Internal Iliac Aneurysm Research Articles

Upside-Down Gore Excluder as an Endoprosthesis for Aortoiliac Aneurysm Exclusion: A Retrospective Multicenter Study.

The upside-down configuration of a Gore Excluder contralateral leg endoprosthesis has been used to overcome diameter differences in the endovascular treatment of aortoiliac aneurysms. Our goal was not to describe the technique but to study the applicability and safety. Patients were retrospectively enrolled. The indication and details of the procedure were at the discretion of the treating physicians. A case report form was completed including baseline characteristics, indication for treatment, procedural data, and outcomes during follow-up. A total of 31 subjects were enrolled with a range of indications, including 3 patients treated in the emergency setting (9.7%). In 64.5% (n=20), it was a primary intervention for a common iliac aneurysm (n=10), internal iliac aneurysm (n=4), or abdominal aortic aneurysm (n=6). In 11 subjects (35.5%), treatment was performed after previous aortoiliac interventions, including anastomotic iliac artery aneurysm (n=5), type III endoleak (n=3), and endograft thrombus (n=3). Median follow-up was 13 months (range=1-142 months). During follow-up, 2 patients required an upside-down contralateral leg-related secondary intervention, one for an occlusion and another for a type Ia endoleak. There was no type Ib or III endoleak, and no migration, kinking/stenosis, or conversion to open repair was observed. The aneurysm-related mortality was 3.3% (n=1). An upside-down contralateral leg is a valuable technique that can be used to achieve adequate aneurysm exclusion or resolve complications. It is associated with a limited number of complications. This article studies the use of an upside-down iliac endograft. We describe a wide range of indications in which this previously published technique has been applied. In elective and acute settings and as primary and revision intervention an upside-down iliac endograft was performed successfully. Furthermore, follow-up data is presented showing the effectiveness of the technique. Knowledge of this procedure is a valuable addition to the skillset of every interventionalist.

Superior gluteal artery as a reliable back door to embolize mycotic pseudoaneurysm of an isolated Internal Iliac artery

BackgroundAntegrade access through the origin of the internal iliac and direct percutaneous access under cross-sectional imaging guidance are commonly used for embolization of internal iliac artery aneurysms, pseudoaneurysms, or endoleaks. Here, we report superior gluteal artery retrograde access to treat internal iliac artery mycotic pseudoaneurysm in a patient with failed direct percutaneous access.Case presentationWe present a 65-year-old female with a history of diverticulitis and sigmoidectomy. Post-sigmoidectomy course was complicated by left common iliac artery (CIA) iatrogenic injury which required surgical ligation of the left CIA and graft placement. However, the graft was subsequently resection due to infection. Follow up CT imaging showed a 6 cm mycotic pseudoaneurysm (PSA) of the left internal iliac artery. Initially, the PSA sac was directly accessed and embolized under direct CT-guidance using Onyx. However, enlargement of the PSA sac was noted on one week follow-up CT images. Then, superior gluteal artery was accessed under ultrasound guidance, and the PSA sac and feeding vessels were re-embolized with coil and Onyx under fluoroscopy.ConclusionRetrograde access through superior gluteal artery is a feasible and safe approach to embolize internal iliac aneurysms, pseudoaneurysms, or endoleaks, when the antegrade or direct percutaneous access is limited.

Ruptured Isolated Internal Iliac Aneurysm

Ruptured Isolated Internal Iliac Aneurysm

Spontaneous Peripelvic Urinary Extravasation and Internal Iliac Aneurysm.

Spontaneous Peripelvic Urinary Extravasation and Internal Iliac Aneurysm.

A mycotic aneurysm related to Salmonella Rissen infection: a case report

BackgroundSalmonella species commonly causes infection in humans and on occasion leads to serious complications, such as mycotic aneurysms. Here, we present the first case reported of a patient with a mycotic aneurysm likely secondary to Salmonella Rissen infection.Case presentationThe patient presented with 4 weeks of lower back pain, chills and a single episode of diarrhoea 2 months prior during a 14-day trip to Hong Kong and Taiwan. Magnetic resonance imaging revealed an aneurysmal left internal iliac artery with adjacent left iliacus rim-enhancing collection. A stool culture was positive for Salmonella Rissen ST 469 EBG 66 on whole genome sequencing. The patient underwent an emergency bifurcated graft of his internal iliac aneurysm and was successfully treated with appropriate antibiotics.ConclusionsThis case highlights the importance of considering the diagnosis of a mycotic aneurysm in an unusual presentation of back pain with features of infection.

