Technique of Reversed Flared Iliac Stent Graft for Iliac Aneurysms With Discrepant Size Diameters

Power, Adam; Fatima, Javairiah; Kavanagh, Crystal M.; Oderich, Gustavo S.

doi:10.1177/1531003510386495

Cited by 7 publications

(12 citation statements)

References 9 publications

(13 reference statements)

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“…If a bell-bottom 19 or flared stent-graft limb technique was employed, patients received either a flared limb from the manufacturer of the main body stent-graft, an aortic extension cuff, or an aortouni-iliac conversion device using methods previously described. 17,19,20 All overlapping graft segments were molded with a compliant balloon, and completion digital subtraction angiography was obtained to Postoperative CT surveillance with arterial and delayedphase venous imaging was typically obtained at 1, 6, and 12 months and annually thereafter unless radiographic findings dictated otherwise. Timing and need for any reintervention was based on the attending surgeon's judgment.…”

Section: Evar Proceduresmentioning

confidence: 99%

“…Furthermore, off-label techniques for landing in large iliac arteries are often reported, such as inverted aortouni-iliac devices and "bell-bottom" techniques using aortic cuffs. [15][16][17] Limited and conflicting results exist with regard to the natural history and outcomes of using aneurysmal CIA (aCIA) LZs during EVAR. Some series have demonstrated good short and midterm outcomes, while larger registry data suggest that the presence of an iliac aneurysm can lead to a higher risk of type Ib leak, limb occlusion, secondary intervention, or aneurysm rupture after EVAR.…”

Section: Introductionmentioning

confidence: 99%

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Fate of Aneurysmal Common Iliac Artery Landing Zones Used for Endovascular Aneurysm Repair

et al. 2015

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Purpose: To determine outcomes of aneurysmal common iliac arteries (aCIA) used for landing zones (LZs) during endovascular aneurysm repair (EVAR). Methods: This single-center study retrospectively compared 57 EVAR patients (mean age 72±8 years; 56 men) with 70 aCIAs (diameter ≥20 mm) to 25 control EVAR subjects (mean age 73±7 years; 20 men) with 50 normal (≤15-mm) CIA LZs treated consecutively during the same time interval. The CIA LZ measurements were analyzed using random effects linear mixed models to determine diameter change over time. Life tables were used to estimate freedom from endoleak, reintervention, and all-cause mortality. Results: The mean maximum preoperative CIA diameter in the aCIA LZ group was 24.8±4.5 mm (range 20.0-47.3, median 23.9) vs 13.6±1.5 mm (range 9.2-15.0, median 13.9; p<0.001) in the controls. Nineteen aCIA LZs were treated outside the instructions for use of the device. Median follow-up in the aCIAs LZ cohort was 39.2 months [interquartile range (IQR) 15, 61] vs 49.3 months (IQR 36, 61) in the controls (p=0.06). The rate of aCIA LZ change (0.09 mm/mo, 95% CI 0.07 to 0.1) was significantly greater than controls (0.03 mm/mo, 95% CI -0.009 to 0.07; p<0.0001). No type Ib endoleaks developed in either group; however, aCIA LZ patients had 6 (11%) iliac limb-related reinterventions. There were significantly more endograft-related reinterventions in the aCIA LZ patients (n=10, 14%) compared with controls (n=2, 4%; p=0.06). There was no difference in mortality or freedom from any post-hospital discharge endoleak. Conclusion: Aneurysmal CIA LZs used during EVAR experience greater dilatation compared with normal LZs, but no significant difference in outcome was noted in midterm follow-up. However, an increased incidence of graft limb complications or endograft-related reintervention may be encountered. Use of aCIA LZs appears to be safe; however, greater patient numbers and longer follow-up are needed to understand the clinical implications of morphologic changes in these vessels when used during EVAR.

