Iliac Artery Aneurysm Research Articles

Endovascular Aneurysm Repair Using Physician-Modified Fenestrated Endurant Contralateral Limb for Internal Iliac Artery Preservation.

We developed a novel Endovascular aortic repair technique for internal iliac artery preservation using a physician modified Endurant contralateral limb. This procedure was safe and reliable for preserving internal iliac artery flow in 24 patients with common and internal iliac artery aneurysms. We believe that our technique has the potential to expand the anatomic indications for internal iliac artery preserving procedures.

Clinical data, guidelines and real-world outcomes of endovascular iliac aneurysm repair with the GORE® EXCLUDER® Iliac Branch EndoprosthesisProvision of Services for People with Vascular Disease 2021

Isolated aneurysms of the iliac arteries are extremely rare. They most frequently occur in the common iliac artery (CIA) and are least frequent in the external iliac artery (EIA).1 Most (95%) affected patients are male and the median age of diagnosis is in the seventh decade of life.2 The underlying pathology of isolated iliac artery aneurysms is similar to that of abdominal aortic aneurysms. This includes degenerative aneurysm, pseudoaneurysm, penetrating ulcer, post-dissection aneurysm mycotic aneurysm, and traumatic aneurysm.3 Unlike patients with abdominal aortic aneurysms, those with iliac artery aneurysms present with symptoms of compression of other structures, particularly the ureter, sacral plexus and iliac veins. Reported growth rate of isolated iliac artery aneurysms is similar to that of abdominal aortic aneurysms. Ruptured isolated iliac artery aneurysms are associated with significant mortality,4 which is higher when treatment is undertaken as an emergency rather than an elective surgical procedure. Effective and timely intervention is therefore essential to improve survival. The aim of surgical treatment is to exclude the aneurysm from the circulation to prevent further growth and rupture. Traditional open surgical repair (OSR) was the mainstay of treatment but is technically challenging due to the location of the aneurysms in the pelvis and a frequent prior history of abdominal aortic aneurysms.1 Endovascular repair (EVAR) of isolated iliac artery aneurysms is a less invasive alternative to OSR. It is performed by a combination of branch-vessel coil embolisation and stent grafting, and has potential advantages over OSR in reducing perioperative morbidity and mortality.5 This supplement is a report of a satellite symposium held during the Vascular Societies' Annual Scientific Meeting in November 2022. It reviews clinical data, guidelines and real-world outcomes of endovascular iliac aneurysm repair with the GORE® EXCLUDER® Iliac Branch Endoprosthesis.

Abstract 17775: Utilization Patterns and Outcomes Associated With Open vs. Endovascular Abdominal Aortic Aneurysm Repair: Findings From the National Inpatient Sample

Introduction: Abdominal aortic aneurysm (AAA) is associated with significant morbidity and mortality. Treatment options include open and endovascular AAA repair. We explored the utilization patterns and outcomes of open and endovascular AAA repair among hospitalized patients in the US. Hypothesis: We hypothesized that there would be no difference in the utilization patterns of open and endovascular AAA repair by race and gender. Methods: Using the ICD-10 diagnosis and procedure codes, we queried the National Inpatient Sample 2016 to 2019 for hospitalizations among patients ≥18 years old who had an open or endovascular AAA repair. Multivariable logistic regression was used to estimate the odds of death and discharge dispositions comparing open to endovascular AAA repair. Regression models were adjusted for age, sex, median income zip, history of aneurysm of carotid, iliac, and lower extremity artery, co-morbidities including diabetes, hypertension, smoking, obesity, chronic kidney disease, congestive heart failure, myocardial infarction, COPD, and atherosclerosis. Results: Our study included 132,775 and 36,010 weighted hospitalizations for endovascular and open AAA repair, respectively. The open AAA repair cohort were younger compared to those of endovascular AAA repair (mean age ± S.D: 65.0 ± 10.4 Vs.73.3 ± 9.0). A higher proportion of female underwent open AAA repair than endovascular AAA repair (33.5% vs. 20.9%). Across all racial/ethnic groups, endovascular repair for AAA was more common than open AAA repair among males, except for black males. A higher proportion of black males underwent open AAA repair than endovascular repair (5.7% vs. 3.9%). Patients who had open AAA repair had higher odds of death compared to those who had endovascular repair (Adjusted odds ratio [aOR], 5.99 [95% CI, 5.22-6.87]; p<.0001 ). Conversely, a higher odd of discharge to home/short term facility was noted among patients who had endovascular compared to open AAA repair (aOR, 5.83 [95% CI, 5.38 - 6.32]; p<.0001) . Conclusions: Disparities exist in the utilization of open versus endovascular AAA repair among hospitalized patients. Results could be used to support future research to examine factors driving these disparities.

