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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

Angiography of an EVAR with a surgeon-modified IBD. (a) Preoperative aortagram demonstrated overall aneurysms of both CIAs and the left IIA; (b) Completion aortagram showed exclusion of the aneurysms following a right-sided modified IBD, an iliac arm to IIA stent-graft, embolization of the left IIA, an aorta main body on the bifurcation, and a right-sided extender graft; (c) Contralateral oblique 30° angiography showed patency of the right IIA and its branches without endoleak. CIA: Common iliac artery; EVAR: Endovascular aneurysm repair; IBD: Iliac branch device; IIA: Internal iliac artery.
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Figure 3: Angiography of an EVAR with a surgeon-modified IBD. (a) Preoperative aortagram demonstrated overall aneurysms of both CIAs and the left IIA; (b) Completion aortagram showed exclusion of the aneurysms following a right-sided modified IBD, an iliac arm to IIA stent-graft, embolization of the left IIA, an aorta main body on the bifurcation, and a right-sided extender graft; (c) Contralateral oblique 30° angiography showed patency of the right IIA and its branches without endoleak. CIA: Common iliac artery; EVAR: Endovascular aneurysm repair; IBD: Iliac branch device; IIA: Internal iliac artery.

Mentions: After the initial angiography [Figure 3a], the IBD was advanced into the right CIA just inferior to the aortic bifurcation and extended into the EIA. The distal end of the arm graft was positioned 10 mm proximal direct to the patent IIA orifice. After the IBD was deployed, through a cross-over approach via the contralateral femoral artery, and through the IBD and its side branch, the distal right IIA was selectively catheterized, and a stiffer 0.035-inch Supra Core wire (Abbott, Santa Clara, CA, USA) was then exchanged. A 10-F artery sheath (SearCare, Shenzhen, China) was introduced into the IIA via the guiding of a half-inflated 5 mm-diameter balloon catheter (Cordis, Oosteinde, LJ Roden, The Netherlands). Then, a self-expandable Fluency covered stent (Bard, Wachhausstrasse, Karlsruhe, Germany) measuring 8 mm × 80 mm was delivered through the sheath and deployed to span the distance from the proximal end of the side branch into the right IIA.


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)

Angiography of an EVAR with a surgeon-modified IBD. (a) Preoperative aortagram demonstrated overall aneurysms of both CIAs and the left IIA; (b) Completion aortagram showed exclusion of the aneurysms following a right-sided modified IBD, an iliac arm to IIA stent-graft, embolization of the left IIA, an aorta main body on the bifurcation, and a right-sided extender graft; (c) Contralateral oblique 30° angiography showed patency of the right IIA and its branches without endoleak. CIA: Common iliac artery; EVAR: Endovascular aneurysm repair; IBD: Iliac branch device; IIA: Internal iliac artery.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Angiography of an EVAR with a surgeon-modified IBD. (a) Preoperative aortagram demonstrated overall aneurysms of both CIAs and the left IIA; (b) Completion aortagram showed exclusion of the aneurysms following a right-sided modified IBD, an iliac arm to IIA stent-graft, embolization of the left IIA, an aorta main body on the bifurcation, and a right-sided extender graft; (c) Contralateral oblique 30° angiography showed patency of the right IIA and its branches without endoleak. CIA: Common iliac artery; EVAR: Endovascular aneurysm repair; IBD: Iliac branch device; IIA: Internal iliac artery.
Mentions: After the initial angiography [Figure 3a], the IBD was advanced into the right CIA just inferior to the aortic bifurcation and extended into the EIA. The distal end of the arm graft was positioned 10 mm proximal direct to the patent IIA orifice. After the IBD was deployed, through a cross-over approach via the contralateral femoral artery, and through the IBD and its side branch, the distal right IIA was selectively catheterized, and a stiffer 0.035-inch Supra Core wire (Abbott, Santa Clara, CA, USA) was then exchanged. A 10-F artery sheath (SearCare, Shenzhen, China) was introduced into the IIA via the guiding of a half-inflated 5 mm-diameter balloon catheter (Cordis, Oosteinde, LJ Roden, The Netherlands). Then, a self-expandable Fluency covered stent (Bard, Wachhausstrasse, Karlsruhe, Germany) measuring 8 mm × 80 mm was delivered through the sheath and deployed to span the distance from the proximal end of the side branch into the right IIA.

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