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Title: Endovascular Tubular Stent-Graft Placement for Isolated Iliac Artery Aneurysms

Abstract

Purpose: To evaluate the safety, efficacy, and mid-term outcomes of endovascular tubular stent-graft placement for repair of isolated iliac artery aneurysms (IAAs). Materials and Methods: Between January 2002 and March 2010, 20 patients (7 women and 13 men; mean age 74 years) underwent endovascular repair of 22 isolated IAAs. Two patients underwent endovascular repair for bilateral aneurysms. Ten para-anastomotic aneurysms (45%) developed after open abdominal aortic aneurysm (AAA) repair with an aorto-iliac graft, and 12 were true aneurysms (55%). Eleven straight and 11 tapered stent-grafts were placed. Contrast-enhanced computed tomography (CT) was performed to detect complications and evaluate aneurysmal shrinkage at week 1, 3, 6, and 12 months and once every year thereafter. Non-contrast-enhanced CT was performed in seven patients with chronic kidney disease. Results: All procedures were successful, without serious complications, during the mean (range) follow-up period of 746 days (47-2651). Type II endoleak not requiring treatment was noted in one patient. The mean (SD) diameters of the true and para-anastomotic aneurysms significantly (p < 0.05) decreased from 42.0 (9.3) to 36.9 (13.6) mm and from 40.1 (13.0) to 33.6 (15.8) mm, respectively; the mean (SD) shrinkage rates were 15.1% (20.2%) and 18.9% (22.4%), respectively. The primary patency ratemore » was 100%, and no secondary interventions were required. Four patients (21%) developed transient buttock claudication, and one patient (5%) developed colorectal ischaemia, which was treated conservatively. Conclusion: Endovascular tubular stent-graft placement for the repair of isolated IAAs is safe and efficacious. Tapered stent-grafts of various sizes are required for accurate placement.« less

Authors:
;  [1];  [2];  [3];  [2];  [4]; ;  [1]
  1. Kobe University Graduate School of Medicine, Department of Radiology (Japan)
  2. Kobe University Graduate School of Medicine, Center for Endovascular Therapy (Japan)
  3. Hyogo Brain and Heart Center, Department of Radiology (Japan)
  4. Kobe University Graduate School of Medicine, Department of Cardiovascular Surgery (Japan)
Publication Date:
OSTI Identifier:
21608607
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 35; Journal Issue: 1; Other Information: DOI: 10.1007/s00270-010-0084-8; Copyright (c) 2012 Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ARTERIES; COMPUTERIZED TOMOGRAPHY; DISEASES; GRAFTS; KIDNEYS; MATERIALS; MEN; PATIENTS; SAFETY; WOMEN; ANIMALS; BLOOD VESSELS; BODY; CARDIOVASCULAR SYSTEM; DIAGNOSTIC TECHNIQUES; FEMALES; MALES; MAMMALS; MAN; ORGANS; PRIMATES; TOMOGRAPHY; TRANSPLANTS; VERTEBRATES