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Section: Evar Proceduresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fate of Aneurysmal Common Iliac Artery Landing Zones Used for Endovascular Aneurysm Repair

et al. 2015

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“…[19][20][21] An FE can enhance filament adherence in regions where the luminal diameter changes markedly. 20 Park et al 22 reported that compared to SE stents, FE stents exhibited less stent displacement (2.4% vs. 15.4%) and reduced the complication risk in those with diseases of the digestive system. Previous studies on patients with intracranial vascular diseases found that FDs may become displaced or shortened to various extents.…”

Section: Discussionmentioning

confidence: 99%

Filament inadequate wall apposition of the different ends of flow diverters in the abdominal aorta of rabbits

Wang

Jin²,

et al. 2019

Neuroradiol J

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Background Flow diverters (FDs) with flared ends (FEs) or straight ends (SEs) are used either alone or when overlapped to treat complex intracranial aneurysms. We evaluated filament inadequate wall apposition (IWA) of the FEs and SEs of FDs in vivo. Methods A total of 24 FDs with FEs and SEs were placed in an overlapping manner in the abdominal aortae of six rabbits (two sets per rabbit). Digital subtraction angiography was performed immediately after stent insertion and three months later. The anatomical and histopathological aortic features at FEs and SEs were evaluated. Results Angiography revealed no significant difference in terms of changes in arterial diameter between the FE and SE groups ( p = 0.877). Gross anatomical evaluation revealed IWA of the different ends of FDs but no thrombi or bleeding, showing that the metallic filaments were not in touch with the vessel wall and nor had they penetrated the vessel wall. The filaments’ IWA rates of FEs and SEs were 8.33% and 8.85%, respectively. The IWA rate at overlapping ends was lower than that at non-overlapping ends. The maximum neo-intimal thickness at FEs was greater than that at SEs (149.4 ± 48.9 and 98.6 ± 26.6 µm, respectively; p < 0.001). Conclusions Both the FEs and SEs of FDs can exhibit IMA. IWA events are reduced at the overlapped regions. On pathological evaluation, FEs increased neo-intimal thicknesses more than SEs did, but hyperplasia was minimal on angiography.

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“…To re-load it, squeezing it with surgical umbilical strips or multiple silk ties or inserting it into the peel-away sheath may be helpful ( Fig. 1 – 3 ) [ 8 , 9 ]. However, manual reinsertion is different from that of the original production process.…”

Section: Discussionmentioning

confidence: 99%

Use of Reversed Iliac Leg Stent-Graft for the Treatment of Isolated Aneurysm of Internal Iliac Artery

Song

Lee

Nam

et al. 2014

VSI

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This is to report the technique of reversed iliac leg stent-graft in endovascular treatment for isolated internal iliac artery (IIA) aneurysm, which had significant size discrepancy between the common iliac artery (CIA) and external iliac artery (EIA) in 3 patients from different hospitals. Three patients were a 85- and two 82-year-old men. Treated were right IIA aneurysms, sized 6.5×6.2 cm, 5.0×4.0 cm, and 4.1 cm in longest diameter, respectively. The diameters of the right CIA and right EIA measured 21 mm/11 mm, 15 mm/11 mm, and 20 mm/10 mm, respectively. In all cases, reversed iliac leg stent-grafts were prepared on-site; unsheathed and mounted upside-down manually, and deployed in each right CIA. Post-stent-graft angiograms showed complete exclusion of the aneurysms, except for minimal type 1 endoleak in one case. This technique is a useful treatment option in patients with isolated IIA aneurysm.

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Technique of Reversed Flared Iliac Stent Graft for Iliac Aneurysms With Discrepant Size Diameters

Abstract: The technique of reversed flared iliac stent graft limb is a feasible option in patients with iliac aneurysms and significant discrepancy in the diameter of the iliac arteries.

Cited by 7 publications

References 9 publications

Fate of Aneurysmal Common Iliac Artery Landing Zones Used for Endovascular Aneurysm Repair

Fate of Aneurysmal Common Iliac Artery Landing Zones Used for Endovascular Aneurysm Repair

Filament inadequate wall apposition of the different ends of flow diverters in the abdominal aorta of rabbits

Use of Reversed Iliac Leg Stent-Graft for the Treatment of Isolated Aneurysm of Internal Iliac Artery

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