A Case of Abdominal Aortic and Left Internal Iliac Aneurysms in a Patient with a Left Persistent Sciatic Artery That Had to be Preserved Using an Iliac Branch System

A Case of Abdominal Aortic and Left Internal Iliac Aneurysms in a Patient with a Left Persistent Sciatic Artery That Had to be Preserved Using an Iliac Branch System

Embolisation of Bilateral Internal Iliac Aneurysm Through A Percutaneous Ultrasound Guided Anterior Approach in A Patient Previously Treated by Proximal Aneurysm Ligation

Embolisation of Bilateral Internal Iliac Aneurysm Through A Percutaneous Ultrasound Guided Anterior Approach in A Patient Previously Treated by Proximal Aneurysm Ligation

Comparison of Perioperative Outcomes of Patients with Iliac Aneurysms Treated by Open Surgery or Endovascular Repair with Iliac Branch Endoprosthesis

Treatment of common and internal iliac aneurysms is usually done by open surgery. A novel iliac branch endoprosthesis (IBE) is commercially available with encouraging initial results. Our objective is to compare perioperative outcomes of patients with iliac aneurysms treated by open surgery (OS) versus endovascular repair with IBE. The study was a retrospective, single-center review of patients who were treated for aortoiliac or isolated common and/or internal iliac artery aneurysms from 2014 to 2017. Patients with connective tissue disorders, infected grafts, or thoracoabdominal aneurysms were excluded. Primary outcomes were perioperative mortality, length of hospital (LOS) and intensive care unit (ICU) stay, estimated blood loss, need for red blood cell transfusion (RBC), and perioperative reinterventions. Sixty-seven patients (96% male) were treated with OS (n=25, mean age 68±8years) or IBE (n=42, mean age 73±8years; P=0.02) with 1 symptomatic patient in each group. Perioperative mortality occurred in 1 patient in the OS group (4%), with no mortality in the IBE group (P=0.37) Total LOS and ICU stay was higher for OS compared to IBE (total stay 7.5±3.4 vs. 1.7±1.4days for IBE, P<0.0001 and ICU LOS 3.3±2.1 vs. 0.1±0.4days, P<0.0001). Estimated blood loss was higher for patients undergoing OS (4,732±2,540mL) compared to patients treated with IBE (263±451mL, P<0.0001), resulting in higher RBC transfusion requirements (1.5±2.4 vs. 0.2±0.8 units, P=0.001). Five patients in the OS group had early procedure-related reinterventions, while 2 patients in the IBE group required reintervention for access site complications (20% vs. 4.7%, P=0.09). Endovascular repair of iliac aneurysms with IBE is feasible and is associated with lower blood loss, LOS and ICU stay, and had lower RBC transfusion requirements. Cost analysis and long-term follow-up will be needed to define the value of this modality for iliac artery aneurysm repair.

Minimally invasive treatment for isolated internal iliac artery aneurysms preserving superior gluteal artery flow.

To prevent buttock claudication, we performed endovascular aortic aneurysm repair (EVAR) for isolated internal iliac aneurysms (IIAAs) with selective preservation of the superior gluteal artery (SGA) flow. This study evaluates early clinical outcomes of this treatment. We retrospectively evaluated 6 patients with isolated IIAA who underwent EVAR under local anesthesia between October 2017 and July 2018 at Tokyo Women's Medical University Hospital. We used self-expanding stent grafts to exclude the IIAA while preserving SGA flow. If necessary, we occluded the inferior gluteal artery and other branches with vascular plugs to prevent type II endoleak. The mean proximal neck diameter and length of the IIAAs to be 9.4 ± 2.4mm and 17.7 ± 11.3mm. The mean diameter of the SGA was 6.5 ± 0.9mm. There were no procedural complications, and the mean procedure time was 84 ± 24min. All patients were free from buttock claudication at follow-up. Postoperative computed tomography demonstrated a 100% primary patency rate of the SGA stent graft: there was no case of migration or endoleak. EVAR for IIAAs with SGA flow preservation shows favorable early clinical outcomes. To prevent buttock claudication, SGA flow is necessary and sufficient. This novel approach is less invasive compared to conventional IIAA repair.

