Bilateral Common Iliac Artery Aneurysms Research Articles

Endovascular repair of bilateral common iliac artery aneurysms using intraoperative positioning system

Intraoperative positioning system (IOPS; Centerline Biomedical, Inc) is a novel technology that allows for real-time intravascular navigation of endovascular devices using an electromagnetic field. In this report, we describe the use of IOPS for effective treatment of bilateral common iliac artery aneurysms with endovascular aortoiliac repair using iliac branch endoprostheses. Our experience suggests that this technology has the potential to reduce radiation and contrast use in endovascular procedures, although its application is currently limited. To the best of our knowledge, this is the first reported case of bilateral internal iliac cannulations for iliac branch endoprosthesis placement using IOPS.

Internal iliac debranching in combination with abdominal aortic stent graft to treat bilateral common iliac aneurysms

Introduction
 Common iliac artery aneurysms are often diagnosed during routine screening for infrarenal abdominal aortic aneurysms. Preserving the internal iliac artery helps avoid colonic ischemia and buttocks claudication. Hybrid surgery combining internal iliac artery transposition and endovascular treatment is a method with good early and long-term results.
 Methods
 We report of a case of bilateral common iliac artery aneurysm treated by hybrid surgery and endovascular intervention at Dong Nai General Hospital
 Results
 A 69 year-old male, diagnosed with bilateral common iliac artery aneurysm and left internal iliac artery occlusion. Surgical transposition was performed to repimplant the right internal iliac artery into the right external iliac artery, folowed by endovascular treatment, the right branch of the graft was placed at the external iliac artery, the left branch of the graft was placed at the common iliac artery. Postoperative condition was stable, no early complications recorded
 Conclusion
 Hybrid surgery to treat iliac aortic aneurysms and common iliac artery aneurysms has quite good mid- and long-term results. The initial successful implementation of this technique at Dong Nai General Hospital contributes to team development, reduces the load on central hospitals and brings practical benefits to patients.

Incorporation of internal iliac arteries as target vessels during physician-modified fenestrated branched endovascular repair of pararenal abdominal aortic aneurysm with concomitant bilateral short common iliac artery aneurysms

This report describes an alternative endovascular approach to iliac branch devices for treatment of an abdominal aortic aneurysm with concomitant bilateral short common iliac aneurysms. The short distance between the renal arteries and internal iliac artery origins made the addition of distal iliac branch devices to the proximal fenestrated stent graft challenging. We elected to perform physician-modified fenestrated branched endovascular repair, using four fenestrations for the visceral and renal arteries and an additional two directional branches for the bilateral internal iliac arteries. The patient recovered uneventfully, and the 24-month follow-up imaging shows successful aneurysm exclusion with patent internal iliac artery branches.

The Use of an Iliac Branch Device: Single-Center Study of Endovascular Preservation of Internal Iliac Artery Flow.

To determine the efficacy and safety of iliac branch device (IBD) implantation and to evaluate its limitations based on 7 years of experience in a single center. This single-center study included patients with bilateral common iliac artery aneurysms (CIAAs). We investigated follow-up CT and reviewed the internal iliac artery (IIA) patency and complications related to IBD. A retrospective analysis was performed and the overall survival rate and freedom from reintervention rate were reported according to the Kaplan-Meier method. Of the 38 patients with CIAAs, only 10 (12 CIAAs) were suitable for IBD treatment. Five patients underwent unilateral IBD insertion with contralateral IIA embolization, and three (60%) showed claudication; however, symptoms resolved within 6 months. The 7-year freedom from IBD-related reintervention rate was 77.8%. No procedure-related deaths occurred. IBD has good technical success and long-term patency rates; however, anatomical factors frequently limit its application, particularly in Asians. Additionally, unilateral IIA embolization showed relatively mild complications and a good prognosis; therefore, it can be performed safely for anatomically complex aortoiliac aneurysms.

Long-term results of large common iliac artery aneurysms caused by Kawasaki disease in four patients.

