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Salimi J, Mangouri A, Samimiat A, Shokri A. Endovascular repair of a hypogastric artery aneurysm with arteriovenous fistula in a patient with iliac vein thrombosis: A case report. Int J Surg Case Rep 2025; 129:111139. [PMID: 40147203 PMCID: PMC11986233 DOI: 10.1016/j.ijscr.2025.111139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2025] [Revised: 02/25/2025] [Accepted: 03/11/2025] [Indexed: 03/29/2025] Open
Abstract
INTRODUCTION AND IMPORTANCE Abdominal aneurysms, often involving the iliac arteries, pose serious risks if untreated. Iliac arteriovenous fistulas (AVFs) are rare, typically secondary to trauma or deep vein thrombosis, with unclear mechanisms. They may present with high-output heart failure, abdominal bruits, and venous congestion. Computed tomography angiography (CTA) is essential for diagnosing aortoiliac aneurysms and fistulas. Endovascular repair, including recanalization and stenting, is the preferred approach, emphasizing precise preoperative planning and intraoperative execution to restore hemodynamics and minimize complications. CASE PRESENTATION A 65-year-old male with chronic venous insufficiency for 12 years presented with acute left leg pain, severe edema, and inflammation. Despite persistent symptoms, no prior work-up had been performed, and he had only used compression stockings. Doppler sonography revealed acute thrombosis of the left common and external iliac veins with a pelvic vascular mass. He was admitted and started on anticoagulation. CTA identified a 90-mm left internal iliac artery aneurysm, an iliac AVF, and left common iliac vein occlusion. Endovascular repair was planned with initial coil embolization, but due to the aneurysm's size, a stent graft was deployed from the left common iliac to the proximal external iliac artery, successfully excluding the aneurysm. The patient recovered uneventfully with significant symptom relief. CLINICAL DISCUSSION The coexistence of an aneurysm and an AVF has not been reported in Iran. Ilio-iliac AVF, a rare complication of aortoiliac aneurysms, requires thorough evaluation. CONCLUSION CT angiography is crucial, especially in atypical cases. Selecting the optimal endovascular approach remains a challenge, requiring individualized management.
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Affiliation(s)
- Javad Salimi
- Department of Vascular Surgery, Sina Hospital, Tehran University of Medical Science, Tehran, Iran.
| | - Amir Mangouri
- Fellowship of Vascular & Trauma Surgery, Department of General Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Samimiat
- Department of General Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Shokri
- Fellowship of Vascular & Trauma Surgery, Department of General Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Panthofer A, Bresler AM, Olson SL, Kuramochi Y, Eagleton M, Böckler D, Schneider DB, Lyden SP, Blackwelder WC, Meadows W, Pauli T, DeRoo E, Matsumura JS. Multicenter CT Image-Based Anatomic Assessment of Patients with Aortoiliac Aneurysm Undergoing Endovascular Repair with Iliac Branch Devices. Ann Vasc Surg 2024; 108:484-497. [PMID: 39009130 DOI: 10.1016/j.avsg.2024.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/29/2024] [Accepted: 05/02/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND The Global Iliac Branch Study (NCT05607277) is an international, multicenter, retrospective cohort study of anatomic predictors of adverse iliac events (AIEs) in aortoiliac aneurysms treated with iliac branch devices (IBDs). METHODS Patients with pre-IBD and post-IBD computed tomography imaging were included. We measured arterial diameters, stenosis, calcification, bifurcation angles, and tortuosity indices using a standardized, validated protocol. A composite of ipsilateral AIE was defined, a priori, as occlusion, type I or III endoleak, device constriction, or clinical event requiring reintervention. Paired t-test compared tortuosity indices and splay angles pretreatment and post-treatment for all IBDs and by device material (stainless steel and nitinol). Two-sample t-test compared anatomical changes from pretreatment to post-treatment by device material. Logistic regression assessed associations between AIE and anatomic measurements. Analysis was performed by IBD. RESULTS We analyzed 297 patients (286 males, 11 females) with 331 IBDs (227 stainless steel, 104 nitinol). Median clinical follow-up was 3.8 years. Iliac anatomy was significantly straightened with all IBD treatment, though stainless steel IBDs had a greater reduction in total iliac artery tortuosity index and aortic splay angle compared to nitinol IBDs (absolute reduction -0.20 [-0.22 to -0.18] vs. -0.09 [-0.12 to -0.06], P < 0.0001 and -19.6° [-22.4° to -16.9°] vs. -11.2° [-15.3° to -7.0°], P = 0.001, respectively). There were 54 AIEs in 44 IBDs in 42 patients (AIE in 13.3% of IBD systems), requiring 35 reinterventions (median time to event 41 days; median time to reintervention 153 days). There were 18 endoleaks, 29 occlusions, and 5 device constrictions. There were no strong associations between anatomic measurements and AIE overall, though internal iliac diameter was inversely associated with AIE in nitinol devices (nAIE, nitinol = 8). CONCLUSIONS Purpose-built IBDs effectively treat aortoiliac disease, including that with tortuous anatomy, with a high patency rate (91.5%) and low reintervention rate (9.1%) at 4 years. Anatomic predictors of AIE are limited.
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Affiliation(s)
- Annalise Panthofer
- Division of Vascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
| | | | - Sydney L Olson
- Division of Vascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Yuki Kuramochi
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Matthew Eagleton
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Dittmar Böckler
- Department of Vascular Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Darren B Schneider
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Sean P Lyden
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - William C Blackwelder
- Division of Vascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Epidemiology & Public Health, University of Maryland, Baltimore, MD
| | - Wendy Meadows
- Division of Vascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI; Division of Vascular Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Tom Pauli
- Division of Vascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI; Division of Vascular Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Elise DeRoo
- Division of Vascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jon S Matsumura
- Division of Vascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI; Division of Vascular Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
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Osman A, Das R, Pinas A, Hartopp R, Livermore D, Hawthorn B, Chun JY, Mailli L, Morgan R, Ratnam L. Outcome evaluation of prophylactic internal iliac balloon occlusion in the management of patients with placenta accreta spectrum. CVIR Endovasc 2024; 7:57. [PMID: 39039376 PMCID: PMC11263516 DOI: 10.1186/s42155-024-00466-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/24/2024] [Indexed: 07/24/2024] Open
Abstract
PURPOSE To evaluate outcomes and complications of prophylactic internal iliac balloon occlusion (PIIBO) in the management of patients with placenta accreta spectrum (PAS) at a large regional referral centre. MATERIALS AND METHODS A retrospective review of all PIIBO for PAS performed over a 12-year period (2010-2022). Information for analysis was gathered from the local RIS/PACS and clinical documentation. Collected data included patient demographics, indication for procedure, sheath insertion and removal time, total duration of balloon inflation and complications that occurred. RESULTS 106 patients underwent temporary internal iliac artery balloon occlusion within the 12-year period. All procedures utilised bilateral common femoral artery punctures, 6Fr sheath and 5Fr Le Maitre occlusion balloons. Catheters were successfully positioned and balloons inflated in obstetric theatre following caesarean delivery in 100% of the cases. The uterus was conserved in every case. There was no maternal mortality or foetal morbidity. Twenty patients (18.9%) had some form of complication that required further intervention. Of these, 7(6.6%) had post-operative PPH, which was treated with uterine artery embolisation; and 13 (12.3%) had arterial thrombus which required aspiration thrombectomy. All procedures were technically successful with no long-term sequelae. CONCLUSION PIIBO plays an important part in reducing morbidity and mortality in patients with PAS. Clear pathways and multidisciplinary team working is critical in the management of these patients to ensure that any complications are dealt with promptly to avoid long-term sequelae.
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Affiliation(s)
- Asaad Osman
- Department of Radiology, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK
| | - Raj Das
- Department of Radiology, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK
| | - Ana Pinas
- Department of Obstetrics and Gynaecology, St George's Hospital University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK
| | - Richard Hartopp
- Department of Anaesthetics, St George's Hospital University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK
| | - Deborah Livermore
- Department of Obstetrics and Gynaecology, St George's Hospital University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK
| | - Benjamin Hawthorn
- Department of Radiology, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK
| | - Joo-Young Chun
- Department of Radiology, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK
| | - Leto Mailli
- Department of Radiology, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK
| | - Robert Morgan
- Department of Radiology, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK
| | - Lakshmi Ratnam
- Department of Radiology, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK.
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Kim HJ, Hwang D, Kim HK, Huh S, Yun WS. Clinical Outcomes of Internal Iliac Artery Interruption during Endovascular Aneurysm Repair. Vasc Specialist Int 2023; 39:19. [PMID: 37475562 PMCID: PMC10359766 DOI: 10.5758/vsi.230032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/11/2023] [Accepted: 06/22/2023] [Indexed: 07/22/2023] Open
Abstract
Purpose 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. Materials and Methods 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. Results 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. Conclusion 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.
