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Using a surgeon-modified iliac branch device to preserve the internal iliac artery during endovascular aneurysm repair: single-center experiences and early results.

Wu WW, Lin C, Liu B, Liu CW - Chin. Med. J. (2015)

Bottom Line: Technical successes were obtained in all patients.All grafts remained patent without any sign of endoleaks.There were no aneurysm ruptures, deaths, or other complications related to pelvic flow.

View Article: PubMed Central - PubMed

Affiliation: Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730, China.

ABSTRACT

Background: To evaluate the feasibility of a new surgeon-modified iliac branch device (IBD) technique to maintain pelvic perfusion in the management of common iliac artery (CIA) aneurysm during endovascular aneurysm repair (EVAR).

Methods: From January 2011 to December 2013, a new surgeon-modified IBD technique was performed in department of vascular surgery of Peking Union Medical College Hospital in five patients treated for CIA aneurysm with or without abdominal aortic aneurysm. A stent-graft limb was initially deployed in vitro, anastomosed with vascular graft, creating a modified IBD reloaded into a larger sheath, with or without a guidewire preloaded into the side branch. The reloaded IBD was then placed in the iliac artery, with a covered stent bridging internal iliac artery and the branch. Finally, a bifurcated stent-graft was deployed, and a limb device was used to connect the main body and IBD.

Results: Technical successes were obtained in all patients. The mean follow-up length was 24 months (range: 6-38 months). All grafts remained patent without any sign of endoleaks. There were no aneurysm ruptures, deaths, or other complications related to pelvic flow.

Conclusions: Using the surgeon-modified IBD to preserve pelvic flow is a feasible endovascular technique and an appealing solution for personalized treatment of CIA aneurysm during EVAR.

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Related in: MedlinePlus

Ideograph of EVAR with a surgeon-modified IBD. (a) A modified IBD was firstly placed distal into the EIA, with its side branch direct to the ipsilateral IIA orifice. The contralateral IIA was embolized; (b) Then, via an up and over iliac approach, a covered stent was extended into the IIA connecting the side branch; (c) A bifurcated stent-graft was deployed; (d) Finally, a stent graft limb device was deployed to connect the bifurcated stent-graft and the IBD. EVAR: Endovascular aneurysm repair; EIA: External iliac artery; IIA: Internal iliac artery; IBD: Iliac branch device.
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Figure 1: Ideograph of EVAR with a surgeon-modified IBD. (a) A modified IBD was firstly placed distal into the EIA, with its side branch direct to the ipsilateral IIA orifice. The contralateral IIA was embolized; (b) Then, via an up and over iliac approach, a covered stent was extended into the IIA connecting the side branch; (c) A bifurcated stent-graft was deployed; (d) Finally, a stent graft limb device was deployed to connect the bifurcated stent-graft and the IBD. EVAR: Endovascular aneurysm repair; EIA: External iliac artery; IIA: Internal iliac artery; IBD: Iliac branch device.

Mentions: The technique was illustrated in a 69-year-old man with asymptomatic aneurysms involving bilateral CIAs and left IIA. The plan was to insert a modified IBD into the right iliac artery with its branch toward the right patent IIA, deploy a covered stent to bridge the right IIA and side branch to keep pelvic flow, then embolize left IIA, place a bifurcated stent-graft on the bifurcation, and place an extension to connect main body and IBD [Figure 1].


Using a surgeon-modified iliac branch device to preserve the internal iliac artery during endovascular aneurysm repair: single-center experiences and early results.

Wu WW, Lin C, Liu B, Liu CW - Chin. Med. J. (2015)

Ideograph of EVAR with a surgeon-modified IBD. (a) A modified IBD was firstly placed distal into the EIA, with its side branch direct to the ipsilateral IIA orifice. The contralateral IIA was embolized; (b) Then, via an up and over iliac approach, a covered stent was extended into the IIA connecting the side branch; (c) A bifurcated stent-graft was deployed; (d) Finally, a stent graft limb device was deployed to connect the bifurcated stent-graft and the IBD. EVAR: Endovascular aneurysm repair; EIA: External iliac artery; IIA: Internal iliac artery; IBD: Iliac branch device.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834782&req=5

Figure 1: Ideograph of EVAR with a surgeon-modified IBD. (a) A modified IBD was firstly placed distal into the EIA, with its side branch direct to the ipsilateral IIA orifice. The contralateral IIA was embolized; (b) Then, via an up and over iliac approach, a covered stent was extended into the IIA connecting the side branch; (c) A bifurcated stent-graft was deployed; (d) Finally, a stent graft limb device was deployed to connect the bifurcated stent-graft and the IBD. EVAR: Endovascular aneurysm repair; EIA: External iliac artery; IIA: Internal iliac artery; IBD: Iliac branch device.
Mentions: The technique was illustrated in a 69-year-old man with asymptomatic aneurysms involving bilateral CIAs and left IIA. The plan was to insert a modified IBD into the right iliac artery with its branch toward the right patent IIA, deploy a covered stent to bridge the right IIA and side branch to keep pelvic flow, then embolize left IIA, place a bifurcated stent-graft on the bifurcation, and place an extension to connect main body and IBD [Figure 1].

Bottom Line: Technical successes were obtained in all patients.All grafts remained patent without any sign of endoleaks.There were no aneurysm ruptures, deaths, or other complications related to pelvic flow.

View Article: PubMed Central - PubMed

Affiliation: Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730, China.

ABSTRACT

Background: To evaluate the feasibility of a new surgeon-modified iliac branch device (IBD) technique to maintain pelvic perfusion in the management of common iliac artery (CIA) aneurysm during endovascular aneurysm repair (EVAR).

Methods: From January 2011 to December 2013, a new surgeon-modified IBD technique was performed in department of vascular surgery of Peking Union Medical College Hospital in five patients treated for CIA aneurysm with or without abdominal aortic aneurysm. A stent-graft limb was initially deployed in vitro, anastomosed with vascular graft, creating a modified IBD reloaded into a larger sheath, with or without a guidewire preloaded into the side branch. The reloaded IBD was then placed in the iliac artery, with a covered stent bridging internal iliac artery and the branch. Finally, a bifurcated stent-graft was deployed, and a limb device was used to connect the main body and IBD.

Results: Technical successes were obtained in all patients. The mean follow-up length was 24 months (range: 6-38 months). All grafts remained patent without any sign of endoleaks. There were no aneurysm ruptures, deaths, or other complications related to pelvic flow.

Conclusions: Using the surgeon-modified IBD to preserve pelvic flow is a feasible endovascular technique and an appealing solution for personalized treatment of CIA aneurysm during EVAR.

Show MeSH
Related in: MedlinePlus