Among Kawasaki disease patients with systemic artery aneurysms, the brachial and internal iliac arteries are the most commonly affected, and occlusions of both arteries are often found. However, the long-term fate of large common iliac artery aneurysms remains unknown, because their prevalence is very low. The long-term outcomes of common iliac artery aneurysms caused by Kawasaki disease in four patients (three females, one male) were investigated retrospectively based on their medical records and angiograms. Their ages ranged from 30 to 36 years-old. The onset age of Kawasaki disease ranged from 4 to 8 months, and the interval from the onset of Kawasaki disease to the latest angiogram ranged from 17 to 21 years. All patients had bilateral large coronary aneurysms and common iliac artery aneurysms with maximal diameters greater than 10 mm. Although all patients had multi-vessel coronary artery stenotic lesions and systemic artery aneurysms, they were asymptomatic. The three female patients underwent coronary artery bypass grafting, and the male patient underwent replacement of artificial vessels for large bilateral common iliac artery aneurysms at 3 years old of age. Over the long-term, common iliac artery aneurysms greater than 10 mm persisted as calcified aneurysms. However, they had no symptoms due to their common iliac artery aneurysms, and their ankle brachial pressure index was preserved, even if the stenosis of the common iliac artery developed as a late outcome, because the collateral arteries were well developed. The progression of stenosis of the common iliac artery after Kawasaki disease was slower.

Broken Iliac Branch Device Indwelling Catheter Tip

A 79 year old man presented with bilateral common iliac artery aneurysms. The left hypogastric artery was embolised and a Zenith iliac branch device (Cook Medical, Bloomington, IN, USA) was introduced through the right groin. After snaring the through and through wire, the broken tip (arrow) of the indwelling catheter was detected. It was floating but still attached (A). Attempts to snare and remove it to avoid embolism were unsuccessful. However, contrary to expectations, the catheter was safely withdrawn without tip embolism. After removal of the indwelling catheter, further inspection showed no transverse but a longitudinal laceration, which is less likely to embolise (B).Image 1

ISOLATED COMMON ILIAC ARTERY ANEURYSM WITH SPECIFIC ANATOMICAL CONSIDERATIONS.

Iliac artery aneurysms (IAA) are a rare entity with a prevalence lower than 2% in the general popula- tion involving typically the common iliac artery in 70-90%. Literature describes that bilateral common IAA may be present in approximately 50% of the affected patients. The authors present an 88 years old male patient with an isolated giant IAA, 84mm maximum diameter, diagnosed following a four-month period of lower abdominal discomfort and pelvic hyperemic mass. The IAA was successfully excluded with an endovascular approach with an Aorto-uni-iliac endograft Endurant II (Medtronic Cardiovascular, Santa Rosa, CA, USA) followed by a femorofemoral right to left bypass. Asymptomatic IAA are difficult to identify due to their anatomical location deep within the pelvis but once symptomatic they are associated with a high rate of morbidity and mortality. Their management has evolved toward an endovascular first approach over the past decades, nevertheless, the type of operative repair depends on patient anatomy, clinical stability and the presence of other concomitant aneurysms.

A Multicenter Assessment of Anatomic Suitability for Iliac Branched Devices in Eastern Asian Patients With Unilateral and Bilateral Aortoiliac Aneurysms.