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Affiliation(s)
- Hyeon Ju Kim
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Deokbi Hwang
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Hyung-Kee Kim
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Chilgok Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seung Huh
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Woo-Sung Yun
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
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Comparative effectiveness of pelvic arterial embolization versus laparotomy in adults with pelvic injuries: A National Trauma Data Bank analysis. Clin Imaging 2022; 86:75-82. [DOI: 10.1016/j.clinimag.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 11/21/2022]
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Wang L, Shu C, Li Q, Li M, He H, Li X, Shi Y, Qiu J, Wang T, Yang C, Wang M, Li J, Wang H, Sun L. Application of a Novel Common-Iliac-Artery Skirt Technology (CST) in Treating Challenge Aorto-Iliac or Isolated Iliac Artery Aneurysms. Front Cardiovasc Med 2021; 8:745250. [PMID: 34733894 PMCID: PMC8558348 DOI: 10.3389/fcvm.2021.745250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To report a novel common-iliac-artery skirt technology (CST) in treating challenge iliac artery aneurysms. Methods: When required healthy landing zone of common iliac artery (CIA) is not available, CST is a strategy to exclude the internal iliac artery (IIA) and prevent IIA reflux without need of embolization. Patients who received endovascular aneurysm repair (EVAR) in our center from 2014 to 2020 were retrospectively screened, and patients treated with CST or with IIA embolization (IIAE) were enrolled. Results: After retrospective screen of 524 EVAR patients, 39 CST patients, 26 IIAE patients, and 7 CST + IIAE patients were enrolled in this study. CST group suggested to have more aged, hyperlipemia, and smoking patients than IIAE group. Two groups had comparable maximal diameter of abdominal aorta (AA), CIA, EIA, but larger diameter of IIA (CST 19.82 ± 2.281 vs. IIAE 27.82 ± 3.401, p = 0.048), and CIA bifurcation (CST 25.01 ± 1.316 vs. IIAE 29.76 ± 2.775, p = 0.087) was found in IIAE group. Anatomy of 79.5% of CST patients and 92.3% of IIAE patients (p = 0.293) was not suitable for potential use of iliac branch device. CST group had significant shorter surgery time (CST 97.42 ± 3.891 vs. IIAE 141.0 ± 8.010, p < 0.001), shorter hospital stay (CST 15.35 ± 0.873 vs. IIAE 19.32 ± 1.067, p = 0.009), lower in-hospital [CST 0% (0/39) vs. IIAE 11.5% (3/26), p = 0.059] and 1-year follow-up stent related MAEs [CST 6.7% (2/30) vs. IIAE 28.6% (6/21), p = 0.052], but comparable mortality and stent related MAEs for all-cohort follow-up analysis comparing to IIAE group. In our study, a lower in-hospital buttock claudication (BC) rate for CST (CST 20.5% vs. IIAE 46.2%, p = 0.053) and a comparable erectile dysfunction (ED) rate (CST 10.3% vs. IIAE 23.1%, p = 0.352) were found between CST and IIAE groups. After 1 year, both groups had about one third relief of BC symptoms [CST 33.3% (4/12) vs. IIAE 30.7% (4/13), p = 1.000]. Subgroup analysis of 14 patents concomitant with IIA aneurysm in CST group and the 7 CST + IIAE patients were carried out, and no difference was found in mortality, stent MAEs, sac dilation, or reintervention rate. Last, illustration of seven typical CST cases was presented. Conclusion: In selected cases, the CST is a safe, feasible-and-effective choose in treating challenge iliac artery aneurysms and preventing IIA endoleak.
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Affiliation(s)
- Lunchang Wang
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
| | - Chang Shu
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China.,Department of Vascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Quanming Li
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
| | - Ming Li
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
| | - Hao He
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
| | - Xin Li
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
| | - Yin Shi
- Department of Vascular Surgery, Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Jian Qiu
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
| | - Tun Wang
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
| | - Chenzi Yang
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
| | - Mo Wang
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
| | - Jiehua Li
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
| | - Hui Wang
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
| | - Likun Sun
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
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Zarkowsky DS, Johnson C, Hiramoto JS. Coil-Covering Caliber-Conforming Stent Grafting: The 4CSG Technique. Ann Vasc Surg 2020; 69:448.e1-448.e3. [PMID: 32479880 DOI: 10.1016/j.avsg.2020.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 10/24/2022]
Abstract
Stable coil placement is an imperative when treating arterial pathology at branch points. Coil kick and escape threaten distal organs, particularly as the pack tightens. Before the development of the VBX balloon-expandable stent graft (W.L. Gore, Flagstaff, AZ), vessel caliber change often precluded straightforward stent graft coverage with a single device to secure coils in place. We describe 3 cases using this unique feature of the Gore VBX device to accommodate challenging anatomy. All 3 patients recovered well.
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Affiliation(s)
- D S Zarkowsky
- Division of Vascular and Endovascular Therapy, University of Colorado, Aurora, CO.
| | - C Johnson
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, CA
| | - J S Hiramoto
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, CA
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Drac P, Cerna M, Kocher M, Utikal P, Thomas RP. Is endovascular treatment of aorto-iliac aneurysms with simultaneous unilateral revascularization of internal iliac artery by branched iliac stentgraft sufficient? Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 165:169-174. [PMID: 32116312 DOI: 10.5507/bp.2020.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/28/2020] [Indexed: 11/23/2022] Open
Abstract
AIMS The coverage / occlusion of internal iliac artery (IIA) during endovascular treatment of aorto-iliac aneurysms (AIA) can be associated with risk of ischemic complications. To reduce these complications, unilateral or bilateral iliac branch device implantation (IBDI) has been reported. This study aims at evaluating the efficacy of simultaneous unilateral IBDI in the treatment of AIAs and comparing our results with literature. MATERIALS AND METHODS From March 2010 to December 2019, 27 patients (25 men, 2 women, range 54-84 years) were treated for aorto-iliac/isolated common iliac aneurysms with simultaneous unilateral revascularization of IIA and surgical / endovascular occlusion of contralateral IIA. 27 iliac-branched devices were implanted in 27 patients. The results including ischemic complications were evaluated and compared with literature. RESULTS The technical success was 100% with no perioperative mortality and morbidity of 3.7%. Primary internal iliac branch patency at a median follow-up of 52 months (range 1-118 months) was 96.42%. Secondary endoleak was observed in 6 patients (Type 1a [1], Type 1b [1], Type II [4]) and inflammatory complication in 1 patient. The incidence of buttock claudication one year after the procedure was 11.1%. Except for buttock claudication no other ischemic complications occurred. CONCLUSION Unilateral flow preservation in the IIA territory using IBDI is associated with a lesser, but a certain risk of ischemic complications. Bilateral IBDI with bilateral flow preservation of IIAs increases the complexity, procedure -/ fluoroscopy times, contrast agent volume and cost, however, may further reduce these ischemic complications.
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Affiliation(s)
- Petr Drac
- Department of Surgery II - Vascular and Transplantation Surgery, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Marie Cerna
- Department of Radiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Martin Kocher
- Department of Radiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Petr Utikal
- Department of Surgery II - Vascular and Transplantation Surgery, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Rohit Philip Thomas
- Department of Diagnostic and Interventional Radiology, UKGM University Hospital Marburg, Philipps University, Marburg, Germany
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9
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Mehmutjan M, ZHOU M. [Risk factors of pelvic ischemic symptoms after iliac artery occlusion during endovascular aneurysm repair]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2019; 48:546-551. [PMID: 31901030 PMCID: PMC8800759 DOI: 10.3785/j.issn.1008-9292.2019.10.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/25/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To analyze risk factors of pelvic ischemia after occlusion of the internal iliac artery during endovascular aneurysm repair (EVAR) surgery. METHODS The clinical data, preoperative CT angiography (CTA) findings and follow-up results of 82 patients with unilateral embolization of internal iliac artery undergoing EVAR were analyzed retrospectively. Among 82 patients, pelvic ischemic symptoms were developed in 20 patients (ischemia group) and the remaining patients served as control group. The risk factors for pelvic ischemia after occlusion of internal iliac artery during EVAR surgery were explored using univariate and multivariate analysis, and the clinical value was evaluated using ROC curves. RESULTS The univariate analysis showed that the numbers of the contralateral internal iliac artery and the ipsilateral deep femoral artery stenosis in the pelvic ischemia group were less than those in the control group (both P<0.05). Multivariate Logistic regression analysis showed that the decreased number of internal iliac artery branches (OR=8.383, 95%CI:1.469-47.841, P<0.05) was an independent risk of pelvic ischemia. The ROC curve analysis showed that AUC of the decreased number of contralateral internal iliac artery branches for predicting the incidence of pelvic ischemia was 0.816; when the number of 3.5 was taken as cut-off value, the corresponding sensitivity was 0.861 and the specificity was 0.167. CONCLUSIONS The decrease in number of the contralateral internal iliac artery branches on preoperative CTA is an independent risk factor for pelvic ischemia after occlusion of the internal iliac artery during EVAR surgery, but it does not show enough clinical value.
