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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

CTA before and after an IBD procedure. (a) A completed modified IBD; (b) The device was reloaded into a sheath with a preloaded guidewire; (c) Preoperative CTA from an anterior view disclosed large aortoiliac aneurysms; (d) Postoperative CTA from a posterior view revealed the patent left IIA with its branches and a crucial bridging balloon-expendable stent graft, covering the discrepancy between the side branch and the IIA, like an “up-side-down taper,” without any endoleak after 12-month follow-up. CTA: Computed tomographic angiography; IBD: Iliac branch device; IIA: Internal iliac artery.
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Figure 4: CTA before and after an IBD procedure. (a) A completed modified IBD; (b) The device was reloaded into a sheath with a preloaded guidewire; (c) Preoperative CTA from an anterior view disclosed large aortoiliac aneurysms; (d) Postoperative CTA from a posterior view revealed the patent left IIA with its branches and a crucial bridging balloon-expendable stent graft, covering the discrepancy between the side branch and the IIA, like an “up-side-down taper,” without any endoleak after 12-month follow-up. CTA: Computed tomographic angiography; IBD: Iliac branch device; IIA: Internal iliac artery.

Mentions: The technique was performed in five patients with excellent results and was modified when reloading the modified IBD in the recent four patients. Before reloading into the sheath, modified IBD was preloaded with a guidewire into its side branch through the proximal end of the branch graft. The soft tip of the guidewire exceeded the end of the side branch and was reloaded into the sheath together. The body of the guidewire ran out parallel with the tip of the reloading sheath [Figure 4a and b]. Thereby, the following way was used to capture the end of the guidewire. First, a catheter was delivered out of the ipsilateral CFA from the contralateral CFA to create a through-and-through passage. After the body of the preloaded guidewire was inserted into the catheter, it was captured from the contralateral side. The IBD was delivered into the ipsilateral iliac artery simultaneously with the retraction of the catheter till the aortic bifurcation. The IBD was partially released, and the side branch was open direct to the IIA orifice. The soft tip of the guidewire was positioned into the IIA under the help of the catheter. Then a cross-over long artery sheath was put into the IIA via the guidewire, through which a covered stent was delivered. Finally, the distal part of the IBD was full-released.


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)

CTA before and after an IBD procedure. (a) A completed modified IBD; (b) The device was reloaded into a sheath with a preloaded guidewire; (c) Preoperative CTA from an anterior view disclosed large aortoiliac aneurysms; (d) Postoperative CTA from a posterior view revealed the patent left IIA with its branches and a crucial bridging balloon-expendable stent graft, covering the discrepancy between the side branch and the IIA, like an “up-side-down taper,” without any endoleak after 12-month follow-up. CTA: Computed tomographic angiography; 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 4: CTA before and after an IBD procedure. (a) A completed modified IBD; (b) The device was reloaded into a sheath with a preloaded guidewire; (c) Preoperative CTA from an anterior view disclosed large aortoiliac aneurysms; (d) Postoperative CTA from a posterior view revealed the patent left IIA with its branches and a crucial bridging balloon-expendable stent graft, covering the discrepancy between the side branch and the IIA, like an “up-side-down taper,” without any endoleak after 12-month follow-up. CTA: Computed tomographic angiography; IBD: Iliac branch device; IIA: Internal iliac artery.
Mentions: The technique was performed in five patients with excellent results and was modified when reloading the modified IBD in the recent four patients. Before reloading into the sheath, modified IBD was preloaded with a guidewire into its side branch through the proximal end of the branch graft. The soft tip of the guidewire exceeded the end of the side branch and was reloaded into the sheath together. The body of the guidewire ran out parallel with the tip of the reloading sheath [Figure 4a and b]. Thereby, the following way was used to capture the end of the guidewire. First, a catheter was delivered out of the ipsilateral CFA from the contralateral CFA to create a through-and-through passage. After the body of the preloaded guidewire was inserted into the catheter, it was captured from the contralateral side. The IBD was delivered into the ipsilateral iliac artery simultaneously with the retraction of the catheter till the aortic bifurcation. The IBD was partially released, and the side branch was open direct to the IIA orifice. The soft tip of the guidewire was positioned into the IIA under the help of the catheter. Then a cross-over long artery sheath was put into the IIA via the guidewire, through which a covered stent was delivered. Finally, the distal part of the IBD was full-released.

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