Objective: This study aims to assess the suitability of four types of commercial iliac branch device systems to treat Eastern Asian abdominal aortic aneurysm (AAA) patients with bilateral or unilateral common iliac artery aneurysms (CIAAs).Methods: Patients with a coexisting AAA and a unilateral or bilateral CIAAs who underwent endovascular aneurysm repair (EVAR) at two tertiary centers in China from 2015 to 2017 were reviewed. Morphology of lesions was measured and the anatomic suitability for Cook iliac branch device (IBD), Gore iliac branch endoprosthesis (IBE), Lifetech iliac branch stent graft (IBSG), and Jotec IBD was evaluated according to the latest instructions for use.Results: Seventy-six patients with AAA were enrolled, including 35 bilateral CIAAs, 41 unilateral CIAAs. A hundred and eleven lesions were investigated aggregately: 16.2, 28.8, 21.6, and 19.8% met the criteria for Cook IBD, Gore IBE, Lifetech IBSG, and Jotec IBD, respectively. A total of 34 (44.7%) patients could be treated for at least one lateral lesion. The diameter of the internal iliac artery (IIA) was the most common restriction for IBD application. Additionally, the IIA diameter of lesions in the bilateral group was significantly larger compared with the unilateral group (P < 0.001). Based on the anatomical characteristics alone, it is likely that IBDs will be more suitable for unilateral lesions than bilateral ones (P < 0.05). However, there was no difference between the suitability for patients with unilateral or bilateral CIAAs (P > 0.05).Conclusions: Less than half of Eastern Asian patients with aortoiliac aneurysms were eligible for IBD application. This was primarily due to the IIA diameter failing to meet the criteria. And thus, the suitability of lesions in bilateral group was significantly lower than that in the unilateral group. Aiming to expand the indications and optimize the design of the iliac branch devices, IIA diameter and the anatomical characteristics of the bilateral lesions should be considered deliberately.

Endovascular Iliac Artery Aneurysm Repair With Iliac Branch Endoprosthesis in Type III Loeys-Dietz Syndrome

Loeys-Dietz syndrome (LDS) type III is a rare connective tissue disorder caused by SMAD3 gene mutations that manifests with arterial tortuosity, systemic aneurysms, aortic root dilatation, and osteoarthritis. The endovascular treatment of iliac artery aneurysms with an iliac branch endoprosthesis (IBE) in LDS patients has not been described. We have presented the safety and technical feasibility of branched endovascular iliac artery aneurysm repair in a patient with a rare variant SMAD3 mutation resulting in LDS type III. A 52-year-old man with an ascending aortic root aneurysm, intercostal artery aneurysm, infrarenal abdominal aortic aneurysm, and bilateral common iliac artery (CIA) aneurysms underwent extended gene analysis. He was found to have a rare variant heterozygous autosomal dominant SMAD3 gene mutation (p.I396N) consistent with LDS type III. Because the patient was in extremis from infrarenal abdominal aortic aneurysm rupture, he underwent open replacement with a bifurcated Dacron graft and ligation of the right hypogastric artery at an unaffiliated hospital. Computed tomography angiography revealed a residual 4.7-cm left CIA aneurysm and an anatomic constraint for the IBE (proximal CIA diameter, <17 mm; Fig 1). The previously described alternative endograft aortoiliac reconstruction technique facilitated IBE repair by creation of an adequate proximal CIA landing zone with an Ovation limb (Endologix, Irving, Calif). The contralateral gate was cannulated through a left axillary cutdown. Because of a tortuous hypogastric artery, Viabahn endoprostheses (W.L. Gore & Associates, Flagstaff, Ariz) were used for hypogastric extensions, with a bridging Gore VBX stent graft. No perioperative complications occurred. At the 5-month follow-up visit, he was alive without cardiovascular morbidity. Computed tomography angiography showed branch vessel patency and sac regression, with no evidence of an endoleak or stent graft migration (Fig 2). Although branched endovascular iliac artery aneurysm repair is not the historical treatment of choice for patients with LDS type III, IBE repair can be a safe and effective minimally invasive treatment option for anatomically suitable patients.Fig 2Postoperative three-dimensional computed tomography angiogram showing patent left common iliac, external iliac, and hypogastric arteries with no evidence of endoleak or stent graft migration.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Single-Center Experience in the Endovascular Management of the Combination of Isolated Common and Internal Iliac Artery Aneurysms

