Management Of Iliac Artery Aneurysms Research Articles

Endovascular management of iliac artery aneurysms

Purpose: The aim is to evaluate the role of endovascular interventions in treatment of iliac artery aneurysms with one year follow up. Patients and methods: our study included 20 patients with iliac artery aneurysms defined as (iliac artery with a diameter >3cm) with adequate proximal and distal landing zone. Patients with anastomotic aneurysms, infected aneurysms or with severe renal impairment (GFR <30ml/min/1.73m2) were excluded. FOR ISOLATED ILIAC ANEURYSM: access used through either: 1) Retrograde ipsilateral common femoral artery puncture. 2) Contralateral femoral puncture and performing a crossover technique. Under fluoroscopy, the stent graft devices were advanced into the iliac axis up to the planned graft deployment site, Embolization of the IIA was performed in cases where backflow from the IIA was expected to result in a type II endoleak. For Aorto-Iliac Aneurysms: Bilateral femoral access is needed to place endografts and can be performed via surgical femoral cut down. Once vascular access is established and landmarks for positioning the device are obtained with aortography, the main device is positioned with particular attention paid to the location of the opening for the contralateral iliac limb ("contralateral gate").

Incidence and management of iliac artery aneurysms associated with endovascular treatment of juxtarenal and thoracoabdominal aortic aneurysms

BackgroundThis study reports the clinical impact of iliac artery aneurysms (IAAs) in a population of patients with juxtarenal and thoracoabdominal aortic aneurysms being treated with fenestrated or branched aortic endografts. MethodsData from 364 patients with IAA (33%) were extracted from the 1118 patients treated for juxtarenal or thoracoabdominal aortic aneurysms with a fenestrated or branched aortic endograft in a physician-sponsored investigational device exemption trial (2001-2016). IAAs were defined as ≥21 mm in diameter, as measured by an imaging core laboratory. Outcomes were assessed by univariate and multivariable analysis. ResultsIAAs were unilateral in 219 (60%) and bilateral in 145 (40%) of the 364 patients. Treatment was iliac leg endoprosthesis without coverage of the hypogastric artery (seal distal to the IAA in the common iliac artery), placement of a hypogastric branched endograft in 105 (21%), and hypogastric artery coverage with extension into the external iliac artery in 103 (20%); 67 (13%) were untreated. Procedure duration was longer for those with IAA (5.3 ± 1.79 hours vs 4.6 ± 1.74 hours; P < .001), although hospital stay was not. There was no difference in aneurysm-related mortality and all-cause mortality for patients with unilateral and bilateral IAAs compared with those without an IAA. Treatment of patients with a hypogastric branched endograft had similar all-cause mortality compared with treatment of patients without a hypogastric branched endograft but also with an IAA. Reintervention rates were significantly higher in those with bilateral IAAs compared with no IAA (hazard ratio, 1.886; P < .001). Spinal cord ischemia trended higher in patients with bilateral IAA. ConclusionsIAA management at the time of fenestrated or branched endovascular aneurysm repair increases procedure time without increasing hospitalization. The reintervention rate and spinal cord ischemia rate are higher in patients with bilateral IAA compared with those with no IAA.

RS11 Incidence and Management of Iliac Artery Aneurysms Associated With Endovascular Treatment of Juxtarenal and Thoracoabdominal Aortic Aneurysms

