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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

Technique of device modification using an iliac stent graft limb. (a) The iliac limb was deployed in vitro; (b) An elliptical graftotomy was created in the third stent using vascular scissors; (c) A PTFE graft was anastomosed end-to-side to the modified limb; (d) The strut of the arm graft was secured helically to the iliac limb; (e) The arm graft was tailored, and sewed with a marker at each end for orientation; (f) The modified IBD was completed and (g) reloaded into a sheath. IBD: Iliac branch device; PTFE: Polytetrafluoroethylene.
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Figure 2: Technique of device modification using an iliac stent graft limb. (a) The iliac limb was deployed in vitro; (b) An elliptical graftotomy was created in the third stent using vascular scissors; (c) A PTFE graft was anastomosed end-to-side to the modified limb; (d) The strut of the arm graft was secured helically to the iliac limb; (e) The arm graft was tailored, and sewed with a marker at each end for orientation; (f) The modified IBD was completed and (g) reloaded into a sheath. IBD: Iliac branch device; PTFE: Polytetrafluoroethylene.

Mentions: The procedure was performed under general anesthesia beginning with administration of unfractionated heparin (80–100 U/kg). Prophylactic antibiotics were given 30 min before the procedure. An on-table IBD modification was prepared. A 16 mm3 × 12 mm3 × 120 mm3 MicroPort iliac stent-graft limb (MicroPort, Shanghai, China) was selected based on the landing zone diameter of right EIA. The whole limb was deployed in vitro [Figure 2a]. An elliptical graftotomy 45° oblique to the long axis was performed to the third stent at about 30 mm to its proximal end for a secure overlap of the limb extender, using vascular scissors [Figure 2b]. Then, a 7 mm expanded polytetrafluoroethylene (PTFE) vascular graft (Gore, Flagstaff, AZ, USA) was anastomosed end-to-side to the modified limb with its beveled cut end [Figure 2c]. The strut of the arm graft was secured helically to the iliac limb with several sutures [Figure 2d]. The side arm was tailored to 30 mm long, and two metal markers were sewed at both ends of the arm graft for orientation [Figure 2e]. Lastly, this modified device [Figure 2f] was reloaded into a 22-F sheath (MicroPort, Shanghai, China) with no guidewire preloaded [Figure 2g].


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)

Technique of device modification using an iliac stent graft limb. (a) The iliac limb was deployed in vitro; (b) An elliptical graftotomy was created in the third stent using vascular scissors; (c) A PTFE graft was anastomosed end-to-side to the modified limb; (d) The strut of the arm graft was secured helically to the iliac limb; (e) The arm graft was tailored, and sewed with a marker at each end for orientation; (f) The modified IBD was completed and (g) reloaded into a sheath. IBD: Iliac branch device; PTFE: Polytetrafluoroethylene.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Technique of device modification using an iliac stent graft limb. (a) The iliac limb was deployed in vitro; (b) An elliptical graftotomy was created in the third stent using vascular scissors; (c) A PTFE graft was anastomosed end-to-side to the modified limb; (d) The strut of the arm graft was secured helically to the iliac limb; (e) The arm graft was tailored, and sewed with a marker at each end for orientation; (f) The modified IBD was completed and (g) reloaded into a sheath. IBD: Iliac branch device; PTFE: Polytetrafluoroethylene.
Mentions: The procedure was performed under general anesthesia beginning with administration of unfractionated heparin (80–100 U/kg). Prophylactic antibiotics were given 30 min before the procedure. An on-table IBD modification was prepared. A 16 mm3 × 12 mm3 × 120 mm3 MicroPort iliac stent-graft limb (MicroPort, Shanghai, China) was selected based on the landing zone diameter of right EIA. The whole limb was deployed in vitro [Figure 2a]. An elliptical graftotomy 45° oblique to the long axis was performed to the third stent at about 30 mm to its proximal end for a secure overlap of the limb extender, using vascular scissors [Figure 2b]. Then, a 7 mm expanded polytetrafluoroethylene (PTFE) vascular graft (Gore, Flagstaff, AZ, USA) was anastomosed end-to-side to the modified limb with its beveled cut end [Figure 2c]. The strut of the arm graft was secured helically to the iliac limb with several sutures [Figure 2d]. The side arm was tailored to 30 mm long, and two metal markers were sewed at both ends of the arm graft for orientation [Figure 2e]. Lastly, this modified device [Figure 2f] was reloaded into a 22-F sheath (MicroPort, Shanghai, China) with no guidewire preloaded [Figure 2g].

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