LOWER EXTREMITY ARTERY ANEURYSMS AND THEIR MANAGEMENT-AN INSTITUTIONAL EXPERIENCE

Objective: To study the clinical presentation, etiology and outcomes of Lower extremity aneurysms management at a teritiary care centre. Methodology: This is a retrospective study covering a period of 5 years from june 2018 to july 2023 conducted at the Institute of Vascular Surgery, Madras Medical College, Chennai. Case sheets were retrieved and reviewed from CMCHS database. Inclusion criteria: Patients with true aneurysms and pseudoaneurysms involving lower limb who were managed by surgery or endovascular means were included in the study. Exclusion Criteria: Pseudoaneurysms related to dialysis and Iliac artery aneurysms Results There were 23 patients who presented with aneurysms of the extremities that fell in the inclusion criteria. Of these 14 patients were male and 09 were female. Children (<18 years) constituted 14.2 % of patients. Youngest- 7-month-old boy- Right PFA Pseudoaneurysm Oldest - 72yrs old male- Left PFA Pseudoneurysm • Major vessels involved were SFA-8/23(34.7%) and common femoral artery 5/23(21.7%.). Complications developed in 4 of the 23 cases (17.4%), which included recurrent pseudoaneurysm, surgical site infection, post- operative hematoma and surgical site infection ending up in AK amputation. Limb salvage rate was- 95.6% Amputation rate- 4% (1 patient). Conclusion: Extremity artery aneurysms are uncommon. Majority are pseudoaneurysms. Results of both open surgery and endovascular management are excellent.

Transfemoral Access to Implant Iliac Branch Devices After Previous Aortic Grafts.

To report on the outcomes of patients undergoing an iliac branch device implantation after previous open or endovascular aorto-biliac repair, using exclusively femoral access for catheterization and delivery of the covering stent to the hypogastric artery. Single-center retrospective study in which all patients in whom an iliac branch device was implanted after previous open or endovascular aorto-biliac repair were identified. Patients in whom the hypogastric artery catheterization and delivery of the bridging cover stent were achieved via exclusive femoral access were included. Different techniques were used based on surgeon preference. Technical success and access-related complications, as well as iliac branch device endoleak or occlusions during follow-up, were evaluated. From 2015 to 2021, 28 patients with a prior open or endovascular aorto-biliac repair underwent 34 iliac branch device implantations. Most (71%) had juxtarenal or thoracoabdominal aortic aneurysms, 82% had common iliac artery aneurysms, and 25% had hypogastric artery aneurysms. Bilateral iliac branch device implantations were performed in 21% of the patients, and in 26% of cases, landing in the superior gluteal artery was obtained. An "up-and-over" technique from the contralateral groin was used in 65% of the cases, and a steerable sheath in 35%. Technical success was 94%, with no complications related to access or technique to catheterize and deliver the stents in the hypogastric artery. The cohort had 20% of major complications, with 3 perioperative deaths. Kaplan-Meier estimated an iliac branch device freedom from occlusion and endoleak was 92% and 83% at 2 years. The implantation of an iliac branch device over previous aortic or open endografts involving the aortic bifurcation is feasible and safe. We suggest using a femoral approach as the primary access of choice. In this study we present 28 patients with previous aortoiliac grafts in which iliac branch devices were performed as a subsequent step.We demonstrated the feasibility of the technique despite the difficulty of crossing a neobifurcation, with a steep angle, without complications associated with the technique. Based on our experience, we recommend transfemoral access as the first option for bypassing the hypogastric artery stent, preserving upper extremity access and its possible complications.

