Outcomes of an iliac branch endoprosthesis using an “up-and-over” technique for endovascular repair of failed bifurcated grafts

Tenorio, Emanuel R.; Oderich, Gustavo S.; Sandri, Giuliano A.; Kärkkäinen, Jussi M.; Kalra, Manju; DeMartino, Randall R.; Johnstone, Jill K.; Shuja, Fahad

doi:10.1016/j.jvs.2018.10.098

Cited by 29 publications

(14 citation statements)

References 28 publications

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“…In the entire cohort, 62 (84%) of 74 patients underwent concomitant aortic repair (9 F/BEVAR, 53 EVAR). In 14 (19%) patients the previously described "up and over technique" 6 was required for IBE implantation due to the presence of prior aortic repair. An individual technical failure in each group due to inability to catheterize the target vessel resulted in a 97% per-patient technical success rate (Table 2), without any difference between the groups (p=0.43).…”

Section: Procedures Detailsmentioning

confidence: 99%

Outcomes of the Gore Excluder Iliac Branch Endoprosthesis Using Division Branches of the Internal Iliac Artery as Distal Landing Zones

et al. 2020

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Purpose: To evaluate the outcomes of the Gore Excluder Iliac Branch Endoprosthesis (IBE) using division branches of the internal iliac artery (IIA) as distal landing zones. Materials and Methods: Between January 1, 2014, and December 31, 2018, 74 patients (mean age 74±7 years; 72 men) treated for aortoiliac or common iliac artery aneurysms had an IBE deployed with distal landing of the side branch within the main trunk (n=60) of the internal iliac artery (IIA) vs within a division branch (n=25). Thirteen (17%) patients received bilateral IBE implantations for a total of 85 vessels evaluated. Early endpoints were technical success, 30-day mortality, 30-day major adverse events (MAEs), and 30-day major access complications. Late endpoints were survival, primary and secondary IIA patency, freedom from IIA branch instability, freedom from new-onset buttock claudication, and aneurysm sac diameter changes. Time-dependent outcomes were reported as Kaplan-Meier curves with differences assessed using the log-rank test. Estimates are presented with the 95% confidence interval (CI). Results: The overall technical success rate was 97%, with 1 technical failure per group (p=0.43). Two patients, one from each group, died within 30 days (p=0.43). No significant differences were seen in the rates of 30-day MAEs (7% vs 17%, p=0.35) or major access complications (9% vs 11%, p>0.99) for patients receiving distal landing in the main trunk vs a division branch, respectively. The mean follow-up for the entire cohort was 19±12 months. The overall 1-year survival rate was 94% (95% CI 74% to 99%). The primary and secondary patency rates at 1 year were 98% (95% CI 88% to 99%) vs 95% (95% CI 72% to 99%, p=0.72) and 98% (95% CI 88% to 99%) vs 100% (p=0.41) for the main trunk vs division branch groups, respectively. Freedom from IIA branch instability estimates were also similar at 1-year follow-up [93% (95% CI 82% to 97%) vs 90% (95% CI 66% to 97%), p=0.29], as were the freedom from new-onset buttock claudication estimates [98% (95% CI 86% to 99%) and 94% (95% CI 67% to 99%), respectively; p=0.62]. Mean sac diameter change was 5.4±5.3 mm, not significantly different between the groups (p=0.85). Conclusion: Use of the posterior or anterior division of the IIA as a distal landing zone for the Gore Excluder IBE was safe and efficacious in the midterm. This technique may permit extending indications for endovascular repair of aortoiliac aneurysms to cases with unsuitable anatomy within the IIA main trunk. Long-term assessment is needed to affirm the efficacy of this technique.

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Section: Procedures Detailsmentioning

confidence: 99%

Outcomes of the Gore Excluder Iliac Branch Endoprosthesis Using Division Branches of the Internal Iliac Artery as Distal Landing Zones

et al. 2020

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“…The up-and-over transfemoral technique is generally a suitable alternative. 7,8 However, our patient had been previously treated with a FEVAR after a previous infrarenal EVAR, which limits the distance between the lowest fenestrations and the flow divider. For this reason, the up-and-over technique would have resulted in a risk of damaging the side branch stents.…”

Section: Discussionmentioning

confidence: 98%

Steerable sheath for exclusively femoral bilateral extension of previous fenestrated endovascular aneurysm repair with iliac branch devices

Vaccarino

Karelis

Sonesson

et al. 2021

Journal of Vascular Surgery Cases, Innovations and Techniques

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We report the treatment of type Ib endoleak after fenestrated endovascular aneurysm repair (FEVAR) with iliac branch device (IBD) to allow exclusive transfemoral access without a femoral-to-femoral through-and-through wire. The patient was treated with fenestrated endovascular aneurysm repair and showed expansion of the aneurysm owing to a type Ib endoleak. An IBD was implanted by the use of a contralateral steerable sheath for internal iliac artery catheterizing. A computed tomography scan showed the patency of the target vessels and resolution of the endoleak. The use of a steerable sheath without femoral-to-femoral through-and-through wire to bridge the internal iliac artery in patients receiving an IBD after prior EVAR is feasible and avoids the risks associated with upper extremity access.

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“…Tracking a 12F sheath over the flow divider in these instances is challenging and requires either downward tension on the main body of the endograft, risking graft migration, or the use of alternative access (ie, brachial access) or various up-and-over techniques, such as the push-and-pull technique previously described. 9 , 10 , 11 …”

Section: Discussionmentioning

confidence: 99%

“…brachial access) or various up-and-over techniques, such as the "push-and-pull" technique previously described. [9][10][11] While these techniques avoid placing downward tension on the flow divider, they are associated with other possible complications, especially in the setting of brachial access, such as brachial sheath hematomas, median nerve injury, and upper extremity ischemic complications from distal embolization, brachial artery thrombosis, or dissection. Previous studies have demonstrated minor complication (pseudoaneurysm or hematoma) rates of 2-14% and major complication (distal embolization; brachial artery thrombosis, dissection, or fistula formation) rates of 1.9-10% associated with brachial access.…”

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

Bilateral internal iliac branch device with ipsilateral deployment

Hemingway

Ohlsson

Hurd

et al. 2021

Journal of Vascular Surgery Cases, Innovations and Techniques

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Outcomes of an iliac branch endoprosthesis using an “up-and-over” technique for endovascular repair of failed bifurcated grafts

Cited by 29 publications

References 28 publications

Outcomes of the Gore Excluder Iliac Branch Endoprosthesis Using Division Branches of the Internal Iliac Artery as Distal Landing Zones

Outcomes of the Gore Excluder Iliac Branch Endoprosthesis Using Division Branches of the Internal Iliac Artery as Distal Landing Zones

Steerable sheath for exclusively femoral bilateral extension of previous fenestrated endovascular aneurysm repair with iliac branch devices

Bilateral internal iliac branch device with ipsilateral deployment

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