Treatment 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").

Compensated Patient Injuries in the Treatment of Abdominal Aortic and Iliac Artery Aneurysms in Finland: A Nationwide Patient Insurance Registry Study

Patient injury claims data and insurance records provide detailed information on patient injuries. This study aimed to identify the errors and adverse events that led to patient injuries in vascular surgery for the treatments of abdominal aortic aneurysms (AAA) and iliac artery aneurysms (IAA) in Finland. The study also assessed the severity and preventability of the injuries. A retrospective analysis of Finnish Patient Insurance Centre's insurance charts of compensated patient injuries in the treatment of AAA and IAA. Records of all compensated patient injury claims involving AAA and IAA between 2004 and 2017 inclusive were reviewed. Contributing factors to injury were identified and classified. The injuries were assessed for their preventability by using the WHO Surgical Safety Checklist correctly. The degree of harm was graded by Clavien-Dindo classification. Twenty-six patient injury incidents were identified in the treatment of 23 patients. Typical injuries involved delays in diagnosis or treatment, errors in surgical technique or injuries to adjacent anatomic organs. Three (13.0%) patients died due to patient injury. Two deaths were caused by delays in diagnosis of ruptured abdominal aortic aneurysm (RAAA) and the third death was due to missed diagnosis of post-operative myocardial infarction. Retained foreign material caused injuries to two (8.7%) patients. One (4.3%) patient had a severe postoperative infection. Three (13.0%) patients experienced an injury to an adjacent organ. One patient had a bilateral and another a unilateral above-the-knee amputation due to patient injury. Three injuries were considered preventable. Most harms were grade IIIb Clavien-Dindo classification in which injured patients required a surgical intervention under general anesthesia. Compensated patient injuries involving the treatment of AAA and IAA are rare, but are often serious. Injuries were identified during all stages of care. Most injuries involved open surgical procedures.

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)

ISOLATED ILIAC ARTERY ANEURYSM- 10 YEARS INSTITUTIONAL EXPERIENCE

Objective: To review the experience of our institution in repairing isolated iliac artery aneurysm (isolated IAA) in the last 10 years. Introduction: Unlike abdominal and combined aortoiliac artery aneurysms, isolated iliac artery aneurysms (IIAAs) are uncommon. An isolated iliac artery aneurysm is dened as a twofold increase in the diameter of the iliac artery without a coexisting aneurysm at another location. IIAA was encountered infrequently in the past, comprising 0.9% to 4.7% of all intra-abdominal aneurysms according to a review of previous studies; however, in recent times, many asymptomatic IIAAs have been detected incidentally because of the widespread use of abdominal ultrasonography and computed tomography. Methods: The medical records of patients who underwent isolated IAA repair at Institute of vascular sciences, MMC and RGGGH, Chennai, India, were reviewed, to obtain information on patients' demographics, vascular risk factors, type of treatment and outcome Results: A total of 13 patients with 18 aneurysms, 11 men(84.6%) 2 women(15.4%), with a mean age of 58.1±6 years, and two paediatric patients of age 11yrs (Female) and 3 months (Male) were treated. The mean diameter was 4.6 ± 1.0 for non-ruptured at elective repair; 5.5±2.1 cm on the emergency cases. The majority of aneurysms were at the common iliac artery. All of them except one, underwent open repair.Ten (84%) had elective operations, and two (16%) emergency repair for ruptured aneurysm. Hypertension and diabetes were seen as the most common risk factors with most of the patients were smokers. One was a known case of CKD and the paediatric female was a known case of RHD. There was one postoperative death in this series, patient succumbed on POD 1. Conclusion: This case series reviews the literature with regard to the natural history, diagnostic workup, and treatment of iliac artery aneurysms. For patients undergoing elective repair, preoperative imaging with computed tomography or magnetic resonance is advocated. Repair is recommended for good-risk patients with aneurysms larger than 3.5 cm as there is high chances of rupture with increasing diameter.