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.

Giant Right Common Iliac Artery Aneurysm with Right Common Iliac Vein Fistula, Masquerading as Deep-Vein Thrombosis

Abstract Iliac artery aneurysm is rarely known to rupture into iliac vein, leading to features of aneurysm and in particular, right ventricular volume overload, and pulmonary artery hypertension, due to the extracardiac left to right shunt. Herein, we report the case of a 67-year-old gentleman who presented with massively swollen right lower limb, leading to pain and inability to walk without support for 1 month. He was diagnosed to have and treatment for deep vein thrombosis with Vitamin K antagonist for 2 years. Contrast computed tomography angiogram of the abdomen revealed giant right iliac artery aneurysm above its bifurcation with iliac vein fistula. He underwent open repair of aneurysm and transaneurysmal suture closure of the iliac fistula. However, for transient renal dysfunction and reexploration for pelvic hematoma, his recovery, including normalized right lower limb, was smooth.

A hybrid approach to previously excluded, expanding internal iliac artery aneurysms

Previously excluded internal iliac artery (IIA) aneurysms can continue to expand and pose a risk of rupture. In this case series, we present three patients with previously excluded, expanding IIA aneurysms after endovascular stent coverage or open surgical ligation of the proximal IIA. We describe a hybrid approach to treat these patients safely and effectively.

False Aneurysm With Contained Rupture Of The Right Primitive Iliac Artery: A Case Operated On At The Festoc Center In Bamako

An iliac artery aneurysm is defined as a localized and permanent dilatation of the artery with a diameter greater than 1.5 cm. We report the case of a 32-year-old patient who had been admitted to the André Festoc center for one month of evolving lumbar pain, and in whom the morphological work-up revealed an aneurysm of the right common iliac artery. The aneurysm was cured by flattening and interposition of a PTFE prosthesis. Post-operative management was straightforward. Initially, Bechet's disease was suspected in view of the genital ulcerations, but the ophthalmological examination was normal. Syphilitic origin was therefore considered, as syphilis serology can be negative in the primary phase.

Open surgical treatment for aortic arch and coronary artery aneurysms associated with immunoglobulin G4-related disease: a case report

BackgroundImmunoglobulin G4-related disease (IgG4RD) is a systemic autoimmune disease characterized by a dense lymphoplasmacytic infiltrate containing IgG4-positive plasma cells that can cause aneurysms in various organs and tissues. There have been many reports of IgG4RD aneurysms; however, the surgical procedures adopted remain controversial. Herein, we report a case in which surgical treatment for IgG4-related aneurysms was successful.Case presentationAn 83-year-old woman with IgG4-related disease developed multiple aneurysms, including thoracic aortic aneurysm (TAA), right coronary artery aneurysm (CAA), abdominal aortic aneurysm, and common iliac artery aneurysm. Enhanced computed tomography (CT) revealed progressive enlargement of the TAA, while positron emission tomography-CT revealed intense 18F-fluorodeoxyglucose uptake around the TAA and CAA, suggesting the presence of adhesive tissue caused by adventitial inflammation around the aneurysms. Open aortic arch replacement with frozen elephant trunk procedure and coronary artery bypass grafting with ligation of the coronary artery were performed to treat the TAA and CAA. No surgical complications occurred. The postoperative CT scan showed no endoleak around the open stent graft and the coronary artery was patent. The patient is being followed up on an outpatient basis after discontinuing steroid therapy.ConclusionsWe report the successful surgical treatment of IgG4-related multiple aneurysms. Our findings reveal that the main site of inflammation in aneurysms of IgG4RD is the adventitia and the frozen elephant trunk procedure is useful for avoiding complications.

Simultaneous aortoiliac kissing Endovascular stenting for management of isolated monolateral common iliac artery aneurysm with no proximal landing zone.