Spontaneous ureteral rupture caused by iliac aneurysm: a case report

BackgroundRupture of the ureter with extravasation resulting from an iliac aneurysm is extremely rare. Herein, we report a case of ureteric rupture with urinary extravasation secondary to an iliac aneurysm.Case presentationAn 80-year-old man was admitted to our hospital for sudden onset of severe abdominal pain. Contrast-enhanced computed tomography demonstrated a large left internal iliac aneurysm (6.5 cm in diameter) and a ureteric rupture with leakage of contrast media from the left ureter, indicating a spontaneous ureteral rupture. The patient was treated with placement of a ureteral double-J stent under endoscopic and X-ray fluoroscopic guidance and endovascular aortic repair. His postoperative course was uneventful and he was discharged on postoperative day 20. A computed tomography scan at 2 weeks after surgery showed no contrast extravasation from the ureter or end leak.ConclusionCombination treatment with ureteral and endovascular stenting is effective in avoiding aneurysmal rupture and the serious consequences of a ureteral rupture, which include a perinephric or retroperitoneal collection, abscess formation, subsequent urosepsis, and graft infection.

Endovascular Treatment of Type 1a Endoleak after Treatment of Suspending Rupture of Bilateral Internal Iliac Aneurysms for Preserving the Inferior Mesenteric Artery

An 86-year-old man presented with lower abdominal pain. Enhanced CT revealed large bilateral internal iliac arterial aneurysms. After embolization of the bilateral internal iliac arteries, leg type stent grafts were implanted. 1 month later an enhanced CT showed a type 1a endoleak, so additional endovascular treatment was necessary. A bifurcated type stent graft was lowered into the terminal aorta to bail out the inferior mesenteric artery. The type 1a endoleak disappeared, nor were complications. The use of this simple and easy technique can prevent serious and fatal complications after bilateral internal iliac artery embolization.

A Rare Cause of Lower Gastrointestinal Bleed: Internal Iliac Aneurysm With Rupture into Rectum

An 85-year-old male with history of atrial fibrillation for which he was on warfarin, tobacco use, and vascular disease presented with acute onset of pulsatile rectal hemorrhage followed by unresponsiveness. Physical examination revealed confusion and tachycardia with a benign abdomen. Labs revealed a two-gram hemoglobin drop and INR of 5. The patient was resuscitated and coagulopathy was reversed. Enhanced CT abdomen/pelvis revealed a 2.2 x 1.8 cm distal right internal iliac artery aneurysm with contained rupture, evidenced by a 2.5 x 2.2 medially projecting pseudoaneurysm (Figure A). There was no enteric endoluminal extravasation of contrast to suggest a fistula, although presentation was suggestive of one. An urgent angiogram revealed an aneurysm arising from a distal branch of the anterior division of the right internal iliac artery, with no active extravasation (Figure B). Coil embolization of the outflow artery was performed (Figure C). The inflow artery to the aneurysm was then embolized and follow-up angiogram showed no additional feeding vessels into the aneurysm. Following the procedure, there was no further hematochezia and the hemoglobin remained stable. A literature search for ruptured internal iliac artery aneurysm with fistulization to the colon mainly showed cases occurring secondary to vasculitis or previous vascular reconstructive surgery. Primary fistulae occur most frequently between the aorta and esophagus or duodenum. Primary iliac-enteric fistulae are rare, occurring in about 0.07% of the general population.1 However, this is a possible cause of brisk lower gastrointestinal bleeding and should be considered in the differential of these patients. A small case series describing six patients with primary aorto/iliac-enteric fistulae found the overall 30-day mortality rate to be 50%.2 If there is suspicion for this, an enhanced CT scan should be obtained immediately as proceeding with endoscopic evaluation will only delay definitive therapy.FigureFigureFigure

Internal iliac aneurysm: an unusual cause of acute abdomen pain – case presentation and brief review

Internal iliac aneurysms (IIAs) are a rare group of intra-abdominal aneurysms that, if not diagnosed and treated promptly, can lead to significant morbidity and mortality. We present a case of an elderly Chinese male who presented acutely with abdominal pain due to a leaking left IIA. Prompt diagnosis and expedient treatment with a hybrid approach, i.e. with endovascular balloon occlusion followed by surgical excision of the IIA, led to an excellent outcome. Case presentation is followed by a brief discussion of the current literature on the management of this elusive condition.

Isolated Bilateral Common Iliac Artery Aneurysm

The incidence of isolated iliac artery aneurysm is rare. We report a 78-year-old male with isolated bilateral common iliac artery and internal iliac aneurysm. Computerized tomography angiogram of the aorta revealed partially thrombosed aneurysms involving bilateral common iliac and internal arteries with mass effect. The infrarenal abdominal aorta is tortuous and ectatic. The clinical presentation and management are discussed.