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Affiliation(s)
| | - Min ZHOU
- 周敏(1979-), 男, 博士研究生, 副教授, 主任医师, 主要从事血管外科研究; E-mail:
;
https://orcid.org/0000-0003-3707-1542
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Overstenting the hypogastric artery during endovascular aneurysm repair with and without prior coil embolization: A comparative analysis from the ENGAGE Registry. J Vasc Surg 2018; 67:134-141. [DOI: 10.1016/j.jvs.2017.04.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 04/29/2017] [Indexed: 01/18/2023]
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The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg 2018; 67:2-77.e2. [DOI: 10.1016/j.jvs.2017.10.044] [Citation(s) in RCA: 1150] [Impact Index Per Article: 164.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Farivar BS, Kalsi R, Drucker CB, Goldstein CB, Sarkar R, Toursavadkohi S. Implications of concomitant hypogastric artery embolization with endovascular repair of infrarenal abdominal aortic aneurysms. J Vasc Surg 2017; 66:95-101. [DOI: 10.1016/j.jvs.2016.10.124] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/27/2016] [Indexed: 11/24/2022]
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Saengprakai W, van Herwaarden JA, Georgiadis GS, Slisatkorn W, Moll FL. Clinical outcomes of hypogastric artery occlusion for endovascular aortic aneurysm repair. MINIM INVASIV THER 2017; 26:362-371. [DOI: 10.1080/13645706.2017.1326385] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Wuttichai Saengprakai
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | | | - George S. Georgiadis
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Vascular Surgery, ‘Democritus’ University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Worawong Slisatkorn
- Division of Cardio-thoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Frans L. Moll
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Shin SH, Starnes BW. Bifurcated-bifurcated aneurysm repair is a novel technique to repair infrarenal aortic aneurysms in the setting of iliac aneurysms. J Vasc Surg 2017; 66:1398-1405. [PMID: 28502552 DOI: 10.1016/j.jvs.2017.02.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/10/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Up to 40% of abdominal aortic aneurysms (AAAs) have coexistent iliac artery aneurysms (IAAs). In the past, successful endovascular repair required internal iliac artery (IIA) embolization, which can lead to pelvic or buttock ischemia. This study describes a technique that uses a readily available solution with a minimally altered off-the-shelf bifurcated graft in the IAA to maintain IIA perfusion. METHODS From August 2009 to May 2015, 14 patients with AAAs and coexisting IAAs underwent repair with a bifurcated-bifurcated approach. A 22-mm or 24-mm bifurcated main body device was used in the IAA with extension of the "contralateral" limb into the IIA. Intraoperative details including operative time, fluoroscopy time, and contrast agent use were recorded. Outcome measures assessed were operative technical success and a composite outcome measure of IIA patency, freedom from reintervention, and clinically significant endoleak at 1 year. RESULTS Fourteen patients underwent bifurcated-bifurcated repair during the study period. Technical success was achieved in 93% of patients, with successful treatment of the AAA and IAA and preservation of flow to at least one IIA. The procedure was performed with a completely percutaneous bilateral femoral approach in 92% of patients. Three patients had a type II endoleak on initial follow-up imaging, but none were clinically significant. There were no cases of bowel ischemia or erectile dysfunction. One patient had buttock claudication ipsilateral to IIA coil embolization (contralateral to bifurcated iliac repair and preserved IIA) that resolved by 6-month follow-up. Two patients required reinterventions. One patient presented to his first follow-up visit on postoperative day 25 with thrombosis of the right external iliac limb ipsilateral to the bifurcated iliac repair, which was successfully treated with thrombectomy and stenting of the limb. This same patient presented at 83 months with growth of the preserved IIA to 3.9 cm and underwent coil embolization of the aneurysm. Another patient presented for surveillance 44 months after his original repair with component separation of the mating stent and the iliac bifurcated stent grafts. This was treated with a limb extension and endoanchors to fuse the endografts. Of the 13 patients who underwent bifurcated-bifurcated repair, 100% of the preserved IIAs remained patent at last follow-up. The composite outcome measure of IIA patency and freedom from reintervention and clinically significant endoleak at 1 year was 92% (n = 12/13). CONCLUSIONS In this small retrospective review, bifurcated-bifurcated aneurysm repair of aortoiliac aneurysms with preservation of perfusion to the IIA is technically feasible and safe with good short-term and midterm results in male patients.
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Bosanquet D, Wilcox C, Whitehurst L, Cox A, Williams I, Twine C, Bell R, Bicknell C, Coughlin P, Hayes P, Jenkins M, Vallabhaneni S. Systematic Review and Meta-analysis of the Effect of Internal Iliac Artery Exclusion for Patients Undergoing EVAR. Eur J Vasc Endovasc Surg 2017; 53:534-548. [DOI: 10.1016/j.ejvs.2017.01.009] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 01/15/2017] [Indexed: 12/13/2022]
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Dierks A, Sauer A, Wolfschmidt F, Hassold N, Kellersmann R, Bley TA, Kickuth R. Proximal occlusion of unaffected internal iliac artery versus distal occlusion of aneurysmatic internal iliac artery prior to EVAR: a comparative evaluation of efficacy and clinical outcome. Br J Radiol 2017; 90:20160527. [PMID: 28256907 DOI: 10.1259/bjr.20160527] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Occlusion of the internal iliac artery (IIA) may be necessary prior to endovascular aneurysm repair (EVAR) to prevent endoleak Type II. We compared efficacy and clinical outcome after proximal occlusion of an unaffected IIA (ProxEmbx) using an Amplatzer vascular plug (AVP) I vs distal occlusion of aneurysmatic IIA with coils and plugs (DistEmbx). METHODS Between 2009 and 2012, 22 patients underwent EVAR. In 9 patients with unaffected IIA, occlusion was performed by a single AVP. In 13 patients with aneurysmatic IIA, more distal embolization (DistEmbX) was conducted by using several coils and additional AVPs. Retrospectively, technical success, clinical outcome and complications were evaluated. RESULTS Embolization of the IIA was successful in all patients. Three patients with more DistEmbX of aneurysmatic IIAs suffered from new onset of sexual dysfunction after occlusion without statistically significant difference (p > 0.05). Transient buttock claudication was observed in three patients in each group. Bowel ischaemia did not occur. The procedure time (p = 0.013) and fluoroscopy time (p = 0.038) was significantly lower in the ProxEmbx group than in the DistEmbx group. CONCLUSION Proximal occlusion of an unaffected IIA and more distal occlusion of an aneurysmatic IIA prior to EVAR had the same technical and clinical outcome. However, proximal plug embolization of an unaffected IIA prior to EVAR was associated with shorter procedure and fluoroscopy time in comparison with more DistEmbX of aneurysmatic IIAs. Advances in knowledge: Proximal embolization of unaffected IIA and DistEmbX of aneurysmatic IIA before EVAR are both effective in preventing Type II endoleaks and have the same technical and clinical outcome.
