoperative CT scans revealed an absence of a landing zone, the diameter of proximal CIA diameter was less than 13.0 mm, and normal diameter of the nonaneurysmal infrarenal aorta, making it challenging to use an IBD alone or a standard bifurcated aortic endograft to provide a proximal landing zone for iliac artery stenting. To overcome the small diameter of the infrarenal aorta, we implanted an aortic bifurcated unibody endograft. Then, we utilized a balloon-expandable covered stent-graft with overdilation as a modified sandwich technique to create an “eye of the tiger” configuration to prevent gutter leakage. The final angiography performed during the procedure revealed successful exclusion of the aneurysms, with blood flow to the right IIA and no type III endoleak. During the postoperative follow-up period, no patients exhibited symptoms associated with pelvic ischemia. There were no endoleaks or sac expansions on the two-year follow-up CT scans, and all external and internal iliac graft limbs were patent. This study demonstrated that a combination of an aortic bifurcated unibody endograft and a modified sandwich technique can effectively treat bilateral isolated CIAAs with certain anatomical constraints.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%