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Self expandable stent application to prevent limb occlusion in external iliac artery during endovascular aneurysm repair

View Article: PubMed Central - PubMed

ABSTRACT

Purpose: Iliac extension of stent-graft during endovascular aneurysm repair (EVAR) increases the incidence of limb occlusion (LO). Hypothetically, adjunctive iliac stent (AIS) could offer some additional protection to overcome this anatomic hostility. But still there is no consensus in terms of effective stent characteristics or configuration. We retrospectively reviewed our center's experience to offer a possible answer to this question.

Methods: Our study included 30 patients (38 limbs) with AIS placed in the external iliac artery (EIA) from January 2010 to December 2013. We classified iliac tortuosity based on anatomic characteristics. AIS's were deployed in EIA with a minimum 5-mm stick-out configuration from the distal edge of the stent-graft.

Results: According to the iliac artery tortuosity index, grade 0, grade 1, and grade 2 were 5 (13.2%), 30 (78.9%), and 3 (7.9%), respectively. The diameter of all AIS was 12 mm, which was as large as or larger than the diameter of the stent-graft distal limb. SMART stents were preferred in 34 limbs (89.5%) and stents with 60-mm length were usually used (89.5%). During a mean follow-up of 9.13 ± 10.78 months, ischemic limb pain, which could be the sign of LO, was not noticed in any patients. There was no fracture, kinking, migration, in-stent restenosis, or occlusion of AIS.

Conclusion: The installation of AIS after extension of stent-graft to EIA reduced the risk of LO without any complications. AIS should be considered as a preventive procedure of LO if stent-graft needs to be extended to EIA during EVAR.

No MeSH data available.


(A) Both iliac stent-graft limbs were deployed on external iliac arteries. The right internal iliac artery was embolized with coils, and adjunctive iliac stents were deployed on both external iliac arteries. (B) Both iliac stent-graft limbs were deployed on external iliac arteries. The right internal iliac artery was embolized with coils, and adjunctive iliac stents were deployed on both external iliac arteries.
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Figure 1: (A) Both iliac stent-graft limbs were deployed on external iliac arteries. The right internal iliac artery was embolized with coils, and adjunctive iliac stents were deployed on both external iliac arteries. (B) Both iliac stent-graft limbs were deployed on external iliac arteries. The right internal iliac artery was embolized with coils, and adjunctive iliac stents were deployed on both external iliac arteries.

Mentions: After standard deployment of the endovascular stent-graft, AIS was implanted in EIA. Self-expandable, bare metal stents, such as SMART stent (Cordis Co., Miami, FL, USA), Zilver stent (Cook Inc., Bloominton, IN, USA) and Wall stent (Boston Scientific, Natick, Ma, USA) were used as AIS in our institution. The diameter of all AIS was 12 mm regardless of the diameter of stent-graft distal limb. The AIS was deployed a minimum of 5 mm beyond the distal stent-graft into the EIA, rendering a smooth transition from the stent-graft limb into the native iliac arterial curvature. All of the AIS were placed from the limb to native artery (Fig. 1).


Self expandable stent application to prevent limb occlusion in external iliac artery during endovascular aneurysm repair
(A) Both iliac stent-graft limbs were deployed on external iliac arteries. The right internal iliac artery was embolized with coils, and adjunctive iliac stents were deployed on both external iliac arteries. (B) Both iliac stent-graft limbs were deployed on external iliac arteries. The right internal iliac artery was embolized with coils, and adjunctive iliac stents were deployed on both external iliac arteries.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016604&req=5

Figure 1: (A) Both iliac stent-graft limbs were deployed on external iliac arteries. The right internal iliac artery was embolized with coils, and adjunctive iliac stents were deployed on both external iliac arteries. (B) Both iliac stent-graft limbs were deployed on external iliac arteries. The right internal iliac artery was embolized with coils, and adjunctive iliac stents were deployed on both external iliac arteries.
Mentions: After standard deployment of the endovascular stent-graft, AIS was implanted in EIA. Self-expandable, bare metal stents, such as SMART stent (Cordis Co., Miami, FL, USA), Zilver stent (Cook Inc., Bloominton, IN, USA) and Wall stent (Boston Scientific, Natick, Ma, USA) were used as AIS in our institution. The diameter of all AIS was 12 mm regardless of the diameter of stent-graft distal limb. The AIS was deployed a minimum of 5 mm beyond the distal stent-graft into the EIA, rendering a smooth transition from the stent-graft limb into the native iliac arterial curvature. All of the AIS were placed from the limb to native artery (Fig. 1).

View Article: PubMed Central - PubMed

ABSTRACT

Purpose: Iliac extension of stent-graft during endovascular aneurysm repair (EVAR) increases the incidence of limb occlusion (LO). Hypothetically, adjunctive iliac stent (AIS) could offer some additional protection to overcome this anatomic hostility. But still there is no consensus in terms of effective stent characteristics or configuration. We retrospectively reviewed our center's experience to offer a possible answer to this question.

Methods: Our study included 30 patients (38 limbs) with AIS placed in the external iliac artery (EIA) from January 2010 to December 2013. We classified iliac tortuosity based on anatomic characteristics. AIS's were deployed in EIA with a minimum 5-mm stick-out configuration from the distal edge of the stent-graft.

Results: According to the iliac artery tortuosity index, grade 0, grade 1, and grade 2 were 5 (13.2%), 30 (78.9%), and 3 (7.9%), respectively. The diameter of all AIS was 12 mm, which was as large as or larger than the diameter of the stent-graft distal limb. SMART stents were preferred in 34 limbs (89.5%) and stents with 60-mm length were usually used (89.5%). During a mean follow-up of 9.13 ± 10.78 months, ischemic limb pain, which could be the sign of LO, was not noticed in any patients. There was no fracture, kinking, migration, in-stent restenosis, or occlusion of AIS.

Conclusion: The installation of AIS after extension of stent-graft to EIA reduced the risk of LO without any complications. AIS should be considered as a preventive procedure of LO if stent-graft needs to be extended to EIA during EVAR.

No MeSH data available.