Isolated iliac artery aneurysm (IIAA) is an uncommon finding. It, accounts for 0.03% of all patients and 2% of all abdominal aneurysm. Endovascular approach represents the treatment of choice for most patients with IIAA. We reported our experience on iliac aneurysm with no proximal landing zone by simultaneous aortoiliac kissing endovascular (S.A.K.E.) covered stenting. This is a retrospective analysis of nine consecutive patients with IIAA with no proximal landing zone, who underwent endovascular kissing covered stenting (Gore®Viabahn®VBX) The median aneurysm diameter was 4.1cm, with a median 3-mm proximal neck length. In 3/9 aneurysms involving the internal iliac arteries the origin of the internal iliac artery was covered after its embolization and a stent graft extending to the external iliac artery (EIA) was placed. All stents were flared with semi-compliant balloon. Iliac aneurysm exclusion was obtained in all cases (100%), no graft migration or endo-leak were recorded. The median operative time was 28min; the median fluoroscopy time was 9min and a median 70mL of contrast was used. At a median 24-month follow-up, all patients are alive, and no endo-leak or migration, infection, distal embolization, limb loss were observed. Moderate buttock claudication was experienced in 1/9 patients with internal iliac artery embolization. In 6/9 patients a shrinkage of the aneurysmal sac was recorded after 1year. Endovascular management of IIAAs cases has been reported in literature and it was confirmed to be safe and successful. The IAA usually progresses into expansion which eventually leads into rupture. Adequate long proximal and distal landing zones were the most important feature related to better outcomes. Short proximal neck (˂10mm) represents a real challenge for iliac aneurysm treatment and, nowadays, a classical bifurcated aortoiliac endograft deployment represents the treatment of choice. Endovascular repair of isolated CIA aneurysms with no proximal neck is safe and successful using the SAKE stenting technique with VBX adequately flared and it represents effective and minimally invasive alternative to aortobiliac endograft implantation in the treatment of these aneurysms. To the best of our knowledge, this is the first report which describes this approach in the treatment of IIAA with no adequate proximal landing zone. Our approach overcomes the need to aortic bifurcation graft implantation and reduces procedure time, contrast dose and radiation exposure. It also preserves relevant collaterals vessels thanks to inferior mesenteric artery and lumbar arteries sparing. A proximal aortic bifurcation endograft allows proximal sealing to be regained. Large population study with longer follow-up are needed to establish this approach as a new standard.

Branched endovascular iliac artery repair using the Zenith® Branch Endovascular Iliac Bifurcation graft: outcomes and reinterventions in our retrospective cohort.

The aim of this retrospective cohort study was to analyze the outcomes and the need for reinterventions following branched iliac artery repair using the Zenith® Branch Endovascular Iliac Bifurcation (ZBIS; Cook Medical Europe LTD, Limerick, Ireland) graft. Patient characteristics and follow-up data on 63 patients following branched iliac artery repair using the ZBIS device were evaluated and compared between patients with and without iliac reinterventions. A competing risk regression model was analyzed to identify independent predictors of reinterventions, and to predict the reintervention risk. ZBIS implantation's technical success rate was 100%, and we observed no in-hospital mortality. Internal iliac artery patency was 93% during a median [first quartile, third quartile] follow-up of 19 [5, 39] months. Thirty-two iliac reinterventions were performed in 23 patients (37%) after a mean time of 3.0 months (IQR: 0.4-6.8) (time to first reintervention). Endoleaks type I and II were the most common indication for reinterventions (n=14, 61%). The internal iliac artery's diameter [subdistribution hazard ratio (sHR): 1.046; P=0.0015] and a prior abdominal aortic intervention (sHR: 0.3331; P=0.0370) were identified as significant variables in the competing risk regression model for a reintervention. The risk for reintervention was 33% (95% CI: 20-46%), and 46% (95% CI: 28-63%) after 12 and 36 months, respectively. Endovascular repair of degenerative iliac artery aneurysms with Zenith Branch Iliac Bifurcation device is a feasible and safe option. Perioperative morbidity and mortality are low with good graft patency rates. The risk for secondary iliac artery interventions is considerable and highlights the need for patients with iliac disease to undergo continuous follow-up in a dedicated vascular center.

Outcome of different endovascular modalities to treat common iliac artery aneurysms, single center study.