The reversed bell-bottom technique (ReBel-B) for the endovascular treatment of iliac artery aneurysms.

To describe the results of the reversed bell-bottom (ReBel-B) technique for the endovascular treatment of iliac aneurysms (IA) involving the origin of hypogastric artery (HA). The ReBel-B technique is a strategy for the occlusion of HA in selected patients presenting with IA, in whom the HA cannot be spared or safely occluded with coils or vascular plugs. When employing this technique, an iliac flared ("bell-bottom") extension is deployed in a reverse fashion, through a contralateral crossover femoral access that allows the occlusion of the HA at its origin, by exploiting the flared "bell" part of the reversed endograft. A second limb is then deployed to complete the implant, from the common iliac to the external iliac artery, inside the previous graft. Data of all consecutive patients treated with this technique in our experience were then retrospectively reviewed, and outcomes analyzed. The ReBel-B technique was employed in total of six patients who came in an emergent setting for the rupture of a common IA, from January 2014 to December 2018. Endovascular exclusion was performed using a ReBel-B graft plus iliac leg in five out of six cases. In the remaining case, a bifurcated aortic endograft was used to complete the aneurysm exclusion. Technical success was 100%. No complications occurred. In selected cases, the ReBel-B technique can be used for the complete exclusion of IA preventing type II endoleak from the HA, when the embolization with coils or plug or the preservation of the HA is anatomically unfeasible.

Experience with endovascular treatment of iliac artery aneurysms

Iliac artery aneurysms are relatively uncommon, however requiring early diagnosis and treatment because of high mortality once ruptured. Endovascular correction is currently a method of choice. The standard iliac components of aortic stent grafts have a linear or distally widening shape, whereas the anatomy of aneurysms of iliac arteries requires, as a rule, a larger diameter of the proximal zone of shrinkage. Optimal is considered to be the use of reversed stent grafts, i. e. those tapering distally. The authors herein share their experience in treating iliac artery aneurysms using a flared reversed endograft of the iliac branch of the Anaconda stent graft in three patients presenting with iliac artery aneurysms. Technical success was achieved in all cases. In the remote period (6-12 months postoperatively) the grafts were patent, with no leakage.

AA10. Safety, Feasibility, and Efficacy of the Gore Excluder Side Branch Endoprosthesis in the Treatment of Aortobi-Iliac Aneurysms With Preservation of the Internal Iliac Artery in 23 Consecutive Patients

The Gore Excluder (W. L. Gore & Associates, Flagstaff, Ariz) side branch endoprosthesis for iliac arteries (iliac branch endoprosthesis [IBE]) is a new device for the treatment of solitary or combined aortobi-iliac arterial aneurysms, mainly to prevent major complications occurring from an occluded internal iliac artery. The objective of our study was to evaluate the safety, feasibility, and efficacy of the Gore Excluder IBE in the treatment of iliac artery aneurysms. All consecutive patients who underwent iliac artery repair using the Gore Excluder IBE device in our clinic since 2016 were included. Indication, localization, operation time, blood loss, and hospitalization time as well as complication, reintervention, and patency rates were evaluated. All values are given as median (range). Statistical analysis was performed by non parametric paired tests. Between February 2016 and December 2017, there were 29 asymptomatic iliac aneurysms (4 solitary, 25 combined; 5 double sided) treated in 23 consecutive patients (age, 68 [53-82] years; body mass index, 29 [23-29] kg/m2; 1 female) using the Gore Excluder IBE. The implantation was successful in 28 of 29 cases (97%); in one case, implantation failed because of distinctive atherosclerosis of the internal iliac artery. Hospitalization time was 7 (5-15) days, operation time, 179 (80-541) minutes; and blood loss, 400 (100-3000) mL. Hemoglobin concentration was 14 (11-16) g/dL preoperatively and 12 (9-14) g/dL directly postoperatively (P = .0001). The transfusion of two (two patients) and four, respectively, red cell concentrates was necessary in three patients. Creatinine concentration was 1.02 (0.5-1.62) mg/dL preoperatively and 0.88 (0.39-1.51) mg/dL directly postoperatively (P = .07). Perioperative mortality rate and 30-day reintervention rate were 0%. Double platelet aggregation was used for 6 months postoperatively. Major complications were one cholesterol embolism and one contrast agent-induced nephropathy, not requiring dialysis. The median follow-up time was 5 months (2 weeks-1 year), with an overall patency rate of 96% of the IBEs (27/28 devices) as one patient refused the double platelet inhibitor application. The treatment of aortobi-iliac arterial aneurysms using the Gore Excluder IBE is safe and feasible and results in high short-term patency rates. To validate long-term results, long-term follow-up of the treated patients is required, ideally using duplex ultrasound and contrast-enhanced ultrasound or computed tomography angiography.