Objective: The combination of isolated common and internal iliac artery aneurysms (CIIAA) are rare, life-threatening, abnormal conditions with relatively complex treatment. This study aimed to evaluate the clinical characteristics and treatment outcomes of CIIAA.Methods: We retrospectively reviewed 26 patients with CIIAA consecutively treated between January 2010 and August 2020 at Peking Union Medical College Hospital. Demographic, clinical characteristic, treatment strategy and outcome data were collected and analyzed.Results: Twenty-six patients (24 men and 2 women) with a mean age of 70 years were included. There was a total of 72 aneurysms, and the mean diameters of the common iliac artery aneurysms (CIAA) and internal iliac artery aneurysms (IIAA) were 36 and 38 mm, respectively. Ten patients (38%) presented with bilateral CIAA and unilateral IIAA, and eight (31%) had CIAA with ipsilateral IIAA. All patients were treated with endovascular repair, and the overall primary technical success rate was 100%. The surgical techniques mainly included combined bifurcated stent grafting and embolization (n = 11), combined straight stent grafting and embolization (n = 8), and internal iliac artery (IIA) reconstruction (n = 7). There were no patient deaths or reintervention during hospitalization. The mean follow-up time was 43 months, and the patency rate of the stent was 96.2%. The overall reintervention rate was 7.7%. During the follow-up period, there were no aneurysm-related deaths.Conclusions: Endovascular repair involving stent graft placement, coil embolization and IIA revascularization is a safe and effective treatment for isolated CIIAA.

Hypogastric Preservation Using a Retrograde Endovascular Bypass in a Patient with Ruptured AAA and Concomitant Bilateral Common Iliac Aneurysms: A Feasible Option in the Acute Setting

Preservation of the hypogastric circulation is of major clinical importance in cases of endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (rAAA). Pelvic ischemia can be detrimental and significantly increase post-operative morbidity and mortality. However, the application of a side branch device or a bell-bottom graft is not possible in ruptured aortoiliac aneurysms (due to off-the-shelf unavailability and/or prolonged operative time) and in most cases pelvic circulation may have to be sacrificed. We report a case of a rAAA with bilateral common iliac artery (CIA) aneurysms that was successfully repaired with an aorto-uni-iliac (AUI) endograft, a cross-femoral bypass, and an inverted-U shaped contralateral EIA to IIA endovascular bypass. The procedure is described in detail and certain technical points are further discussed. The steps in cases where the aneurysm has ruptured are different compared to elective repairs and vascular surgeons need to be aware of certain pitfalls. This strategy may be feasible in the acute setting and permits preservation of the hypogastric circulation with the combination of standard techniques and grafts that are readily available in most institutions.

Endovascular treatment of common iliac artery aneurisms

To demonstrate endovascular management of common iliac artery aneurysms with iliac branch devices and to discuss some technical aspects of these interventions including bilateral procedures. Endovascular abdominal aortic aneurysm repair with concomitant implantation of iliac branch devices was performed in 9 patients at the Petrovsky National Research Center of Surgery for the period from January 2019 to December 2020. Mean age of patients was 64.8± years (min 52; max 72 years). Preoperative planning and morphometric analysis were based on CT data with a slice thickness of 1 mm. Angiographic reconstruction was made using Osirix 3D software (OsiriX Foundation, Geneva, Switzerland). Abdominal aortic aneurysm was combined with common iliac artery aneurysm in 7 patients (77.7%). Three (33.3%) patients had isolated common iliac artery aneurysm without significant abdominal aorta enlargement (Reber type I). Bilateral common iliac artery aneurysms were detected in 1 (11.1%) patient. All patients had iliac artery aneurysms over 4 cm. Iliac branch device implantation was accompanied by endovascular abdominal aneurysm repair in all patients. Technical success rate was 100%. Six-month results were followed-up in 5 patients (55.5%), annual outcomes - in 2 patients (22.2%). Control examination consisted of a telephone interview, ultrasound of abdominal aorta, pelvic and lower limb arteries and computed tomography. All patients had no endoleaks, stent-graft thrombosis, as well as signs of ischemia of pelvic organs and lower extremities. Incidence of iliac artery aneurysm combined with abdominal aortic aneurysms is about 20%. Until recently, treatment of these patients was performed exclusively with covering of internal iliac artery. Improvement of technologies and development of iliac branch devices made it possible to preserve blood flow in internal iliac artery after endovascular management. This approach allowed avoiding of ischemic complications associated with embolization of internal iliac arteries.