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Affiliation(s)
- Alexander Dierks
- 1 Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg, Germany
| | - Alexander Sauer
- 1 Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg, Germany
| | - Franziska Wolfschmidt
- 1 Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg, Germany
| | - Nicole Hassold
- 1 Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg, Germany
| | - Richard Kellersmann
- 2 Department of General, Visceral, Vascular and Paediatric Surgery, University of Wuerzburg, Würzburg, Germany
| | - Thorsten A Bley
- 1 Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg, Germany
| | - Ralph Kickuth
- 1 Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg, Germany
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Mansour W, Capoccia L, Sirignano P, Montelione N, Pranteda C, Formiconi M, Sbarigia E, Speziale F. Clinical and Functional Impact of Hypogastric Artery Exclusion During EVAR. Vasc Endovascular Surg 2016; 50:484-490. [PMID: 27651428 DOI: 10.1177/1538574416665968] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Hypogastric artery (HA) revascularization during endovascular aneurysm repair (EVAR) is still open to debate. Moreover, exclusion-related complication rates reported in literature are not negligible. The aim of this study is to present and analyze the outcomes in patients undergoing EVAR with exclusion of 1 or both HAs at our academic center. METHODS We retrospectively reviewed our results in patients submitted to EVAR and needing HA exclusion, in terms of perioperative (30-day) and follow-up rates of intestinal and spinal cord ischemia, buttock claudication, buttock skin necrosis, and sexual dysfunction. RESULTS From January 2008 to December 2014, a total of 527 patients underwent elective standard infrarenal EVAR; among those 104 (19.7%) had iliac involvement needing HA exclusion. In 73 patients with unilateral iliac involvement (70.1%, group UH), many single HAs were excluded. Thirty-one patients (29.9%) had bilateral iliac involvement (group BH), of which 16 (51.6%) had 1 HA excluded with revascularization of the contralateral one (group BHR); in the remaining 15 patients (48.4%) both HAs were excluded (group BHE). No 30-day or follow-up aneurysm-related mortality, intestinal, or spinal cord ischemia were recorded. At 30 days, skin necrosis was observed in 2 patients. Buttock claudication and sexual dysfunction rates were significantly greater in group BHE than in group BHR (P < .05). At a mean 18.6 months follow-up (range: 4-47), buttock claudication and sexual dysfunction rates in group BHE were persistently higher than that in groups UH and BHR (P < .05); HA coil embolization was significantly associated with buttock claudication and sexual dysfunction (P < .05). CONCLUSIONS Whenever anatomically feasible, at least 1 HA should be salvaged in case of bilateral involvement. In case of unilateral HA exclusion, the rate of complications is not negligible. Coil embolization is related to a higher complication rate.
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Affiliation(s)
- Wassim Mansour
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Laura Capoccia
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Pasqualino Sirignano
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Nunzio Montelione
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Chiara Pranteda
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Martina Formiconi
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Enrico Sbarigia
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Francesco Speziale
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
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Kouvelos GN, Katsargyris A, Antoniou GA, Oikonomou K, Verhoeven ELG. Outcome after Interruption or Preservation of Internal Iliac Artery Flow During Endovascular Repair of Abdominal Aorto-iliac Aneurysms. Eur J Vasc Endovasc Surg 2016; 52:621-634. [PMID: 27600731 DOI: 10.1016/j.ejvs.2016.07.081] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 07/19/2016] [Indexed: 11/25/2022]
Abstract
AIM The aim was to conduct a systematic review of the literature investigating outcomes after interruption or preservation of the internal iliac artery (IIA) during endovascular aneurysm repair (EVAR). METHODS A systematic review was undertaken using the MEDLINE and EMBASE databases to identify studies reporting IIA management during EVAR. The search identified 57 articles: 30 reported on IIA interruption (1468 patients) and 27 on IIA preservation (816 patients). RESULTS The pooled 30 day buttock claudication (BC) rate was 29.2% (95% CI 24.2-34.7). Patients undergoing bilateral IIA interruption had a higher incidence of BC than patients with unilateral IIA interruption (36.5% vs. 27.2%, OR 1.7, 95% CI 1.11-2.6, p = .01). During a median follow up of 17 months, the pooled rate of persistent BC was 20.5% (95% CI 15.7-26.2). Of the patients, 93.9% underwent an endovascular revascularization procedure for IIA preservation. Most patients (87.6%) had an iliac branched device, and technical success was 96.2%. Within 30 days of EVAR, 4.3% of internal iliac branches occluded. During a median follow up of 15 months, the pooled occlusion rate at the site of IIA revascularization was 8.8% (95% CI 6.8-11.3). In patients treated with an iliac-branched device, 5.2% of internal iliac branches and 1.7% of external iliac arteries occluded. The pooled BC rate on the side of the IIA revascularization during follow up was 4.1% (95% CI 2.9-5.9). Pooled rates of late device related endoleak type I or III and secondary procedures on the side of the previous IIA revascularization were 4.6% (95% CI 3.2-6.5) and 7.8% (95% CI 5.7-10.7) respectively. CONCLUSION Unilateral or bilateral IIA occlusion during EVAR seems to carry a substantial risk of significant ischemic complications in nearly one quarter of patients. Bilateral IIA occlusion was related to a significantly higher rate of BC. IIA preservation techniques represent a significant improvement in the treatment of aorto-iliac aneurysms and have been associated with high technical success and low morbidity.
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Affiliation(s)
- G N Kouvelos
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Germany.
| | - A Katsargyris
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Germany
| | - G A Antoniou
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - K Oikonomou
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Germany
| | - E L G Verhoeven
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Germany
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Lee MJ, Daniels SL, Drake TM, Adam IJ. Risk factors for ischaemic colitis after surgery for abdominal aortic aneurysm: a systematic review and observational meta-analysis. Int J Colorectal Dis 2016; 31:1273-81. [PMID: 27251703 DOI: 10.1007/s00384-016-2606-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ischaemic colitis is an infrequent but serious complication following repair of abdominal aortic aneurysm (AAA), with high mortality rates. This systematic review set out to identify risk factors for the development of ischaemic colitis after AAA surgery. METHODS A systematic search of the MEDLINE, EMBASE and CINAHL databases was performed. This search was limited to studies published in the English language after 1990. Abstracts were screened by two authors. Eligible studies were obtained as full text for further examination. Data was extracted by two authors, and any disputes were resolved via consensus. Extracted data was pooled using Mantel-Haenszel random effects models. Bias was assessed using two Cochrane-approved tools. Effect sizes are expressed as relative risk ratios alongside the 95 % confidence interval. Statistical significance was defined at the level of p < 0.05. RESULTS From 388 studies identified in the initial search, 33 articles were included in the final synthesis and analysis. Risk factors were grouped into patient (female gender, disease severity) and operative factors (peri-procedural hypotension, operative modality). The risk of ischaemic colitis was significantly higher when undergoing emergency repair versus elective (risk ratio (RR) 7.36, 3.08 to 17.58, p < 0.001). Endovascular repair reduced the likelihood of ischaemic colitis (RR 0.22, 0.12 to 0.39, p < 0.001). DISCUSSION The quality of published evidence on this subject is poor with many retrospective datasets and inconsistent reporting across studies. Despite this, emergency presentation and open repair should prompt close monitoring for the development of IC.
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Affiliation(s)
- Matthew J Lee
- Department of General Surgery, Northern General Hospital, First Floor, Old Nurses Home Herries Road, Sheffield, UK, S5 7AU. .,Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK.
| | - Sarah L Daniels
- Department of General Surgery, Northern General Hospital, First Floor, Old Nurses Home Herries Road, Sheffield, UK, S5 7AU
| | - Thomas M Drake
- Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK
| | - Ian J Adam
- Department of General Surgery, Northern General Hospital, First Floor, Old Nurses Home Herries Road, Sheffield, UK, S5 7AU
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20
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Falkensammer J, Hakaim AG, Falkensammer CE, Broderick GA, Crook JE, Heckman MG, Oldenburg WA, Hugl B. Prevalence of erectile dysfunction in vascular surgery patients. Vasc Med 2016; 12:17-22. [PMID: 17451089 DOI: 10.1177/1358863x06076043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Erectile dysfunction (ED) is frequently associated with cardiovascular disease. Epidemiological data on the frequency of ED in vascular surgery patients is rarely reported. We evaluated the prevalence of this comorbidity in patients consulting the vascular surgery outpatient clinic. Over a 6-month period, a short version of the International Index of Erectile Function (IIEF) questionnaire consisting of six EDrelevant questions was handed out to 440 vascular surgery outpatients. Clinical data were collected from patients' records. Linear regression models with forward selection were used to investigate associations between erectile function score and possible risk factors. The return rate was 31% (137 patients). Eight patients (6%) were taking phosphodiesterase inhibitors. ED, as defined by an erectile function score of 25 or less and/or use of phosphodiesterase inhibitors, was found in 90% (95% CI: 84% to 95%) of cases. Moderate or severe ED, as defined by an erectile function score of 16 or less and/or use of phosphodiesterase inhibitors, was found in 70% (95% CI: 62% to 78%) of cases. Increased age, abdominal aortic aneurysm, peripheral arterial disease, urologic disease, insulin-dependent diabetes mellitus, and use of beta-blockers were significantly associated with a lower erectile function score. In conclusion, erectile dysfunction is a frequent and often missed comorbidity in vascular surgery patients. While ED may have a profound impact on the patient's quality of life, attention should also be paid to the patient's preoperative sexual function, considering the availability of oral pharmacotherapies and possible consequences concerning liability in postoperative patients in whom pre-existing ED was not identified properly.