Open and endovascular repair of iliac artery aneurysms

Iliac artery aneurysms make up 2% of all aneurysms. There are only a few data available on the results of surgical treatment, therefore the optimal treatment is unclear. Our objective was the retrospective analysis of the perioperative morbidity and mortality of patients who underwent iliac artery surgery as well as the comparison of elective open surgery and endovascular iliac aneurysm repair (EVIAR). Retrospective analysis of patients who underwent surgery for iliac artery aneurysm between 1 January 2005 and 31 December 2014. During the 10-year period, 62 patients with a mean age of 68.9 years underwent elective surgery for iliac artery aneurysm (54 males, 87.1%). In 10 cases acute surgery was performed due to aneurysm ruptures (13.9%), 3 patients died within the perioperative period (30%). Regarding anatomical localisation, aneurysm developed mostly on the common iliac artery (80.6%). As an elective surgery, 35 patients (56.5%) underwent open surgery, 25 (40.3%) underwent EVIAR and other endovascular interventions were performed in 2 cases (3.2%). Postoperative complications (1 patient [4.0%] vs. 17 patients [48.5%]; p<0.001) and intensive care treatment (29 patients [82.8%] vs. 2 patients [8.0%]; p<0.001) were significantly rarer after EVIAR than after open surgery. Furthermore, EVIAR resulted in considerably shorter postoperative hospital stays (4.7 ± 2.3 days vs. 11.8 ± 12.2 days; p = 0.006) and significantly less blood transfusion demand (1 patient [4.0%] vs. 26 patients [74.2%]; p<0.001). There were no significant differences regarding long-term survival rates between EVIAR and open surgery (81.4% vs. 71.4%; p = 0.95). In case of the surgical treatment of iliac artery aneurysms, owing to the lower complication rates and shorter postoperative length of stay, EVIAR is primarily recommended. Orv Hetil. 2018; 159(13): 520-525.

Up-and-Over Technique for Implantation of Iliac Branch Devices After Prior Aortic Endograft Repair

Purpose: To describe a modified up-and-over access technique for treatment of iliac artery aneurysms in patients with prior bifurcated stent-grafts for endovascular aneurysm repair (EVAR). Technique: This technique uses a coaxial 12-F flexible sheath that is docked with a through-and-through wire into a 7-F sheath advanced from the contralateral femoral approach. This maneuver allows both sheaths to be moved as a unit while maintaining position of the apex of the system as it loops over the flow divider, avoiding damage to or displacing the extant endograft. Once the 12-F sheath is positioned in the iliac limb of the aortic stent-graft and secured in place with the through-and-through wire, the repair is extended into the internal iliac artery using a bridging stent-graft or covered stent introduced via a coaxial sheath. Conclusion: The up-and-over technique with a flexible 12-F sheath mated with a 7-F sheath from the opposite side allows bilateral femoral access to be used for iliac branch device placement after prior aortic endograft procedures that create a higher, acutely angled bifurcation. Use of a through-and-through wire and a coaxial sheath for stent delivery creates a very stable platform for intervention.

