Exclusively Intrahypogastric Sandwich Technique to Treat an Isolated Internal Iliac Artery Aneurysm

Espeja, Alexandre Garrido; Navarro, Omar Andrés; Rebollo, Enric Roche; Grisales, Julio Cesar Sepúlveda; Grau, Mar Oller; Mattes, N. Argilés

doi:10.1016/j.jvir.2019.09.004

Cited by 1 publication

(4 citation statements)

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“…Additional remarkable treatment modalities and techniques which may be found in case reports or small case series are: retrograde trans-gluteal approach for embolization 24 -26 parallel stent-graft technique for IIIAA exclusion 27,28 deployment of an iliac branch device to exclude the hypogastric aneurysm 29 -32 endovascular exclusion exploiting the distal branches of the hypogastric artery as landing zones 33 …”

Section: Resultsmentioning

confidence: 99%

“…11 In selected cases, the proximal neck may be obtained by using an iliac branch device (IBD) or a parallel graft technique. [27][28][29][30][31] Regarding the distal neck, it is sometimes possible to use the distal branches of the hypogastric artery as a landing zone, thus sacrificing only minor branches with good results. 12,33 No IBD were used by authors of the papers included in this review.…”

Section: Discussionmentioning

confidence: 99%

“…27 Garrido Espeja et al described a sandwich technique to create a neo-bifurcation of the internal iliac artery and preserve distal blood flow. 28 Parallel stent graft technique could be useful when the saving of one hypogastric artery is needed and IBD cannot be used.…”

Section: Discussionmentioning

confidence: 99%

“…Additional remarkable treatment modalities and techniques which may be found in case reports or small case series are: retrograde trans-gluteal approach for embolization [24][25][26] parallel stent-graft technique for IIIAA exclusion 27,28 deployment of an iliac branch device to exclude the hypogastric aneurysm [29][30][31][32] endovascular exclusion exploiting the distal branches of the hypogastric artery as landing zones 33 Excluded noteworthy papers regarding clinical presentation-besides what we described in our qualitative synthesis-included: ureterohydronephrosis, ureteral rupture or haematuria [34][35][36][37] sciatic pain 38 arteriovenous fistula 39,40 deep venous thrombosis and pulmonary embolism 41 ileus, or bowel obstruction 42,43 aortoenteric fistula 44,45…”

Section: Excluded Noteworthy Case Reportsmentioning

confidence: 99%

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Surgical and Endovascular Management of Isolated Internal Iliac Artery Aneurysms: A Systematic Review and Meta-Analysis

Perini

Mariani

Fanelli

et al. 2020

Vasc Endovascular Surg

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Objectives: The purpose of this paper is to report the different modalities for the treatment of isolated internal iliac artery aneurysms (IIIAA), as well as their outcomes. Methods: We performed a systematic review of the literature (database searched: PubMed, Web of Science, Scopus, Cochrane Library; last search: April 2020). We included articles reporting on the outcomes for IIIAA interventions comprising at least 5 patients. Studies were included when presenting extractable outcome data regarding intraoperative and/or early results. We performed meta-analyses of proportions for different outcomes, using random effects model. Results: Thirteen non-randomized studies were included (192 patients with 202 IIIAA). IIIAA were symptomatic in the 18.1% (95%CI 9.3-26.9; I2 54.46%, P = .019). Estimated mean IIIAA diameter was 46.28 mm (95%CI 39.72-52.85; I2 88.85%, P < .001). Open repair was performed in 21/202 cases. Endovascular treatments were: embolization (81/181), embolization and hypogastric artery coverage (79/181), hypogastric artery coverage by stent-grafting (15/181), stent-grafting in the hypogastric artery (6/181). Overall estimated technical success (TS) rate was 91.6% (95% CI 86.8-95.5; I2 45.82%, P = .031). TS rate was 94.5% for open surgery (95%CI 85.3-100; I2 0%, P = .907), and 89.7% for endovascular repair (95%CI 83.8-95.6; I2 55.43%, P = .006). Estimated overall 30-day mortality was 3.1% (95%CI 0.8-5.4; I2 0%, P = .969). Mortality rates after open surgery and endovascular repair were 8.2% (95%CI 3.4-19.8; I2 0%, P = .545) and 2.8% (95%CI 0.5-5.1; I2 0%, P = .994), respectively. Estimated mean follow-up was 32.63 months (95%CI 21.74-43.53; I2 94.45%, P < .001). During this timeframe, IIIAA exclusion was preserved in 92.8% of the patients (95%CI 89.3-96.2; I2 0%, P = .797). Buttock claudication occurred in 13.9% of the patients (95%CI 8.7-19.2; I2 0%, P = .622). Conclusions: IIIAA are frequently large, and symptomatic at presentation. Several treatments are proposed in literature, open and endovascular, both with good results. The endovascular treatment is the preferred method of treatment in literature, since it offers good short- to mid-term results and low early mortality. Buttock claudication after hypogastric artery exclusion is a common complication.

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