A Unique Indication for the Altura Endograft to Repair Bilateral Common Iliac Artery Aneurysms Associated with a Short-Infrarenal Aorta.

A 71-year-old man with end-stage renal disease on hemodialysis presented with bilateral common iliac artery aneurysms diagnosed during the workup of his chronic kidney disease. On computed tomography angiography, common iliac artery aneurysm diameters measured 6.1 cm on the right side and 3.1 cm on the left side. The infrarenal aorta also had a small 3.2-cm aneurysm, but the length from the lowest left renal to the aortic bifurcation was only 6.7 cm, precluding use of most bifurcated endografts. Following an uneventful staged preoperative internal iliac artery embolization, a two-piece D -shaped Altura endograft for the aorta, with bilateral iliac components, landing at the level of the external iliac arteries was successfully performed. Postoperative course was uneventful with no endoleak or endograft migration on computerized tomographic angiography 45 days later, although billowing mimicking an endoleak was evident and will be closely followed.

Bilateral Common Iliac Artery Aneurysm, a Case Report

Bilateral Common Iliac Artery Aneurysm, a Case Report

Association Between Abdominal Aortic and Common Iliac Artery Aneurysms: Case Report

The infrarenal abdominal aortic aneurysm is the most common among arterial aneurysms; it happens when there is an abnormal and irreversible enlargement of the blood vessel. This disease usually compromises other arterial segments and is linked to high mortality rates, mainly due to its rupture. Given its importance, we present a case study of an abdominal aortic aneurysm associated with a common iliac artery aneurysm. During a dissection practice in the Morphofunctional Laboratory at FACERES Medical School, we observed the presence of a mild stenosis in the abdominal aorta below the renal arteries, as well as the formation of an infrarenal abdominal aortic aneurysm. In addition, we noticed that the infrarenal abdominal aortic aneurysm was associated with a bilateral common iliac artery aneurysm. Morphological analyses carried out in the blood vessels showed a large quantity of atheromatous plaques, which are the probable cause of the pathology. The information herein may broaden the knowledge on the infrarenal abdominal aortic aneurysmal disease, thus reducing its complications and mortality rates.

Total robotic iliac aneurysm repair with preservation of the internal iliac artery using sutureless vascular anastomosis

ObjectiveInternal iliac artery (IIA) preservation is associated with improved outcomes after both open and endovascular aortoiliac aneurysm repair. Total robotic laparoscopic repair of aortoiliac aneurysms has been reported in the past, but not in combination with sutureless anastomosis applied to the IIAs. The objective of this study was to demonstrate the feasibility of the total robotic laparoscopic technique including a method of deploying the Gore Hybrid Vascular Graft (GHVG; W. L. Gore & Associates, Flagstaff, Ariz) using robotic instruments. MethodsBetween June 2015 and December 2016, four patients underwent total robotic laparoscopic repair of isolated common iliac artery (CIA) aneurysms. Two patients had unilateral aneurysms and two had bilateral aneurysms. Unilateral CIA aneurysms were treated with a graft from the proximal CIA to the proximal external iliac artery, and bilateral CIA aneurysms were treated with a bifurcated graft between the distal aorta and both proximal external iliac arteries. The nitinol reinforced section of the GHVG was then inserted and deployed into the corresponding IIA, and the nonreinforced segment was sewn in an end-to-side fashion to the iliac graft. ResultsThe median age of patients was 55.5 years (range, 48-64 years); median body mass index was 24.9 kg/m2 (range, 23-26.4 kg/m2). All four cases were technically successful. Operative times were 325 and 332 minutes for unilateral cases and 491 and 385 minutes for bilateral cases. For the entire series, median proximal clamping time was 143 minutes (range, 110-163 minutes), and the median time to deploy the GHVG was 15 minutes (range, 8-27 minutes). The median estimated blood loss was 1800 mL (range, 800-2100 mL). Intraoperative cell salvage was used in all cases. No intraoperative or postoperative complications occurred. No patient required blood transfusion. All patients tolerated a regular diet on postoperative day 2 and were discharged on postoperative day 4. Patients returned to work and full physical activity within 6 weeks (range, 2-6 weeks). At 6-month follow-up, computed tomography angiography demonstrated 100% patency of iliac artery grafts as well as of the GHVGs. ConclusionsTotal robotic laparoscopic CIA aneurysm repair is feasible in both unilateral and bilateral cases in carefully selected patients. The GHVG can be successfully deployed using robotic technique for IIA preservation during total robotic CIA aneurysm repair.