Iliac aneurysms occur in 10% of patients with abdominal aortic aneurysms (AAA). There are three different endovascular approaches to their treatment in the context of infrarenal Endovascular Aortic Aneurysm Repair (EVAR): occlusion by coiling the internal iliac, incorporation using an iliac branch device, and delaying repair using a bell bottom limb. We sought to determine outcomes associated with these three strategies in our practice. The study was a combined prospective cohort study with a retrospective arm: prospective patient recruitment was done for 1year from September 2019 and ended by September 2020, and retrospective data was collected from 2017 to 2019. Demographic, procedural, and imaging data was collected. SPSS was used to analyze data as patients were classified by limbs in four groups: iliac branched, bell bottom, coil and cover technique, and standard treated limbs. There were 65 male and 4 female patients included in this study incorporating 137 limbs with a mean age of 78years (SD ± 8years). Two patients died after discharge (at 3 and 21months postoperatively, without hospital admission) and five patients were lost to long-term follow-up. Three patients had operations that deviated from the plan: one was an IBD converted to bell bottom, one was an IBD that was converted to coil and cover, and one was a bell bottom that did not seal. Follow-up revealed late type IB endoleak in three bell bottom limbs and one limb treated with coil and cover. Common iliac occlusion occurred in one IBD, three bell bottom limbs, and two limbs treated with coil/cover technique. There were four additional ischemic events (buttock claudication in three and intestinal ischemia in one): all ischemic events occurred in the coil and cover group (p = .001). Given the small population size examined in this study, there is no statistical difference between treatment groups; however, there was a trend toward bell bottom technique being associated with higher incidence of type IB endoleak. Coil and cover technique was associated with decreased IB endoleak; however, Buttock claudication and intestinal ischemia occurred more significantly in this group. Using IBD may be the best strategy to improve short- and long-term outcomes in patients with iliac aneurysms.

Clinical Outcomes of Internal Iliac Artery Interruption during Endovascular Aneurysm Repair.

This study aimed to investigate the clinical outcomes of internal iliac artery (IIA) interruption during endovascular aneurysm repair (EVAR) and to identify the risk factors for ischemic complications. Endovascular treatment was performed in 316 patients with aneurysms or pseudoaneurysms of the abdominal aorta or iliac arteries between March 2006 and January 2022. Medical records and radiological imaging studies were retrospectively reviewed. The incidences of buttock claudication, ischemic colitis, and spinal cord ischemia after IIA interruption were investigated as clinical outcomes. Binary logistic regression analysis were performed to identify the risk factors. IIA embolization was performed in 78 patients. Among the 42 patients who underwent IIA flow preservation procedures, the one-month computed tomography detected early failure in five patients. The origin of the IIA was covered with an endograft in ten patients who did not undergo embolization. Eventually, interruption of the IIA by EVAR was observed in 93 patients. Considering preoperative IIA occlusion, there was a total of six patients who did not have at least one IIA patency. Buttock claudication occurred in 32.6% of the patients, and none of the patients had ischemic colitis or spinal cord ischemia. In multivariable analysis, age ≤80 years and isolated iliac artery aneurysm were associated with the development of postoperative buttock claudication. The most common complication after IIA interruption is buttock claudication; however, critical complications such as ischemic colitis or spinal cord ischemia are rare, even in bilateral IIA occlusion. Adjunctive procedures to preserve bilateral IIA perfusion should be adopted selectively.

Identification of Clinical Heterogeneity and Construction of Prediction Models for Novel Subtypes in Patients with Abdominal Aortic Aneurysm: An Unsupervised Machine Learning Study

