Pelvic collateral pathway during endovascular aortoiliac aneurysm repair with internal iliac artery interruption: a retrospective observational study

Abstract

Background Ipsilateral branches of the deep femoral artery (DFA) are qualitatively identified as collateral arteries based on angiography after internal iliac artery (IIA) interruption. The purpose of this study was to quantitatively identify the major collateral pathway after unilateral IIA interruption during endovascular aortoiliac aneurysm repair to preserve the pelvic circulation and reduce the risk of ischemic complications. Methods The study population included 28 patients (mean age 76.3 years) with aortoiliac aneurysm who underwent endovascular aneurysm repair with unilateral IIA interruption from August 2012 to January 2020. The diameters of the bilateral preoperative and postoperative DFA, lateral femoral circumflex artery (LFCA), medial femoral circumflex artery (MFCA) and obturator artery (ObA) were measured on contrast-enhanced computed tomography using a 3-dimensional image analysis system. The measured values were evaluated and analyzed with a repeated measures two-way analysis of variance and Dunnett’s test. Results The postoperative diameters of the MFCA (P = 0.051) and ObA (P = 0.016) were observed to be larger than the preoperative diameters. Such increases in the MFCA (P < 0.001) and ObA (P < 0.001) diameters were only found to be significant on the unilateral side of the IIA interruption, and the diameter of the ipsilateral LFCA (P < 0.001) was also found to have significantly increased in size. However, no significant arterial extension was found on the contralateral side. Conclusions The ipsilateral MFCA-ObA pathway might therefore be a major collateral pathway arising from the DFA to preserve pelvic circulation after unilateral IIA interruption.

Managing an infected femoral artery pseudoaneurysm after thoraco-bifemoral bypass with an innovative configuration

“…Pelvic ischemia is a devastating complication after aortoiliac revascularizations with majority of reported complication after endovascular interventions with an incidence of 28% percent in patients who underwent unilateral IIA interruption and 42% in those with bilateral interuption 9 .…”

“…Of the most reported complications after endovascular intervention, pelvic ischemia has had a reported incidence of 28% for patients after unilateral IIA interruption and 42% after bilateral IIA interruption. 9 To the best of our knowledge, techniques to preserve pelvic perfusion after managing an infected femoral PSA occurring after thoraco-bifemoral bypass have not been previously described. Therefore, consideration of pelvic ischemia was of the utmost importance owing to the significant effect that symptoms such as sciatic nerve palsy, gluteal necrosis, and buttock claudication will have on patient quality of life, as described by Jean-Baptiste et al.…”

Custom-made iliac fenestrated endoprosthesis for the treatment of internal iliac artery aneurysm with preservation of the superior gluteal artery

“…It is usually difficult to preserve pelvic collateral pathways, such as the medial femoral circumflex artery–obturator artery–gluteal artery pathway, when treating IIAAs. 1 Although no commercial endovascular repair devices for the treatment of IIAA are currently available, a few techniques for treating IIAAs and preserving the SGA to prevent ischemic complications has been reported. 2 , 3 , 4 , 5 Noel-Lamy et al 2 treated IIAAs using a Zenith branch iliac endovascular graft (Cook Medical, Bloomington, Ind) with extension of the internal iliac component of the branch stent-graft into the SGA.…”