Aneurismas de arteria iliaca: Actualización y algoritmos de decisión

Isolated iliac artery aneurysms constitute a special case, not only for being extremely rare, 0.4% to 1.9% of all aneurysmal diseases, but also as their repair is more challenging, compared to that of abdominal aortic aneurysm, especially if the internal iliac artery is involved. The onset of endovascular techniques, with decreased morbidity and mortality, has led to a paradigm shift, replacing open surgical repair as the primary means of treatment. Furthermore, preserving internal iliac artery has become a critical issue, leading to newer endovascular techniques being used, such as bell-bottom technique, sandwich technique, the use of iliac branch devices, etc. The aim of this article is to update the management and treatment of iliac artery aneurysms in order to clearly demonstrate, using algorithms, the variety of open and endovascular surgical options.

Técnica de reversão de extensão ilíaca cónica de endoprótese: caso clínico

The treatment of iliac artery aneurysms is challenging. Conventional surgery is associated with high morbidity and mortality, which led to the development of less invasive alternatives, such as endovascular techniques. When performing an endovascular treatment of a common iliac artery (CIA) aneurysm, is essential to ensure good landing zones, which may require extending the distal landing zone to the external iliac artery (EIA), usually smaller than the CIA. To bridge this diameter difference between the proximal and distal landing zones, the off-label technique of reversal of a flared iliac stent graft was described.The authors describe a case of successful endovascular treatment of a CIA aneurysm, applying this technique.

Endovascular Treatment of Isolated Iliac Artery Aneurysms with Anaconda Stent Graft Limb

Isolated aneurysms of the iliac arteries are relatively rare conditions that traditionally have been treated by surgical reconstruction. We report our experience with endovascular treatment of iliac artery aneurysms (IAAs) with Anaconda stent graft limb. Two male patients were found to have 4.5 and 3.6 cm isolated common IAAs, respectively. The endograft was successfully advanced and deployed precisely to the intended position in both cases. In one case the internal iliac artery was embolized. No type I or II endoleak was observed immediately after the procedure. In one patient postimplantation fever (>38°C) and gluteal claudication occurred. After 2 years followup both iliac endovascular stent grafts are patent and without endoleak. Endovascular treatment with Anaconda limb stent graft seems to be a safe and feasible alternative to open surgery.

Use of the Reversed Zenith Iliac Limb Extension in the Treatment of Iliac Artery Aneurysms and Various Aortoiliac Pathologies: Outcome in Midterm Follow-up

To report the midterm follow-up after treatment of various aortoiliac pathologies in an acute setting using reversed Zenith iliac limb extensions when appropriately sized stent-grafts were not available. From 2005 to 2007, 12 patients (10 men; mean age 71.5 ± 7.3 years) were treated with reversed Zenith iliac limb extensions for solitary iliac artery aneurysms (n = 8), an abdominal aortic aneurysm (AAA) in a small caliber aorta (n = 1), an anastomotic pseudoaneurysm in an aortobi-iliac graft (n = 1), a hypogastric artery aneurysm (n = 1), and a ruptured AAA secondary to a late type Ib endoleak after Talent stent-graft implantation (n = 1). The Zenith iliac limb extensions were deployed on the back table and reloaded in a reversed manner to treat aneurysms and other lesions with a broad range of different diameter necks and landing zones. The technical success rate was 100%, and no endoleaks were present at the end of the procedures. The endoleak patient with the ruptured AAA died owing to respiratory insufficiency. The other 11 patients have a mean follow-up of 29±9 months. In this period, 2 patients received a femorofemoral crossover bypass because of an occluded iliac limb extension. One patient had a type II endoleak without growth of the iliac aneurysm. Two patients died of a ruptured 4.4-cm AAA at 16 months and of respiratory insufficiency due to metastases at 47 months, respectively. When necessary, it is feasible to use a revered Zenith limb extension to treat solitary iliac aneurysms and other aortoiliac pathologies, achieving satisfactory midterm outcomes.