Internal Iliac Aneurysms have a Low Risk of Rupture under 4 cm: A Multicentre Study

Internal Iliac Aneurysms have a Low Risk of Rupture under 4 cm: A Multicentre Study

Evaluation of the Risk of Buttock Claudication After Embolization of Internal Iliac Aneurysms

Evaluation of the Risk of Buttock Claudication After Embolization of Internal Iliac Aneurysms

Results of the Gore Hybrid Vascular Graft in Challenging Aortic Branch Revascularization during Complex Aneurysm Repair

Prolonged organ ischemia during complex aortic surgery is associated with increased morbidity and mortality. A novel hybrid graft (Gore Hybrid Vascular Graft) ascomposite of expanded polytetrafluorethylene vascular prosthesis that has a section reinforced with nitinol was investigated for feasibility and effectiveness during aortic repair. Retrospective analysis of all consecutive patients treated with the hybrid vascular graft (HVG). Indication for graft implantation was surgeon's preference for branch revascularization in challenging aortic repair. Within 26months, 25 Gore HVGs and 17 conventional grafts were implanted in 12 patients (age, 73years; range, 33-79 years, 8 men). Eleven patients were treated for thoracoabdominal aortic aneurysms and one for aortoiliac aneurysm (elective=6, urgent=6). Nine visceral debranching procedures, 2 Crawford procedures, and 1 repair of an internal iliac aneurysm were performed. The distribution of HVG use was left renal artery=10, right renal artery=9, superior mesenteric artery=4, celiac trunk=1, and internal iliac artery=1. Time to restore visceral blood flow during visceral debranching was 7±4min for the Gore HVG vs. 12 ± 6min for conventional grafts (P<0.01).Technical success was achieved in all cases. At 12months of median follow-up, cumulative patency of the HVGs was 96%. The Gore HVG offers a new, simplified, and time-sparing technique for visceral anastomoses during complex aneurysm repair. However, long-term results are still lacking and need to be awaited.

Covered stent placement in the superior gluteal artery to preserve pelvic blood flow in a hybrid approach for treatment of internal iliac aneurysms

Covered stent placement in the superior gluteal artery to preserve pelvic blood flow in a hybrid approach for treatment of internal iliac aneurysms

Complex Common and Internal Iliac or Aortoiliac Aneurysms and Current Approach: Individualised Open-Endovascular or Combined Procedures

Objective. Bilateral internal iliac artery aneurysms constitute the utmost configuration of infrarenal aortoiliac disease. We detail characteristic aortoiliac disease patterns and reconstructive techniques we have used, along with a visualized decision-making chart and a short review of the literature. Material and Methods. A retrospective, observational study of twelve clinical cases of patients with aortoiliac disease are described. Two patients had a common iliac artery aneurysm and were managed by the application of inversed stent-grafts; another case was repaired by the insertion of a standard bifurcated stent-graft flared in the right common iliac artery and with an iliac branched device in the left iliac arterial axis. Open approach was used in 5 cases and in 4 cases a combination of aortouniliac stent-grafting with femoral-femoral bypass was applied. Results. Technical success was 100%. One endoleak type Ib in a flared iliac limb was observed and corrected by internal iliac embolism and use of an iliac limb stent-graft extension. We report 100% patency rate during 26.3 months of followup. Conclusion. Individualized techniques for the management of isolated iliac or aortoiliac aneurismal desease with special concern in maintaining internal iliac artery perfusion lead to elimination of perioperative complications and long-term durability and patency rates.

Direct sonographic-guided superior gluteal artery access for treatment of a previously treated expanding internal iliac artery aneurysm

Isolated internal iliac artery aneurysms are relatively uncommon compared with all aortoiliac aneurysms. Transcatheter treatment with coil embolization is an attractive noninvasive alternative to surgical resection. However, if the aneurysm is insufficiently treated with only proximal coil embolization without concurrent embolization of distal runoff vessels, there is a risk of aneurysm expansion from retrograde collateral flow. We present a case of previously treated internal iliac aneurysm that underwent late rapid expansion. Due to occlusion of the internal iliac artery, direct sonographic-guided puncture of the superior gluteal artery was made in order to access the aneurysm. We believe this is the first reported case of such treatment.