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Affiliation(s)
- Juergen Falkensammer
- Section of Vascular Surgery, Mayo Clinic Jacksonville, Jacksonville, FL 32224, USA
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21
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Choi HR, Park KH, Lee JH. Risk Factor Analysis for Buttock Claudication after Internal Iliac Artery Embolization with Endovascular Aortic Aneurysm Repair. Vasc Specialist Int 2016; 32:44-50. [PMID: 27386451 PMCID: PMC4928603 DOI: 10.5758/vsi.2016.32.2.44] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/17/2016] [Accepted: 05/30/2016] [Indexed: 11/20/2022] Open
Abstract
Purpose: Endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs) involving the common iliac artery requires extension of the stent-graft limb into the external iliac artery. For this procedure, internal iliac artery (IIA) embolization is performed to prevent type II endoleak. In this study, we investigated the frequency and risk factor of buttock claudication (BC) in patients having interventional embolization of the IIA. Materials and Methods: From January 2010 to December 2013, a total of 110 patients with AAA were treated with EVAR in our institution. This study included 27 patients (24.5%) who had undergone unilateral IIA coil embolization with EVAR. We examined hospital charts retrospectively and interviewed by telephone for the occurrence of BC. Results: Mean age of total patients was 71.9±7.0 years and 88.9% were males. During a mean follow-up of 8.65±9.04 months, the incidence of BC was 40.7% (11 of 27 patients). In 8 patients with claudication, the symptoms had resolved within 1 month of IIA embolization, but the symptoms persisted for more than 6 months in the remaining 3 patients. In univariate and multivariate analysis, risk factors such as age, sex, comorbidity, patency of collateral arteries, and anatomical characteristics of AAA were not significantly related with BC. Conclusion: In this study, BC was a frequent complication of IIA embolization during EVAR and there was no associated risk factor. Certain principles such as checking preoperative angiogram, proximal and unilateral IIA embolization may have contributed to reducing the incidence of BC.
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Affiliation(s)
- Hye Ryeon Choi
- Division of Vascular and Endovascular Surgery, Department of Surgery, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Ki Hyuk Park
- Division of Vascular and Endovascular Surgery, Department of Surgery, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Jae Hoon Lee
- Division of Vascular and Endovascular Surgery, Department of Surgery, Daegu Catholic University College of Medicine, Daegu, Korea
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22
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Duvnjak S. Endovascular treatment of aortoiliac aneurysms: From intentional occlusion of the internal iliac artery to branch iliac stent graft. World J Radiol 2016; 8:275-280. [PMID: 27027393 PMCID: PMC4807336 DOI: 10.4329/wjr.v8.i3.275] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/23/2015] [Accepted: 01/04/2016] [Indexed: 02/06/2023] Open
Abstract
Approximately 20%-40% of patients with abdominal aortic aneurysms can have unilateral or bilateral iliac artery aneurysms and/or ectasia. This influences and compromises the distal sealing zone during endovascular aneurysm repair. There are a few endovascular techniques that are used to treat these types of aneurysms, including intentional occlusion/over-stenting of the internal iliac artery on one or both sides, the “bell-bottom” technique, and the more recent method of using an iliac branch stent graft. In some cases, other options include the “snorkel and sandwich” technique and hybrid interventions. Pelvic ischemia, represented as buttock claudication, has been reported in 16%-55% of cases; this is followed by impotence, which has been described in 10%-17% of cases following internal iliac artery occlusion. The bell-bottom technique can be used for a common iliac artery up to 24 mm in diameter given that the largest diameter of the stent graft is 28 mm. There is a paucity of data and evidence regarding the “snorkel and sandwich” technique, which can be used in a few clinical scenarios. The hybrid intervention is comprised of a surgical operation, and is not purely endovascular. The newest branch stent graft technology enables preservation of the anterograde flow of important side branches. Technical success with the newest technique ranges from 85%-96.3%, and in some small series, technical success is 100%. Buttock claudication was reported in up to 4% of patients treated with a branch stent graft at 5-year follow-up. Mid- and short-term follow-up results showed branch patency of up to 88% during the 5-6-year period. Furthermore, branch graft occlusion is a potential complication, and it has been described to occur in 1.2%-11% of cases. Iliac branch stent graft placement represents a further development in endovascular medicine, and it has a high technical success rate without serious complications.
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23
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McGarry JG, Alenezi AO, McGrath FP, Given MF, Keeling AN, Moneley DS, Leahy AL, Lee MJ. How safe is internal iliac artery embolisation prior to EVAR? A 10-year retrospective review. Ir J Med Sci 2015; 185:865-869. [PMID: 26597950 DOI: 10.1007/s11845-015-1384-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Internal iliac artery (IIA) embolisation is commonly performed prior to endovascular aneurysm repair (EVAR) of aortoiliac aneurysms to prevent type 2 endoleaks via the internal iliac arteries. The safety of this procedure is controversial due to the high incidence of pelvic ischaemic complications. METHODS We undertook a retrospective review of all patients undergoing IIA embolisation before EVAR from 2002 to 2012, to determine incidence of, and factors associated with pelvic ischaemia. RESULTS Eight of 25 patients (32 %) experienced new-onset ischaemia, including erectile dysfunction (4 %), and buttock claudication (28 %) that persisted >6 months in only four patients (16 %). Both bilateral IIA embolisation and a shorter time interval to EVAR correlate with increased risk (p = 0.006 and p = 0.044). No co-morbidities or demographic factors were predictive. CONCLUSIONS We conclude that IIA embolisation remains a beneficial procedure, however, to minimise the risk of buttock claudication we advise against both bilateral IIA embolisation and short time intervals between embolisation and subsequent EVAR.
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Affiliation(s)
- J G McGarry
- Department of Academic Radiology, Beaumont Hospital Dublin, Dublin, Ireland.
| | - A O Alenezi
- Department of Academic Radiology, Beaumont Hospital Dublin, Dublin, Ireland
| | - F P McGrath
- Department of Academic Radiology, Beaumont Hospital Dublin, Dublin, Ireland
| | - M F Given
- Department of Academic Radiology, Beaumont Hospital Dublin, Dublin, Ireland
| | - A N Keeling
- Department of Academic Radiology, Beaumont Hospital Dublin, Dublin, Ireland
| | - D S Moneley
- Department of Surgery, Beaumont Hospital Dublin, Dublin, Ireland
| | - A L Leahy
- Department of Surgery, Beaumont Hospital Dublin, Dublin, Ireland.,Faculty of Radiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M J Lee
- Department of Academic Radiology, Beaumont Hospital Dublin, Dublin, Ireland.,Faculty of Radiology, Royal College of Surgeons in Ireland, Dublin, Ireland
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Nykamp M, Anderson J, Remund T, Santos A, Laurich C, Schultz G, Kelly P. Use of Physician-Modified Endografts to Repair Unilateral or Bilateral Aortoiliac Aneurysms. Ann Vasc Surg 2015; 29:1468-74. [DOI: 10.1016/j.avsg.2015.04.074] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 12/17/2014] [Accepted: 04/12/2015] [Indexed: 02/04/2023]
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Occlusion of the Internal Iliac Artery Is Associated with Smaller Prostate and Decreased Urinary Tract Symptoms. J Vasc Interv Radiol 2015; 26:1305-10. [DOI: 10.1016/j.jvir.2015.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 03/12/2015] [Accepted: 04/22/2015] [Indexed: 11/21/2022] Open
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Luo H, Huang B, Yuan D, Yang Y, Xiong F, Zeng G, Wu Z, Chen X, Du X, Wen X, Liu C, Yang H, Zhao J. 8-Year Long-Term Outcome Comparison: Two Ways to Exclude the Internal Iliac Artery during Endovascular Aorta Repair (EVAR) Surgery. PLoS One 2015; 10:e0130586. [PMID: 26193113 PMCID: PMC4507853 DOI: 10.1371/journal.pone.0130586] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 05/22/2015] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To evaluate the 8-year long-term outcome after internal iliac artery (IIA) coverage with or without embolization in EVAR. PATIENTS AND METHODS From January 2006 to December 2013, abdominal aortic aneurysm (AAA) subjects that underwent EVAR and IIA exclusion were recruited and analyzed retrospectively. All the subjects were divided into group A or B based on the presence or absence of intraoperative IIA embolization before coverage (group A: without embolization; group B: with embolization). The 30-day mortality, stent patency, and the incidences of endoleaks and ischemia of the buttocks and lower limbs were compared. The follow-up period was 96 months. RESULT There were 137 subjects (A: 74 vs. B: 63), 124 male (91.1%) and 13 female (9.5%), with a mean age of 71.6 years. There were no significant differences in the early outcomes of intraoperative blood loss (87.23±14.07 ml; A: 86.53±9.57 ml vs. B: 88.06±18.04 ml, p = .545) and surgery time (87.13±9.25 min; A: 85.99±7.07 min vs. B: 88.48±11.19 min, p = .130). However, there were significant differences in contrast consumption (65.18±9.85 ml; A: 61.89±7.95 ml vs. B: 69.05±10.50 ml, p<.001) and intraoperative X-ray time (5.9±0.86 min; A: 5.63±0.49 min vs. B: 6.22±1.07 min, P<.001). The 30-day mortality was approximately 0.73%. In the follow-up analysis, no significant differences were identified in the incidence of endoleak (22 subjects; type I: A: 2 vs. B: 2, p = 1.000; type II: A: 8 vs. B: 4, p = .666; type III: A: 4 vs. B: 3, p = 1.000), occlusion (5 subjects; 4.35%; A: 1 vs. B: 4, p = .180), or ischemia (9 subjects; 7.83%; A: 3 vs. B: 6, p = .301). In the analysis of group B, although there were no significant differences between subjects with unilateral and bilateral IIA embolization, but longer hospital stays were required (P<.001), and a more severe complication (skin and gluteus necrosis) occurred in 1 subject with bilateral IIA embolization. CONCLUSION IIA could be excluded during EVAR. IIA coverage without embolization had a good surgical and prognostic outcome, and this procedure was not different significantly from coverage with embolization in terms of endoleaks, patency and ischemia.