Citation Formats

Okada, Takuya, E-mail: okabone@gmail.com, Yamaguchi, Masato, Kitagawa, Atsushi, Kawasaki, Ryota, Nomura, Yoshikatsu, Okita, Yutaka, Sugimura, Kazuro, and Sugimoto, Koji. Endovascular Tubular Stent-Graft Placement for Isolated Iliac Artery Aneurysms. United States: N. p., 2012. Web. doi:10.1007/S00270-010-0084-8.
Okada, Takuya, E-mail: okabone@gmail.com, Yamaguchi, Masato, Kitagawa, Atsushi, Kawasaki, Ryota, Nomura, Yoshikatsu, Okita, Yutaka, Sugimura, Kazuro, & Sugimoto, Koji. Endovascular Tubular Stent-Graft Placement for Isolated Iliac Artery Aneurysms. United States. doi:10.1007/S00270-010-0084-8.
Okada, Takuya, E-mail: okabone@gmail.com, Yamaguchi, Masato, Kitagawa, Atsushi, Kawasaki, Ryota, Nomura, Yoshikatsu, Okita, Yutaka, Sugimura, Kazuro, and Sugimoto, Koji. 2012. "Endovascular Tubular Stent-Graft Placement for Isolated Iliac Artery Aneurysms". United States. doi:10.1007/S00270-010-0084-8.
@article{osti_21608607,
title = {Endovascular Tubular Stent-Graft Placement for Isolated Iliac Artery Aneurysms},
author = {Okada, Takuya, E-mail: okabone@gmail.com and Yamaguchi, Masato and Kitagawa, Atsushi and Kawasaki, Ryota and Nomura, Yoshikatsu and Okita, Yutaka and Sugimura, Kazuro and Sugimoto, Koji},
abstractNote = {Purpose: To evaluate the safety, efficacy, and mid-term outcomes of endovascular tubular stent-graft placement for repair of isolated iliac artery aneurysms (IAAs). Materials and Methods: Between January 2002 and March 2010, 20 patients (7 women and 13 men; mean age 74 years) underwent endovascular repair of 22 isolated IAAs. Two patients underwent endovascular repair for bilateral aneurysms. Ten para-anastomotic aneurysms (45%) developed after open abdominal aortic aneurysm (AAA) repair with an aorto-iliac graft, and 12 were true aneurysms (55%). Eleven straight and 11 tapered stent-grafts were placed. Contrast-enhanced computed tomography (CT) was performed to detect complications and evaluate aneurysmal shrinkage at week 1, 3, 6, and 12 months and once every year thereafter. Non-contrast-enhanced CT was performed in seven patients with chronic kidney disease. Results: All procedures were successful, without serious complications, during the mean (range) follow-up period of 746 days (47-2651). Type II endoleak not requiring treatment was noted in one patient. The mean (SD) diameters of the true and para-anastomotic aneurysms significantly (p < 0.05) decreased from 42.0 (9.3) to 36.9 (13.6) mm and from 40.1 (13.0) to 33.6 (15.8) mm, respectively; the mean (SD) shrinkage rates were 15.1% (20.2%) and 18.9% (22.4%), respectively. The primary patency rate was 100%, and no secondary interventions were required. Four patients (21%) developed transient buttock claudication, and one patient (5%) developed colorectal ischaemia, which was treated conservatively. Conclusion: Endovascular tubular stent-graft placement for the repair of isolated IAAs is safe and efficacious. Tapered stent-grafts of various sizes are required for accurate placement.},
doi = {10.1007/S00270-010-0084-8},
journal = {Cardiovascular and Interventional Radiology},
number = 1,
volume = 35,
place = {United States},
year = 2012,
month = 2
}
  • The endovascular exclusion of an isolated iliac artery aneurysm is recognized as a safe and favorable alternative to open surgical repair, with low associated morbidity and mortality. It has particular advantages in the treatment of internal iliac artery aneurysm (IIAA) given the technical difficulties associated with open surgical repair deep within the pelvis. We describe the use of customized tapered stent-grafts in the exclusion of wide-necked IIAA in five male patients considered high-risk for conventional surgical repair, in whom the common and external iliac artery morphology precluded the use of standard endovascular devices. In each case, IIAA outflow was selectivelymore » embolized and the aneurysm neck excluded by placement of a customized tapered stent-graft across the internal iliac artery origin. This technique was extremely effective, with 100% technical success, no serious associated morbidity, and zero mortality. In all five patients sac size was stable or reduced on computed tomography follow-up of up to 3 years (mean, 24.4 months), with a primary patency rate of 100%. We therefore advocate the use of customized tapered stent-grafts as a further endovascular option in the management of IIAA unsuitable for conventional endovascular repair.« less
  • We present a case of fracture of a single self-expanding stent placed in the common iliac artery (CIA). An 80-year-old woman underwent placement of a self-expanding stent for CIA occlusion. Stent fracture and reocclusion were detected after 18 months. Successful revascularization was achieved using a stent-in-stent maneuver. The possibility of stent fracture with reocclusion should be considered following treatment with a single self-expanding stent for CIA occlusion.
  • We report the case of a patient who developed an asymptomatic pseudoaneurysm in the left external iliac artery after transplant nephrectomy. The pseudoaneurysm most probably arose as a suture aneurysm from the external iliac artery after removal of the graft renal artery. Obviously we can not exclude the possibility it was a true aneurysm, although this seems much less likely. The pseudoaneurysm was detected during a routine CT scan and was treated interventionally with a stent-graft. One month later the asymptomatic patient underwent a vascular ultrasound examination including color Doppler, power Doppler, and B-flow as a routine control. An endoleakmore » with collapse of the stent-graft was diagnosed. There was no evidence of stent infection. At a reintervention, the pseudoaneurysm was successfully treated using two uncovered Palmaz stents at the proximal and distal edge of the stent graft. Peri- and post-interventional ultrasound and CT angiography confirmed the exclusion of the aneurysm without an endoleak.« less
  • The objective of this study was to determine the anatomical relationship and juxtaposition between the common iliac artery and vein in a population of patients with aortic aneurysmal disease and a population clinically and radiologically free of atheroma. It was a retrospective study of 100 consecutive patients undergoing computed tomographic assessment of abdominal aortic aneurysm prior to endovascular or open surgical repair and 100 patients undergoing computed tomographic assessment for other pathologies who did not have clinical or imaging signs of aorto-iliac atheroma. In both groups the anatomical relationship between the right and left iliac artery and vein was studied,more » and the thickness of the fat plane separating the artery from the vein measured. The right iliac vein was posterolateral to the artery at the level of the common iliac artery bifurcation in 95% of patients in both groups. At the same level the left iliac vein was posterior in 23% (p {<=} 0.001). Eighty-three percent of patients in the aneurysm group had a fat plane between the right artery and vein that measured 0 mm (no visible fat plane = 52%) to 1 mm (= 31%). Ninety-eight percent of patients in the aneurysm group had a measurable fat plane between the left iliac artery and vein of up to 5 mm (p = 0.001). Six percent of the control group demonstrated no visible fat plane between the right iliac artery and vein (p {<=} 0.001), while the fat plane measured more than 1 mm (1-5 mm) on the left in 100%. We conclude that in patients where conduit construction is required for aortic stent-graft access, the anatomical configuration and intimate relationship of the iliac arteries and veins should be assessed and taken into account at CT scan evaluation. The distal right common iliac artery should not be used, as venous damage can be predicted from the anatomical and intimate relationship of the iliac artery and vein at this level in patients with atheroma and the difficulties this relationship presents if venous repair is necessary.« less
  • A 65-year-old woman with advanced mucinous carcinoma of the ovary presented with massive rectal bleeding caused by rupture of an iliac artery pseudoaneurysm into the bowel. Surgery was contraindicated due to the patient's poor clinical condition. We successfully placed an endovascular stent-graft that excluded the pseudoaneurysm. There were no complications, and the patient recovered well.