VH01. Open Repair of a Mycotic Aortic Aneurysm in a Patient With Vascular Ehlers-Danlos Syndrome

A 52-year-old man with vascular Ehlers-Danlos syndrome (COL3A1 gene mutation) previously observed for an aortoiliac aneurysm and dissection presented with 2-month history of fever and chills. Blood cultures were positive for Streptococcus equi. Computed tomography angiography demonstrated a 5.7-cm infrarenal abdominal aortic aneurysm with periaortic retroperitoneal stranding and bilateral common iliac artery aneurysms. A fluorodeoxyglucose positron emission tomography scan was performed and demonstrated uptake in the area of retroperitoneal stranding. The patient underwent open repair of the aneurysm with in situ reconstruction with an aortoiliac cryopreserved allograft, proximal anastomosis reinforcement with fascia lata, and bilateral internal iliac bypass. The patient was discharged from the hospital on postoperative day 10. At 6-month follow-up, the patient was asymptomatic with resolution of the infection. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJkZWMxM2RkMTJkYWNlYTFmYzdhZTgyNzIyYThiZGQ0OSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc4NzQ1NjE1fQ.iii30pw28ke654YrxRlJ1iQr64oFiDvYGCGlleJvpMppjJ_K6PNgihSN_6yadSBxPWeRNYLSEOs-ib76dv9qPMqy6ulPyZbjdf_bWkcSs04gzFpFVNRPnvhvD0rXTNwuyp3tNhiYmKUIUYMO6zAriyfsyWMUXphiiqPOcc1ntEPEzsCw6BOm1KnJYl4pDQRNORzf1Khco0TNB595xRtiW4WWINPtORjUCx56eyVswbLEI8rpzur1tSoIo-imT1e5FitJYhJZQ3tEF4DQMOVVxXUd23uP3u6_8tzEdoOCDqwEXaatR40WXqyne_B3bb9fCew0lCUzHMRwtvBiHTls7w Download .mp4 (180.22 MB) Help with .mp4 files Video

AAN 7. Internal Iliac Artery Flow Preservation With Iliac Branch Device During Endovascular Repair of Aortoiliac Aneurysms: Single Center Experience

Iliac branch devices (IBDs) have become a popular option to preserve internal iliac artery (IIA) flow in patients with ectatic or aneurysmal common iliac arteries during endovascular aneurysm repair. This study aimed to assess the outcomes with the use of this device in a single-center setting. All patients undergoing implantation of a Cook Zenith IBD (Cook Medical, Bloomington, Ind) between January 2010 and May 2018 in our center were included. The IBD was indicated in physically active, anatomically suitable patients with unilateral or bilateral common iliac artery aneurysms with or without aortic aneurysm. Data were collected prospectively. In the study period, 137 IBDs were implanted in 104 patients (133 men; mean age, 67.4 ± 9 years); 33 (32%) patients had a bilateral IBD, 77 (74%) had a simultaneous or previous endovascular repair, and the remaining 27 (26%) had a simultaneous or previous complex endovascular repair. Technical success was 96.4% (132/137), with no early mortality. An upper access was used in 41 (30%) procedures. Twenty (14.6%) patients had a contralateral IIA embolization. Six (4.4%) IIA branches occluded during a mean follow-up of 19 months (one bilateral occlusion and four unilateral). Estimated IIA branch patency at 1 year and 3 years was 97.6% ± 1.8% and 88.8% ± 4.7%, respectively. Of the 10 patients with occluded IIA (5 technical failures and 5 patients with IBD occlusion), 2 suffered persistent buttock claudication. The IBD is a safe and effective technique to preserve IIA flow in patients with challenging distal anatomy and is associated with high technical success and midterm patency.