Abdominal aortic aneurysm (AAA) is one of the most common diseases in vascular surgery. Endovascular aneurysm repair (EVAR) can effectively treat AAA. It is essential to accurately classify patients with AAA who need EVAR. We enrolled 266 patients with AAA who underwent EVAR. Unsupervised machine learning algorithms (UMLAs) were used to cluster subjects according to similar clinical characteristics. To verify UMLA's accuracy, the operative and postoperative results of the two clusters were analyzed. Finally, a prediction model was developed using binary logistic regression analysis. UMLAs could correctly classify patients based on their clinical characteristics. Patients in Cluster 1 were older, had a higher BMI, and were more likely than patients in Cluster 2 to develop pneumonia, chronic obstructive pulmonary disease, and cerebrovascular disease. The aneurysm diameter, neck angulation, diameter and angulation of bilateral common iliac arteries, and incidence of iliac artery aneurysm were significantly higher in cluster 1 patients than in cluster 2. Cluster 1 had a longer operative time, a longer length of stay in the intensive care unit and hospital, a higher medical expense, and a higher incidence of reintervention. A nomogram was established based on the BMI, neck angulation, left common iliac artery (LCIA) diameter and angulation, and right common iliac artery (RCIA) diameter and angulation. The nomogram was evaluated using receiver operating characteristic curve analysis, with an area under the curve of 0.933 (95% confidence interval, 0.902-0.963) and a C-index of 0.927. Our findings demonstrate that UMLAs can be used to rationally classify a heterogeneous cohort of patients with AAA effectively, and the analysis of postoperative variables also verified the accuracy of UMLAs. We established a prediction model for new subtypes of AAA, which can improve the quality of management of patients with AAA.

Internal iliac artery aneurysm masquerading as a sciatic nerve schwannoma: illustrative case.

Schwannomas are common peripheral nerve sheath tumors. Imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT) can help to distinguish schwannomas from other types of lesions. However, there have been several reported cases describing the misdiagnosis of aneurysms as schwannomas. A 70-year-old male with ongoing pain despite spinal fusion surgery underwent MRI. A lesion was noted along the left sciatic nerve, which was believed to be a sciatic nerve schwannoma. During the surgery for planned neurolysis and tumor resection, the lesion was noted to be pulsatile. Electromyography mapping and intraoperative ultrasound confirmed vascular pulsations and turbulent flow within the aneurysm, so the surgery was aborted. A formal CT angiogram revealed the lesion to be an internal iliac artery (IIA) branch aneurysm. The patient underwent coil embolization with complete obliteration of the aneurysm. The authors report the first case of an IIA aneurysm misdiagnosed as a sciatic nerve schwannoma. Surgeons should be aware of this potential misdiagnosis and potentially use other imaging modalities to confirm the lesion before proceeding with surgery.

Coil Embolization of Recurrent Internal Iliac Artery Aneurysm via the Superior Gluteal Artery.

We report a case of recurrent internal iliac artery aneurysm previously treated with a combination of stent graft placement and coil embolization in an 85 year-old male patient. The patient was scheduled for the direct puncture embolization of the superior gluteal artery. The patient was placed in a prone position under general anesthesia. An 18G-PTC needle was inserted into the superior gluteal artery under ultrasonographic guidance. A 2.2F microcatheter was inserted through an outer needle and advanced to the aneurysmal sac. Coil embolization was successfully performed without endoleaks. This approach is technically feasible when other treatment options fail or are deemed unsuitable.

Ureteral compression syndrome due to right external iliac artery aneurysm

Ureteral compression syndrome due to right external iliac artery aneurysm

Double-Barrel Technique With Reversed Gore Excluder Stent Graft Limb for Common Iliac Aneurysm Exclusion in a Patient With Prior Aortic Surgical Repair.

Surgical repair of a common iliac artery aneurysm (CIA) after previous open aortic reconstruction is associated with significant morbidity and mortality. Endovascular repair is considered less invasive than surgery. However, if preservation of the internal iliac artery (IIA) is required, the applicability of endovascular techniques may represent a challenge and a limitation to the use of standard aortic endografts or iliac branch devices. In these cases, the off-label use of endovascular devices may be an effective alternative. Herein, we report a successful hybrid approach to treat CIA using a reversed iliac limb endograft coupled with a double-barrel technique with femoro-femoral crossover bypass in a patient who had previously undergone open aortic reconstruction.

Porcelain-looking inflammatory aneurysm of the common iliac artery: a literature review

Porcelain-looking inflammatory aneurysm of the common iliac artery: a literature review