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

Endovascular treatment of iliac artery aneurysms (IAAs) in patients with discrepancy in iliac artery diameters can be challenging because of limited availability of reversed flared stent graft limbs. The authors describe the technique of reversing a Cook Zenith (Bloomington, IN) iliac stent graft extension to accommodate for significant discrepancy in diameter between the common iliac artery (18 mm) and the external iliac artery (11 mm). A 75-year-old male patient with a 7.3-cm right internal IAA was treated with endovascular exclusion of distal internal iliac artery branches using Amplatzer plugs (AGA Medical Corp, Plymouth, MN) and coverage of the internal iliac artery origin using a reversed 12 × 20 mm Cook Zenith TLFE Iliac extension limb (Bloomington, IN). The 12 × 20 mm iliac extension limb was unsheathed on-site using a strict sterile technique, reversed within the introducer and resheathed. Following percutaneous bilateral femoral access and exclusion of the anterior and posterior divisional branches of the internal iliac artery, the reversed flared iliac limb device was deployed from the distal common to the external iliac artery. Completion angiography and follow-up computed tomography angiography revealed no endoleak. The patient was dismissed on postoperative day 1 without complications. 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.

Endovascular treatment of iliac artery aneurysms with a tubular stentgraft: Mid-term results

Endovascular treatment of iliac artery aneurysms with a tubular stentgraft: Mid-term results

The Endovascular Management of Iliac Artery Aneurysms

Isolated aneurysms of the iliac arteries are uncommon. Previously treated by conventional surgery, there is increasing use of endografts to treat these lesions. The purpose of this study was to assess the efficacy, safety, and durability of the stent-grafts for treatment of iliac artery aneurysms (IAAs). The results of endografting for isolated IAAs over a 10-year period were analyzed retrospectively. The treatment methods differed depending on the anatomic location of the aneurysms. Twenty-one patients (1 woman, 20 men) underwent endovascular stent-graft repair, with one procedure carried out under emergency conditions after acute rupture. The mean aneurysm diameter was 4.6 cm. The procedural technical success was 100%. There was zero 30-day mortality. Follow-up was by interval CT scans. At a mean follow-up of 51.2 months, the stent-graft patency rate was 100%. Reintervention was performed in four patients (19%): one patient (4.7%) with a type I endoleak and three patients (14.3%) with type II endoleaks. We conclude that endovascular repair of isolated IAAs is a safe, minimally invasive technique with low morbidity rates. Follow-up results up to 10 years suggest that this approach is durable and should be regarded as a first treatment option for appropriate candidates.

Endovascular treatment of iliac artery aneurysms with a tubular stent-graft: Mid-term results

To report the mid term results of a prospective cohort of iliac artery aneurysms (IAAs) treated with endovascular tubular stent-grafts. All IAAs referred to the University Medical Center Groningen between June 1998 and June 2005 were evaluated for endovascular repair. Criteria for repair were a diameter of > or = 30 mm for anastomotic aneurysms and > or = 35 mm for true aneurysms. Preferentially, tubular grafts were used. Follow-up included both radiographs of the abdomen and duplex examination. In 35 patients, 40 IAAs were treated endovascularly with a tubular stent-graft. Elective repair was performed in 30 patients (86%) and emergent repair in five patients (14%). Aneurysms were false in 26 cases (65%) and true in 14 cases (35%). Local anesthesia was used in 74% of the cases. The stent-grafts that were used included the Excluder contralateral limb (n = 28, 70%), Passager (n = 9, 22.5%), Hemobahn (n = 2, 5%), and Wallgraft (n = 1, 2.5%). The mean operation time was 83 +/- 28 minutes (range, 50 to 150 minutes). Mean hospital stay was 3.3 +/- 2.3 days (range, 1 to 12 days). There was no 30-day mortality. Patients were followed up for a mean of 31.2 +/- 20.7 months (range, 3 to 83 months). Complications occurred in two patients during follow-up, including migration with a proximal type I endoleak in one, and occlusion of the stent-graft in the other. The internal iliac artery was intentionally sacrificed in 28 patients (70%), and this led to gluteal claudication in three patients. Endovascular repair of iliac artery aneurysms with flexible stent-grafts is a minimally invasive technique and is associated with low mortality and morbidity. Follow-up results up to 5 years suggest that the technique is durable. It should be regarded as a first choice treatment option for suitable aneurysms.