Iliac artery aneurysms (IAA) associated with aortic aneurysms can complicate their management. The aim of this study was to evaluate the incidence, management, and outcomes of IAA associated with juxtarenal (JRAA) and thoracoabdominal aortic aneurysms (TAAA) treated with fenestrated/branched aortic endografts (F/B-EVAR). Data from 1118 patients (Table) enrolled in a physician-sponsored investigational device exemption trial (2001-2016) for treatment of JRAA or TAAA with F/B-EVAR were evaluated. Maximum iliac artery diameter was determined by an imaging core laboratory, and IAAs were defined as ≥21 mm in diameter. Clinical management, perioperative outcomes, and long-term outcomes were analyzed. Data are presented as mean ± standard deviation and were assessed using Kaplan-Meier, univariate, and multivariable analysis. Of 364 (33%) patients with IAA, 219 (60%) were unilateral and 145 (40%) were bilateral. Of the 509 IAA, 234 (46%) were treated with an iliac limb without coverage of the hypogastric artery, 103 (20%) had hypogastric artery coverage, 105 (21%) had placement of a hypogastric branched endograft (HBE), and 67 (13%) went untreated. Procedure duration was longer for those with IAA (5.3 ± 1.79 vs 4.6 ± 1.74 hours; P < .001), although hospital stay was not. Hazards of aneurysm-related mortality and all-cause mortality trended higher in unilateral and bilateral IAA groups. Treatment with a HBE had lower hazards of death than those without (adjusted for age, procedure duration, and repair class (HR 0.64, P = .017). Hazards of reintervention were higher in those with unilateral and bilateral IAA compared to no IAA (hazard ratio [HR], 1.45 and 2.09, respectively), but was not associated with the use of HBE. Spinal cord ischemia trended higher in unilateral and bilateral IAA than no IAA (HR 2.59 and 12.96; P = .259 and P = .056, respectively). Patients with unilateral and bilateral IAA comprised a substantial portion of those who underwent F/B-EVAR for JRAA and TAAAs. The complexity of the disease is supported by trends toward higher hazards of aneurysm-related mortality, all-cause mortality, reintervention, and spinal cord ischemia in patients with IAA compared to those with no IAA. Lower hazards of death were found in those treated for IAA with a hypogastric branch, with no difference in reintervention detected. These results suggest that F/B-EVAR including hypogastric branch may be a robust treatment option for complex patients with TAAA and concomitant IAA. Additional efforts are needed to improve outcomes and understand the utility of this treatment option for this complex subset of the TAAA population.TableDemographicsVariableaNo IAA (n = 754)IAA (n = 364)Age (years)74.6 ± 7.7174.7 ± 7.93Male545 (72)328 (90)Smoking Current141 (20)76 (22) Former518 (73)236 (69) Never50 (7)30 (9)Prior aneurysm repair144 (19)73 (20)CVD CHF104 (14)54 (15) MI or unstable angina226 (30)126 (35) AVR/MVR54 (7)19 (5) Hypertension639 (85)318 (87)COPD253 (34)94 (26)CRI122 (16)69 (19)Repair type Type I TAAA15 (2)3 (1) Type II TAAA126 (17)38 (10) Type III TAAA180 (24)101 (28) Type IV TAAA257 (34)138 (38) Juxtarenal176 (23)84 (23)AVR, Aortic valve replacement; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; CRI, chronic renal insufficiency (creatinine >2.0 g/dL); CVD, cardiovascular disease; IAA, iliac artery aneurysm; MI, myocardial infarction; MVR, mitral valve replacement; TAAA, thoracoabdominal aortic aneurysm.aData are shown as mean ± standard deviation or number (%). Open table in a new tab

The Midterm Experience of Tapered Stent Grafts in the Endovascular Management of Iliac Artery Aneurysms With Unfavorable Anatomy

We report our experience and the midterm results of a modern technique for endovascular management of isolated iliac artery aneurysms (IAAs) with unfavorable neck anatomy, which involves the inversion of an iliac leg of a Zenith stent graft. Patients who underwent endovascular IAA repair from 2002 to 2010 were reviewed. A total of 12 patients, with a mean age of 77.6 years, underwent endovascular repair of 13 IAAs. Mean size of the aneurysms was 54.6 mm (range 34-133 mm). Mean proximal neck diameter was 18 mm (range 15-22 mm). In 7 patients, the length of the proximal neck was <15 mm (10-14 mm). Only 1 patient developed thrombosis of the stent graft immediately after the operation. Patients were followed up for a mean of 31.5 months (range 18-72 months). Our midterm results demonstrate the durability of this technique in the management of iliac aneurysms with unfavorable anatomy.

Stent-Graft Repair of Isolated Iliac Aneurysms with Wide or Ectatic Necks with Use of Inverted Zenith Device Legs

Although there is considerable experience in the management of iliac artery aneurysms (IAAs) accompanying abdominal aortic aneurysms, less is known about endovascular management of isolated IAAs. The distal landing zone can be secured if necessary by extending the graft to the external iliac artery, but the proximal landing zone remains a challenging issue, on which technical success is dependent. The present report describes a novel technique for endovascular management of isolated IAAs with wide proximal necks for which no commercially available grafts with fitting sizes exist: inversion of the iliac leg of a Zenith device.