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Affiliation(s)
- Han Luo
- West China Medical School of Sichuan University, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China
| | - Bin Huang
- Department of Vascular Surgery, West China Hospital, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China
| | - Ding Yuan
- Department of Vascular Surgery, West China Hospital, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China
| | - Yi Yang
- Department of Vascular Surgery, West China Hospital, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China
| | - Fei Xiong
- Department of Vascular Surgery, West China Hospital, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China
| | - Guojun Zeng
- Department of Vascular Surgery, West China Hospital, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China
| | - Zhoupeng Wu
- Department of Vascular Surgery, West China Hospital, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China
| | - Xiyang Chen
- Department of Vascular Surgery, West China Hospital, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China
| | - Xiaojiong Du
- Department of Vascular Surgery, West China Hospital, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China
| | - Xiaorong Wen
- Department of Ultrasound, West China Hospital, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China
| | - Chuncheng Liu
- Department of Ultrasound, West China Hospital, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China
| | - Hongliu Yang
- West China Medical School of Sichuan University, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China
| | - Jichun Zhao
- Department of Vascular Surgery, West China Hospital, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China
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Open Surgical Management of Hypogastric Artery during Aortic Surgery: Ligate or Not Ligate? Ann Vasc Surg 2015; 29:780-5. [DOI: 10.1016/j.avsg.2014.12.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 12/29/2014] [Accepted: 12/30/2014] [Indexed: 11/21/2022]
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Kalteis M, Gangl O, Huber F, Adelsgruber P, Kastner M, Lugmayr H. Clinical impact of hypogastric artery occlusion in endovascular aneurysm repair. Vascular 2014; 23:575-9. [DOI: 10.1177/1708538114560462] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose To report the long-term results for patients treated with endovascular aneurysm repair and additional embolization and coverage of the hypogastric artery compared with patients treated with simple endovascular aneurysm repair. Methods A database of our endovascular aneurysm repair patient cohort was reviewed to find patients with iliac artery aneurysms. The baseline characteristics, the procedural data and the results for patients treated with endovascular aneurysm repair and concomitant hypogastric artery embolization were compared with those for patients treated with simple endovascular aneurysm repair. The results were analyzed for significant differences. Results Of 106 endovascular aneurysm repair patients treated at our vascular unit from 2001 to 2010, 24 had undergone additional hypogastric artery embolization. The complication rate was significantly increased in this group (12.5% vs. 2.4%; p = 0.041), and the long-term results were significantly poorer. Additional hypogastric artery embolization resulted in late rupture (1.2% vs. 12.5%; p = 0.036), buttock claudication (8.6% vs. 43.8%; p = 0.001) and new onset erectile dysfunction (17.3% vs. 42.9%; p = 0.043). Conclusion Endovascular aneurysm repair with extension of the stent graft to the external iliac artery and embolization of the hypogastric artery was associated with more complications and worse long-term results compared with simple endovascular aneurysm repair.
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Affiliation(s)
- Manfred Kalteis
- Department of cardiovascular Surgery, Klinikum Wels-Grieskirchen, Wels, Austria
- Department of Surgery, Elisabethinen Hospital, Linz, Austria
| | - Odo Gangl
- Department of Surgery, Elisabethinen Hospital, Linz, Austria
| | - Florian Huber
- Department of cardiovascular Surgery, Klinikum Wels-Grieskirchen, Wels, Austria
| | | | - Manfred Kastner
- Department of Interventional Radiology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Herbert Lugmayr
- Department of Interventional Radiology, Klinikum Wels-Grieskirchen, Wels, Austria
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Blair R, Collins A, Harkin DW. Complex EVAR for abdominal aorto-iliac aneurysm (AAIA) is associated with high rate of endoleak and less aortic sac shrinkage compared to conventional EVAR for AAA. Ir J Med Sci 2014; 184:871-5. [PMID: 25322958 DOI: 10.1007/s11845-014-1210-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 10/06/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Endovascular repair (EVAR) for large abdominal aortic aneurysm (AAA) in anatomically suitable patients is associated with low early mortality and morbidity. However, EVAR is associated with a significant risk of late complication and a high cumulative re-intervention rate. Many large experienced centres have offered complex EVAR to challenging aortic anatomies such as abdominal aorto-iliac aneurysm (AAIA). We hypothesised that complex EVAR, for AAIA, would be associated with an increased risk of late graft-related complications. METHODS The design was a Retrospective Clinical Cohort Study. From a prospective computerised database we identified consecutive patients undergoing EVAR in a single institution between 2008 and 2009. We retrieved analysis clinical data and digital Computed Tomographic Angiography (CTA) scans carried out pre-, early post-, and late post-EVAR. We compared patients undergoing complex EVAR for AAIA with those undergoing conventional standard EVAR for AAA. RESULTS We identified 93 consecutive patients undergoing EVAR, 13 patients were excluded (3 eEVAR, 1 TEVAR, 9 data could not be retrieved) leaving 80 patients for analysis, 63 male and 17 female, average age 74.5 years (range 57-86), average follow-up 38 months (range 27-50), primary EVAR success was 100% and there was no mortality. Complex EVAR, EVAR plus internal iliac artery embolisation (+IIAE) and extension of the ipsilateral graft limb to the external iliac artery, for AAIA were carried out in 19/80 patients. After standard EVAR, late post-EVAR AAA sac diameter was significantly reduced in EVAR (63.24 ± 9.76 vs 54.26 ± 13.70, p < 0.001) but not after complex EVAR+IIAE (58.89 ± 16.39 vs 52.35 ± 12.75, p = 0.62). Endoleak these were significantly more common in the complex EVAR+IIAE, 5/19 (26.32%), as compared to the standard EVAR, 11/61 (18.03%), p < 0.01. Interestingly, inferior mesenteric artery (IMA) Patency was much commoner after complex EVAR+IIAE (15/19, 78.95%) compared EVAR (29/61, 47.54%), p < 0.01. CONCLUSION EVAR can be carried out with low early mortality but has a significant risk of late complication, the commonest of which is endoleak. Complex EVAR for abdominal aorto-iliac aneurysm can be carried out with comparable results to conventional EVAR. However, high rates of persistent endoleak and inferior mesenteric artery patency, and lack of aneurysm sac shrinkage, would suggest they may be at increased risk of late complications and may benefit from enhanced and extended radiological surveillance.
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Affiliation(s)
- R Blair
- Belfast Vascular Centre, Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - A Collins
- Belfast Vascular Centre, Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - D W Harkin
- Belfast Vascular Centre, Royal Victoria Hospital, Belfast, BT12 6BA, UK.
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Kim WC, Jeon YS, Hong KC, Kim JY, Cho SG, Park JY. Internal iliac artery embolization during an endovascular aneurysm repair with detachable interlock microcoils. Korean J Radiol 2014; 15:613-21. [PMID: 25246822 PMCID: PMC4170162 DOI: 10.3348/kjr.2014.15.5.613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 06/09/2014] [Indexed: 12/25/2022] Open
Abstract
Objective The purpose of this study was to evaluate the effectiveness of detachable interlock microcoils for an embolization of the internal iliac artery during an endovascular aneurysm repair (EVAR). Materials and Methods A retrospective review was conducted on 40 patients with aortic aneurysms, who had undergone an EVAR between January 2010 and March 2012. Among them, 16 patients were referred for embolization of the internal iliac artery for the prevention of type II endoleaks. Among 16 patients, 13 patients underwent embolization using detachable interlock microcoils during an EVAR. Computed tomographic angiographies and clinical examinations were performed during the follow-up period. Technical success, clinical outcome, and complications were reviewed. Results Internal iliac artery embolizations using detachable interlock microcoils were technically successful in all 13 patients, with no occurrence of procedure-related complications. Follow-up imaging was accomplished in the 13 cases. In all cases, type II endoleak was not observed with computed tomographic angiography during the median follow-up of 3 months (range, 1-27 months) and the median clinical follow-up of 12 months (range, 1-27 months). Two of 13 (15%) patients had symptoms of buttock pain, and one patient died due to underlying stomach cancer. No significant clinical symptoms such as bowel ischemia were observed. Conclusion Internal iliac artery embolization during an EVAR using detachable interlock microcoils to prevent type II endoleaks appears safe and effective, although this should be further proven in a larger population.