Hypogastric Preservation Using Retrograde Endovascular Bypass

Maintenance of pelvic circulation has been connected to reduced risks of ischemic colitis, buttock claudication, erectile dysfunction, and spinal cord ischemia during the treatment of extensive aortoiliac aneurysmal disease. We evaluate the mid-to-late follow-up of a cohort of patients treated using 1 preservation technique, the endovascular external iliac artery (EIA) to internal iliac artery (IIA) bypass. All patients undergoing elective retrograde EIA-IIA endovascular bypass at a single institution were retrospectively reviewed over a 10-year period from 2006 to 2016. Anatomic inclusion criteria were single or bilateral common iliac artery aneurysms with or without concomitant aortic aneurysm limiting distal landing zone for endovascular repair and an iliac bifurcation angle greater than 45°. Procedures were performed using aortouni-iliac (AUI) endografts extended to 1 EIA (with endovascular occlusion of the ipsilateral hypogastric artery), cross-femoral artery bypass, and retrograde placement of 1 of 3 types of covered stent grafts into the contralateral IIA. In the case of patients with prior open repair, AUI placement was not required. Follow-up surveillance included duplex ultrasound 1 and 6months postoperatively and annually thereafter, with computed tomography scan (with selective contrast usage) 1month postoperatively and annually thereafter. Seventeen patients (mean age 70years, 93% male) were treated over the period studied. Most were treated for primary disease (N=11) while the remainder was secondary interventions following open repair (N=4) or endovascular aneurysm repair (N=2). Nine patients had bilateral common iliac aneurysms, one had bilateral IIA aneurysms, and the remainder had unilateral iliac aneurysmal degeneration with occluded or severely diseased ipsilateral hypogastric arteries. There was no preference for laterality (right iliac N=8, left iliac N=9). Retrograde bypasses were performed using Fluency stent graft (N=1), Viabahn stent graft (N=13), or Gore Excluder limbs (N=3). Additional hypogastric embolization with AUI extension to the EIA (for bilateral common iliac aneurysms) was required in 6 patients. Proximal extension requiring snorkel/fenestration was present in 5 patients. Technical success was 100% with mean operative time was 168min (range 50-300min), and 71cc contrast usage (range 30-115cc). Mean preoperative iliac artery aneurysm size was 4.0cm with iliac bifurcation angle 71° (range 51-102°). Median length of stay was 3days (range 1-13). Over mean follow-up of 29.8months, there were no aorta-related mortalities, 1 EIA-IIA bypass occlusion (asymptomatic), and 1 reintervention (for type II endoleak not attributed to the EIA-IIA bypass). There were no additional endoleaks and no sac growth. The incidence of bowel ischemia, paralysis, and bowel/bladder dysfunction was zero in the series. Retrograde endovascular EIA-IIA bypass provides a low risk, high patency option for preservation of a single hypogastric artery with resultant maintenance of pelvic circulation.

Endovascular Treatment of Concurrent Bilateral Common and Internal Iliac Artery Aneurysms with Preserved Pelvic Circulation: Bilateral Iliac Branch Devices with Opposing Single Division Internal Iliac Artery Sparing

An 83-year-old man with bilateral common iliac artery aneurysms (right, 3.0 cm; left, 2.7 cm), bilateral internal iliac artery aneurysms (right, 3.4 cm; left, 2.6 cm), and an abdominal aortic aneurysm (3.8 cm) was treated with an aortobi-iliac stent graft and bilateral iliac branch devices. The internal iliac components were extended into opposing posterior (left) and anterior (right) divisions of the internal iliac artery using stent grafts. Computed tomography angiography demonstrated that all aneurysms decreased or were stable in size with patent stent grafts at 1 month. The patient was asymptomatic without complications of pelvic ischemia at the last clinical follow-up at 6 months.