Iliac artery recanalization of chronic occlusions to facilitate endovascular aneurysm repair

Vallabhaneni, Raghuveer; Sorial, Ehab; Jordan, William D.; Minion, David J.

doi:10.1016/j.jvs.2012.05.089

Cited by 24 publications

(15 citation statements)

References 21 publications

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“…Hinchliffe et al, Peterson, and Vallabhaneni et al all describe similar techniques of successfully "paving and cracking" the iliac segment to secure proximal arterial access [6][7][8][9]. These techniques again involve relining and dilating stenosed iliac arteries with covered stents prior to the introduction of main body aortic stent [8].…”

Section: Discussionmentioning

confidence: 99%

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Iliac Endoconduit: Application in Unfavorable Iliac Anatomy to Facilitate Emergency Abdominal Aortic Aneurysm Repair

et al. 2016

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Extensive occlusive ilio-femoral arterial disease may be considered a contraindication to endovascular aortic aneurysm repair. Recent technical innovations describe the use of an "internal endoconduit" to navigate challenging iliac anatomy. Internal endoconduit is a technique in which "controlled rupture" of the external iliac artery using a covered stent allows controlled trans-femoral passage of the delivery sheath for endovascular aneurysm repair (EVAR). Here, we present two cases where iliac endoconduit was used to overcome unfavorable iliac artery anatomy in the setting of an emergency EVAR.

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Section: Discussionmentioning

confidence: 99%

“…However, procedural morbidity including hematoma formation and claudication has been infrequently described [2,9]. Further concern involves the coverage of the hypogastric artery and hence the impairment of pelvic perfusion which may manifest as sexual dysfunction, buttock claudication, bowel ischemia or even paraplegia.…”

Section: Discussionmentioning

confidence: 99%

Iliac Endoconduit: Application in Unfavorable Iliac Anatomy to Facilitate Emergency Abdominal Aortic Aneurysm Repair

et al. 2016

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“…More a consideration in these patients, high risk candidates warrant consideration for creative and less invasive endovascular approaches [21].…”

Section: Conduit Selectionmentioning

confidence: 99%

“…For EVAR, the aortouni-iliac configuration is also associated with inferior early and midterm outcomes as well as increased risk of graft infection [43,44]. Therefore, in appropriately selected elective cases, intraluminal or subintimal recanalization from either brachial or femoral approach can be considered as alternative means of facilitating bifurcated EVAR device delivery [21]. Of note, successful subintimal recanalization has been described to facilitate bifurcated endograft placement in the presence of bilateral common iliac occlusive disease, making it an appropriate EVAR delivery method in select patients [14].…”

Section: Intraluminal or Subintimal Recanalizationmentioning

confidence: 99%

Endovascular Aortic Aneurysm Repair in Patients with Aortoiliac Occlusive Disease

Mangum¹,

Fereydooni²,

Nassiri³

2019

Vascular Access Surgery - Tips and Tricks

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Although endovascular aortic aneurysm repair (EVAR) has become an attractive, minimally invasive option for patients with abdominal aortic aneurysms (AAA), significant challenges in arterial access exist in patients with concomitant aortoiliac occlusive disease (AIOD), particularly for more advanced TASC C and D lesions. Under these circumstances, endograft delivery is possible but requires extensive preoperative planning and intraoperative techniques including but not limited to surgical conduit creation, plain balloon angioplasty, endoconduit placement, and subintimal recanalization. Newer generation aortic endografts have also shown promise in accommodating compromised access vessels. Concomitant AIOD and compromised access vessels complicate EVAR and increase operative time and complexity. Therefore, extreme caution, meticulous preoperative planning, familiarity and facility with the various surgical and endovascular options needed to circumvent these obstacles are essential for safe and effective delivery of EVAR in this high-risk subset of patients. The purpose of this chapter is to present standard approaches for access in patients undergoing EVAR; discuss how advanced AIOD precludes routine access; and present various methods to overcome difficult access in patients undergoing EVAR.

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“…The reported incidence of peripheral arterial disease (PAD) with concomitant abdominal aortic aneurysm (AAA) ranges between 10% and 40% (Wanhainen et al 2005 ). Iliac recanalization of occlusive disease is commonly performed during management of aorto-iliac occlusive disease (AIOD), but only few reports have described this technique combined with bifurcated EVAR (Vallabhaneni et al 2012 Scurr et al 2007 ). Further, no reports have described the technical strategy and procedural steps needed to achieve successful results without complications.…”

Section: Introductionmentioning

confidence: 99%

Technical tips and procedural steps in endovascular aortic aneurysm repair with concomitant recanalization of iliac artery occlusions

et al. 2013

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PurposeThe goal of this paper is to describe our technical strategy and procedural steps for endovascular aneurysm repair (EVAR) when performed with concomitant recanalization of the iliac artery occlusion.Materials and methodsThree octogenarians having abdominal aortic aneurysm (AAA)/common iliac artery aneurysms (CIAA) with unilateral external iliac artery (EIA) occlusion underwent EVAR with recanalization of the occluded iliac arteries. Crossing the iliac artery occlusions was attempted in a retrograde approach using a 0.035 inch-hydrophilic guidewire. After passage of a guidewire, predilation was performed using 6mm balloon. Then a 12-Fr sheath was advanced via the occluded EIA for contralateral iliac limb delivery. Internal iliac artery embolization was subsequently performed as needed. A self-expanding stent was then placed in the occluded EIA after EVAR.ResultsRecanalization of the EIA occlusion, followed by stentgraft delivery through the occlusion and EVAR, was successfully performed in all three patients. Penetration of the occluded EIA was successfully achieved only by retrograde approach in two patients, and by bidirectional approach in the other patient. No perioperative complication or death occurred. Postoperative CT showed no type I or III endoleaks in the aneurysms and patent iliac arteries in all patients.ConclusionsTotal endovascular repairs were successfully performed for three patients with AAA and concomitant unilateral EIA occlusions. The proposed steps described in this report might reduce the complication rate and enhance the technical success rate associated with this procedure.

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Iliac artery recanalization of chronic occlusions to facilitate endovascular aneurysm repair

Cited by 24 publications

References 21 publications

Iliac Endoconduit: Application in Unfavorable Iliac Anatomy to Facilitate Emergency Abdominal Aortic Aneurysm Repair

Iliac Endoconduit: Application in Unfavorable Iliac Anatomy to Facilitate Emergency Abdominal Aortic Aneurysm Repair

Endovascular Aortic Aneurysm Repair in Patients with Aortoiliac Occlusive Disease

Technical tips and procedural steps in endovascular aortic aneurysm repair with concomitant recanalization of iliac artery occlusions

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