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Affiliation(s)
- Woo Chul Kim
- Department of Radiology, Inha University Hospital, Inha University School of Medicine, Incheon 400-711, Korea
| | - Yong Sun Jeon
- Department of Radiology, Inha University Hospital, Inha University School of Medicine, Incheon 400-711, Korea
| | - Kee Chun Hong
- Department of Vascular Surgery, Inha University Hospital, Inha University School of Medicine, Incheon 400-711, Korea
| | - Jang Yong Kim
- Department of Vascular and Endovascular Surgery, The Catholic University of Korea School of Medicine, Seoul 137-701, Korea
| | - Soon Gu Cho
- Department of Radiology, Inha University Hospital, Inha University School of Medicine, Incheon 400-711, Korea
| | - Jae Young Park
- Department of Vascular Surgery, Inha University Hospital, Inha University School of Medicine, Incheon 400-711, Korea
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Chun JY, Mailli L, Abbasi MA, Belli AM, Gonsalves M, Munneke G, Ratnam L, Loftus IM, Morgan R. Embolization of the internal iliac artery before EVAR: is it effective? Is it safe? Which technique should be used? Cardiovasc Intervent Radiol 2013; 37:329-36. [PMID: 23771327 DOI: 10.1007/s00270-013-0659-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 05/11/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the clinical outcomes of internal iliac artery (IIA) embolization before endovascular aneurysm repair (EVAR). METHODS Between 2002 and 2011, 88 patients underwent IIA embolization prior to EVAR. Sixty-five patients underwent unilateral and 23 underwent bilateral IIA embolization. A total of 111 IIAs were embolized: 56 were embolized with coils, 41 with Amplatzer plugs, and 14 with a combination of embolic agents. The outcomes were assessed retrospectively by reviewing medical records and follow-up imaging. RESULTS IIA embolization was technically successful in 95.7% of cases. Type 2 endoleak from previously embolized IIAs was seen in 4 cases, and in 1 case this was significant necessitating re-intervention. Buttock claudication was reported in 38% of cases, whereas new onset erectile dysfunction occurred in 10% of cases. No severe ischemic complications, such as spinal cord ischaemia or buttock necrosis, were reported. Analysis comparing unilateral versus bilateral embolization, simultaneous versus sequential embolization, and the type of embolic material used showed no statistical significance. CONCLUSION IIA embolization is technically successful and effective in preventing significant type 2 endoleak in the majority of cases. It is a relatively safe procedure without major complications, but the incidence of buttock claudication and erectile dysfunction remain relatively high, and patients should be consented appropriately. There is no significant benefit for adopting a particular embolization technique, but there is a tendency towards reduced pelvic ischaemia with proximal embolization. Four cases of type II endoleak occurring after technically successful IIA embolization supports the school of thought that IIA should be embolized prior to coverage and extension of the distal landing zone.
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Affiliation(s)
- Joo-Young Chun
- Department of Radiology, St. George's Hospital, London, SW17 0QT, UK,
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Nakai M, Sato M, Sato H, Sakaguchi H, Tanaka F, Ikoma A, Sanda H, Nakata K, Minamiguchi H, Kawai N, Sonomura T, Nishimura Y, Okamura Y. Midterm results of endovascular abdominal aortic aneurysm repair: comparison of instruction-for-use (IFU) cases and non-IFU cases. Jpn J Radiol 2013; 31:585-92. [DOI: 10.1007/s11604-013-0223-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 05/26/2013] [Indexed: 10/26/2022]
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Comparison of outcomes with coils versus vascular plug embolization of the internal iliac artery for endovascular aortoiliac aneurysm repair. J Vasc Surg 2012; 56:1239-45. [DOI: 10.1016/j.jvs.2012.05.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 04/24/2012] [Accepted: 05/02/2012] [Indexed: 11/20/2022]
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Rand T, Uberoi R, Cil B, Munneke G, Tsetis D. Quality improvement guidelines for imaging detection and treatment of endoleaks following endovascular aneurysm repair (EVAR). Cardiovasc Intervent Radiol 2012; 36:35-45. [PMID: 22833173 DOI: 10.1007/s00270-012-0439-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 06/18/2012] [Indexed: 10/28/2022]
Abstract
Major concerns after aortic aneurysm repair are caused by the presence of endoleaks, which are defined as persistent perigraft flow within the aortic aneurysm sac. Diagnosis of endoleaks can be performed with various imaging modalities, and indications for treatment are based on further subclassifications. Early detection and correct classification of endoleaks are crucial for planning patient management. The vast majority of endoleaks can be treated successfully by interventional means. Guidelines for Imaging Detection and Treatment of endoleaks are described in this article.
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Affiliation(s)
- T Rand
- Department of Radiology, General Hospital Hietzing, Wolkersbergenstr1, 1130, Vienna, Austria.
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Pavlidis D, Hörmann M, Libicher M, Gawenda M, Brunkwall J. Buttock Claudication After Interventional Occlusion of the Hypogastric Artery—A Mid-Term Follow-Up. Vasc Endovascular Surg 2012; 46:236-41. [DOI: 10.1177/1538574411436329] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Interventional occlusion of the hypogastric artery (HA) can be used for endovascular aneurysm repair (EVAR) in the iliac arteries. Most frequent ischemic complication is buttock claudication (BC). Aim. To investigate the frequency and progression of BC after interventional occlusion of the HA prior to EVAR. Methods. A retrospective analysis was performed in patients with EVAR and occlusion of the HA between September 2004 and August 2010. Acute and persistent BC symptoms were assessed. Results. Fifty-four catheter occlusions of the HA were performed. In 10 cases, claudication could not be evaluated. During a mean follow-up of 17 months, 23 occlusions (52.3%) of the HA showed BC, in 52% symptoms were persistent. Of the 5 patients, 3 patients who underwent bilateral occlusion had BC and in 2 cases, persistent in the follow-up. Conclusion. Buttock claudication after occlusion of the HA prior to EVAR is a frequent complication, which often persists during follow-up. Alternatives that maintain pelvic perfusion should be considered.
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Affiliation(s)
- Daphne Pavlidis
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
| | - M. Hörmann
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
| | - M. Libicher
- Department of Radiology, Diakonie Clinic, Schwäbisch Hall, Germany
| | - M. Gawenda
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
| | - J. Brunkwall
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
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Libicher M, Pavlidis D, Bangard C, Gawenda M. Occlusion of the Internal Iliac Artery Prior EVAR. Vasc Endovascular Surg 2011; 46:34-9. [DOI: 10.1177/1538574411427786] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: We compared occlusion of the internal iliac artery (IIA) using coils or the Amplatzer vascular plug (AVP) II prior to endovascular aortic aneurysm repair. Materials and Methods: Occlusion of the IIA was performed in 32 patients (aged 74 ± 8 years) using coils (N = 17) or the AVP II (N = 15). We retrospectively compared procedural data, initial success, and clinical outcome in a 12-month follow-up. Results: Occlusion was successful in all patients without detection of an endoleak after 12 months. Procedure time and fluoroscopy time for coils versus plugs were 77 ± 35 versus 43 ± 13 minutes and 36 ± 19 versus 18 ± 8 minutes, respectively ( P < .003). Incidence of initial buttock claudication (BC) for coils versus plugs was 47% versus 27% and was significantly more severe after coil occlusion ( P = .03). After a 12-month follow-up, 2 patients of each group reported of mild BC. Conclusion: Occlusion of the IIA is safe and effective using coils or plugs. Initial BC is significantly more severe when coils are used, but after a 12-month follow-up, there is no significant difference. Using a plug is associated with a significant reduction of procedure time and radiation exposure.
