Endovascular abdominal aortic aneurysm repair in patients with common iliac artery aneurysms – Initial experience with the Zenith bifurcated iliac side branch device
Abstract:This device provides an alternative for the management of patients with aorto-iliac aneurysms that is safe and less complex than, previously described, hybrid procedures that preserve internal iliac flow.
“…This new device appears to prevent the temporary, but frustrating buttock claudication that may occur with coil embolization of this vessel. 15,16 Further studies are necessary to define the role of side branch devices in anticipation of this problem.…”
These data demonstrate that in appropriately selected patients, endovascular repair of isolated iliac artery aneurysms is a safe, effective alternative to open repair with mid-term follow-up. Endovascular repair is associated with a significantly reduced hospital length of stay and may be associated with decreased need for transfusion and mortality when compared with open repair.
“…This new device appears to prevent the temporary, but frustrating buttock claudication that may occur with coil embolization of this vessel. 15,16 Further studies are necessary to define the role of side branch devices in anticipation of this problem.…”
These data demonstrate that in appropriately selected patients, endovascular repair of isolated iliac artery aneurysms is a safe, effective alternative to open repair with mid-term follow-up. Endovascular repair is associated with a significantly reduced hospital length of stay and may be associated with decreased need for transfusion and mortality when compared with open repair.
“…While a few recent series have demonstrated the feasibility of this approach in preserving pelvic flow, ensuring distal sealing during EVAR, they failed to contrast this new technique to other contemporary endovascular procedures for management of iliac aneurysms. [5][6][7][8][9] The purpose of this study was to compare early and 1-year outcome of the IBD approach with that of hypogastric embolization followed by endograft extension across the iliac bifurcation, in a consecutive series of patients treated for significant (Ͻ24 mm) unilateral or bilateral iliac aneurysms associated or not with aortic aneurysm. In particular, rates of pelvic ischemia, failure of aneurysm exclusion, and need for reintervention were analyzed.…”
Endovascular treatment of iliac aneurysm with hypogastric revascularization through side branched endografts is feasible and safe in the mid-term. When compared with hypogastric embolization, this option leads to similar technical success and reintervention rates. Endoleak and buttock claudication occur frequently in patients with iliac aneurysm treated with hypogastric exclusion, while are uncommon in those with hypogastric revascularization. Side branch endografting for iliac aneurysm may be considered a primary choice in younger, active patients with suitable anatomy, but larger studies and longer postoperative observation periods are needed.
“…[26][27][28][29][30][31][32] The technical success rate has been demonstrated to be between 85% and 100%, showing relatively high feasibility of the devices, while the indication for usage of IBDs is limited by various morphologic factors of the targeted iliac arteries. Aneurysmal involvement or stenosis at the orifice of IIA or severe tortuosity or calcification of iliac arteries hampers successful implantation of the devices.…”
EVAR with simultaneous unilateral IIA embolization and contralateral EIA-to-IIA bypass grafting is feasible, with a relatively low risk of complications. It can be a useful treatment option in cases with complex aortoiliac aneurysms, including those with bilateral IIA aneurysms.
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