Isolated Iliac Artery Aneurysms

Isolated aneurysms of the iliac arteries are extremely rare, comprising less than 2% of all aneurysmal disease. These aneurysms are typically seen in older men. Their natural history, although fairly indolent, carries a significant risk of rupture when the aneurysms have attained a large size. Their operative mortality is significantly higher when undertaken as an emergent versus elective procedure, underscoring the importance of early diagnosis and appropriate management. This article reviews the literature with regard to the natural history, diagnostic workup, and treatment of iliac artery aneurysms. For patients undergoing elective repair, preoperative imaging with computed tomography or magnetic resonance is advocated. Repair is recommended for good-risk patients with aneurysms larger than 3.5 cm. A working classification based on aneurysmal anatomy is provided along with an outline of the suggested open and endovascular surgical options. Results of open and endovascular strategies are summarized and follow-up recommendations are proposed.

Endovascular Treatment of Iliac Artery Aneurysms

Endovascular treatment is now an alternative to surgery for the treatment of iliac artery aneurysms (IAAs). A variety of minimally invasive therapeutic options are available (eg, coil embolization, stent-graft placement), and choosing an appropriate option is essential for achieving excellent long-term results and reducing potential complications. Preprocedural imaging with multi-detector row computed tomography or magnetic resonance imaging is necessary for evaluating patient eligibility and planning the interventional procedure. An imaging classification system for IAAs that is based on anatomic features and endovascular treatment options has been developed and may help determine therapeutic strategies for affected patients. Early experience indicates that endovascular treatment is safe and effective in treating IAAs, and it is expected that various devices that will make endovascular treatment easier to perform will soon become commercially available. However, large, long-term follow-up studies will be needed to determine whether this approach is a practical alternative to open surgery.

Coil embolization of iliac artery aneurysms developing after abdominal aortic aneurysm repair with a conventional bifurcated graft.

To evaluate the efficacy of embolizing iliac artery aneurysms (IAAs) developing after abdominal aortic aneurysm (AAA) repair. The records of 6 patients (5 men; mean age 79 years, range 61-87) with unilateral (n=3) or bilateral (n=3) IAAs that had developed after AAA repair were reviewed. In all patients, the limbs of the bifurcated graft were anastomosed end-to-end or end-to-side with the external iliac arteries during AAA repair. Before embolization, superior mesenteric artery (SMA) arteriography was done in all patients to evaluate collateral pathways to the inferior mesenteric artery (IMA). The unilateral IAAs were treated by proximal and distal embolization. In 2 patients with bilateral IAAs, SMA angiography showed sufficient collateral flow to the IMA, so the aneurysms were treated by proximal embolization and packing. In the other bilateral IAA case, the left 6-cm IAA was treated by proximal and distal embolization, while the contralateral 3-cm IAA was not embolized because angiography demonstrated inadequate collateral flow to the IMA, indicating a possible risk of colon ischemia if both IAAs were embolized. Immediate postprocedural angiography in all patients showed complete exclusion of the IAAs. Mild buttock claudication occurred in 1 patient. There were no episodes of rupture over a mean 46-month follow-up. Embolization is a safe and effective alternative to open surgery for the treatment of IAAs that develop after AAA repair. However, before embolization, angiographic evaluation of collateral pathways to the IMA is essential to reduce the risk of colon ischemia.