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Affiliation(s)
- Martin Libicher
- Department of Diagnostic and Interventional Radiology, Deaconess Hospital, Schwäbisch Hall, Germany
| | - Daphne Pavlidis
- Department of Vascular Surgery, University of Cologne, Cologne, Germany
| | | | - Michael Gawenda
- Department of Vascular Surgery, University of Cologne, Cologne, Germany
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Lee JH, Kim HJ, Choi SK, Shin WY, Kim JY, Hong KC, Jeon YS, Cho SG. Effectiveness of Embolization of Internal Iliac Artery during Endovascular Aneurysm Repair. Vasc Specialist Int 2011. [DOI: 10.5758/kjves.2011.27.4.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Joo Hyung Lee
- Department of Surgery, Inha University College of Medicine, Incheon, Korea
| | - Hyun Ji Kim
- Department of Surgery, Inha University College of Medicine, Incheon, Korea
| | - Sun Keun Choi
- Department of Surgery, Inha University College of Medicine, Incheon, Korea
| | - Woo Young Shin
- Department of Surgery, Inha University College of Medicine, Incheon, Korea
| | - Jang Yong Kim
- Department of Surgery, Inha University College of Medicine, Incheon, Korea
| | - Kee Chun Hong
- Department of Surgery, Inha University College of Medicine, Incheon, Korea
| | - Yong Sun Jeon
- Department of Radiology, Inha University College of Medicine, Incheon, Korea
| | - Soon Gu Cho
- Department of Radiology, Inha University College of Medicine, Incheon, Korea
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Krievins D, Holden A, Savlovskis J, Calderas C, Donayre C, Moll F, Katzen B, Zarins C. EVAR Using the Nellix Sac-anchoring Endoprosthesis: Treatment of Favourable and Adverse Anatomy. Eur J Vasc Endovasc Surg 2011; 42:38-46. [DOI: 10.1016/j.ejvs.2011.03.007] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 03/04/2011] [Indexed: 11/28/2022]
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Cherry RA, Goodspeed DC, Lynch FC, Delgado J, Reid SJ. Intraoperative angioembolization in the management of pelvic-fracture related hemodynamic instability. J Trauma Manag Outcomes 2011; 5:6. [PMID: 21569480 PMCID: PMC3113950 DOI: 10.1186/1752-2897-5-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 05/13/2011] [Indexed: 11/23/2022]
Abstract
Background This case series report discusses patients presenting with hemorrhage and hemodymanic compromise due to severe pelvic fractures and undergoing intraoperative angioembolization (IAE) with other resuscitative procedures. Methods We used portable digital subtraction fluoroscopy units for IAE in patients with severe pelvic hemorrhage and hemodynamic instability (5/03-4/09). Data was collected on demographics, injury severity, resource utilization, and outcomes at our Level 1 trauma center. Results There were 6,538 adult admissions with 912 having pelvic fractures and 65 of these undergoing pelvic angioembolization. Twelve hemodynamically compromised patients (10 males, 2 females) had intraoperative pelvic angiography (age: 22-79 years; mean 51.3 ± 17.4). Injury severity score (ISS) was 37.5 ± 8.4 (22-50). Mean emergency department (ED) length of stay (LOS) was 57.4 min ± 47.9 with 10 patients transported directly to the OR and 2 to the SICU prior to OR. Ten of 12 patients underwent exploratory laparotomy followed by angioembolization. Mortality was 50%. Among the 6 survivors (ISS 22 - 50), all had a pre-op CT scan, five had an initial base deficit <13, and four were transfused ≤ 6 units pre-incision/pre-procedure. Four of the 6 survivors had unilateral embolization. In contrast, all 6 non-survivors (ISS 29-41) required massive transfusion prior to OR (>6 units PRBCs) with 4 having a based deficit >13. Three of these patients bypassed CT and five underwent bilateral internal iliac embolization (BIIE). Conclusions IAE for severe pelvic hemorrhage can be successfully performed concurrently with exploratory laparotomy, pelvic packing or other resuscitative procedures. Patients most likely to benefit have a base deficit <13, and do not require massive transfusion prior to IAE or suffer from a vertically unstable pelvis fracture.
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Affiliation(s)
- Robert A Cherry
- University of Wisconsin Hospital & Clinics Department of Orthopaedics & Rehabilitation 1685 Highland Avenue Madison, WI 53705 (608) 263-9456, USA.
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Nakai M, Nakata K, Sato M, Ikoma A, Minamiguchi H, Kawai N, Sonomura T, Hatada A, Nishimura Y, Okamura Y. Sequential Dilatation of the Superior Gluteal Artery Following Coil Embolization of the Internal Iliac Artery and Endovascular Abdominal Aneurysm Repair: A Case Report. Ann Vasc Dis 2011; 4:134-8. [DOI: 10.3400/avd.cr.10.01038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 02/03/2011] [Indexed: 11/13/2022] Open
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Embolization of the Internal Iliac Artery with Glubran 2 Acrylic Glue: Initial Experience with an Adjunctive Outflow Occlusive Agent. J Vasc Interv Radiol 2010; 21:1109-14. [DOI: 10.1016/j.jvir.2010.02.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Revised: 02/08/2010] [Accepted: 02/19/2010] [Indexed: 11/24/2022] Open
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Maleux G, Willems E, Vaninbroukx J, Nevelsteen A, Heye S. Outcome of Proximal Internal Iliac Artery Coil Embolization prior to Stent-graft Extension in Patients Previously Treated by Endovascular Aortic Repair. J Vasc Interv Radiol 2010; 21:990-4. [DOI: 10.1016/j.jvir.2010.02.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 02/19/2010] [Accepted: 02/25/2010] [Indexed: 10/19/2022] Open
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Cochennec F, Marzelle J, Allaire E, Desgranges P, Becquemin JP. Open vs endovascular repair of abdominal aortic aneurysm involving the iliac bifurcation. J Vasc Surg 2010; 51:1360-6. [DOI: 10.1016/j.jvs.2010.01.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 01/13/2010] [Accepted: 01/14/2010] [Indexed: 10/19/2022]
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44
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Chaikof EL, Brewster DC, Dalman RL, Makaroun MS, Illig KA, Sicard GA, Timaran CH, Upchurch GR, Veith FJ. The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. J Vasc Surg 2009; 50:S2-49. [PMID: 19786250 DOI: 10.1016/j.jvs.2009.07.002] [Citation(s) in RCA: 467] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 07/06/2009] [Accepted: 07/06/2009] [Indexed: 02/08/2023]
Affiliation(s)
- Elliot L Chaikof
- Department of Surgery, Emory University, Atlanta, Ga 30322, USA.
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Endovascular Abdominal Aortic Aneurysm Repair: Part I. Ann Vasc Surg 2009; 23:799-812. [DOI: 10.1016/j.avsg.2009.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Accepted: 03/21/2009] [Indexed: 12/20/2022]
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Lin PH, Chen AY, Vij A. Hypogastric Artery Preservation during Endovascular Aortic Aneurysm Repair: Is It Important? Semin Vasc Surg 2009; 22:193-200. [DOI: 10.1053/j.semvascsurg.2009.07.012] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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47
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Jonker FH, Aruny J, Muhs BE. Management of Type II Endoleaks: Preoperative versus Postoperative versus Expectant Management. Semin Vasc Surg 2009; 22:165-71. [DOI: 10.1053/j.semvascsurg.2009.07.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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48
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Franz RW, Knapp ED. Staged Endovascular Repair of Bilateral Internal Iliac Artery Aneurysms. Ann Vasc Surg 2009; 23:136-8. [DOI: 10.1016/j.avsg.2007.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Revised: 10/30/2007] [Accepted: 11/03/2007] [Indexed: 10/21/2022]
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49
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Farahmand P, Becquemin J, Desgranges P, Allaire E, Marzelle J, Roudot-Thoraval F. Is Hypogastric Artery Embolization during Endovascular Aortoiliac Aneurysm Repair (EVAR) Innocuous and Useful? Eur J Vasc Endovasc Surg 2008; 35:429-35. [DOI: 10.1016/j.ejvs.2007.12.001] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Accepted: 12/08/2007] [Indexed: 10/22/2022]
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50
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Rayt HS, Bown MJ, Lambert KV, Fishwick NG, McCarthy MJ, London NJM, Sayers RD. Buttock Claudication and Erectile Dysfunction After Internal Iliac Artery Embolization in Patients Prior to Endovascular Aortic Aneurysm Repair. Cardiovasc Intervent Radiol 2008; 31:728-34. [PMID: 18338212 DOI: 10.1007/s00270-008-9319-3] [Citation(s) in RCA: 204] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Revised: 02/11/2008] [Accepted: 02/15/2008] [Indexed: 01/13/2023]
Affiliation(s)
- H S Rayt
- Division of Cardiovascular Sciences, Vascular Surgery Research Group, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester, LE2 7LX, UK.
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