1.Using a surgeon-modified iliac branch device to preserve the internal iliac artery during endovascular aneurysm repair: single-center experiences and early results.
Wei-Wei WU ; Chen LIN ; Bao LIU ; Chang-Wei LIU
Chinese Medical Journal 2015;128(5):674-679
BACKGROUNDTo 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).
METHODSFrom 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.
RESULTSTechnical 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.
CONCLUSIONSUsing 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.
Aged ; Aortic Aneurysm, Abdominal ; surgery ; Endovascular Procedures ; methods ; Female ; Humans ; Iliac Aneurysm ; surgery ; Iliac Artery ; Male ; Surgeons
2.Risk factors of pelvic ischemic symptoms after iliac artery occlusion during endovascular aneurysm repair.
Journal of Zhejiang University. Medical sciences 2019;48(5):546-551
OBJECTIVE:
To analyze risk factors of pelvic ischemia after occlusion of the internal iliac artery during endovascular aneurysm repair (EVAR) surgery.
METHODS:
The clinical data, preoperative CT angiography (CTA) findings and follow-up results of 82 patients with unilateral embolization of internal iliac artery undergoing EVAR were analyzed retrospectively. Among 82 patients, pelvic ischemic symptoms were developed in 20 patients (ischemia group) and the remaining patients served as control group. The risk factors for pelvic ischemia after occlusion of internal iliac artery during EVAR surgery were explored using univariate and multivariate analysis, and the clinical value was evaluated using ROC curves.
RESULTS:
The univariate analysis showed that the numbers of the contralateral internal iliac artery and the ipsilateral deep femoral artery stenosis in the pelvic ischemia group were less than those in the control group (both <0.05). Multivariate Logistic regression analysis showed that the decreased number of internal iliac artery branches (=8.383, 95%:1.469-47.841, <0.05) was an independent risk of pelvic ischemia. The ROC curve analysis showed that of the decreased number of contralateral internal iliac artery branches for predicting the incidence of pelvic ischemia was 0.816; when the number of 3.5 was taken as cut-off value, the corresponding sensitivity was 0.861 and the specificity was 0.167.
CONCLUSIONS
The decrease in number of the contralateral internal iliac artery branches on preoperative CTA is an independent risk factor for pelvic ischemia after occlusion of the internal iliac artery during EVAR surgery, but it does not show enough clinical value.
Aortic Aneurysm, Abdominal
;
surgery
;
Blood Vessel Prosthesis Implantation
;
Case-Control Studies
;
Embolization, Therapeutic
;
Endovascular Procedures
;
Humans
;
Iliac Aneurysm
;
Iliac Artery
;
surgery
;
Retrospective Studies
;
Risk Factors
;
Treatment Outcome
3.Endovascular repair of aortoiliac aneurysm with a hybrid technique to preserve pelvic perfusion.
Wei-Wei WU ; Xue-Ying JIANG ; Bao LIU ; Yu CHEN ; Chang-Wei LIU
Chinese Medical Journal 2011;124(23):4105-4108
Endovascular aneurysm repair (EVAR) has been proven to be an effective and safe technique for abdominal or iliac artery aneurysm. However, for aneurysms extending to both iliac bifurcations, routine EVAR will occlude both internal iliac arteries (IIAs), which may increase the risk for pelvic ischemia. New endovascular techniques have been developed to preserve the pelvic perfusion in EVAR for such situation. This article reports an endovascular repair of an aortoiliac aneurysm with an external iliac artery (EIA) to the IIA endograft to preserve the pelvic perfusion. First, an endograft was advanced into the left IIA under the help of an inflated aortic balloon. Coils were deployed to embolize the distal type-1 endoleak from the tunnel around the endograft. and an aortouniiliac endograft and an iliac extension were deployed below the renal arteries extending to the right EIA. Finally, a right-to-left femoro-femoral artery bypass was constructed. Angiography at completion and computed tomography after 6 months demonstrated patency of all grafts and complete exclusion of the aneurysm without any endoleak. Endovascular repair with an EIA-to-IIA endograft to preserve the pelvic inflow is a feasible and effective technique for aortoiliac aneurysms. Coil embolization might be an option to repair the distal type of endoleak. The balloon assisted U-turn technique may help advance the endovascular device over a sharp-angled vessel bifurcation.
Aged
;
Angiography
;
Aortic Aneurysm, Abdominal
;
diagnostic imaging
;
surgery
;
Humans
;
Iliac Aneurysm
;
diagnostic imaging
;
surgery
;
Male
;
Pelvis
;
Vascular Surgical Procedures
4.Experiences of retroperitoneal approach for aortoiliac reconstruction.
Bao-zhong YANG ; Qing-hua WU ; Yan-min HAN ; Zhong CHEN ; Xin HUO
Chinese Journal of Surgery 2005;43(14):926-928
OBJECTIVETo summarize experiences of aortoiliac reconstruction through retroperitoneal approach.
METHODSTwenty-eight patients underwent retroperitoneal aortoiliac reconstructions, including aortic aneurysmectomy with graft replacement, aortic endarterectomy with patch angioplasty, thoraco-abdominal aortic bypass, resection of retroperitoneal mass with ilio-femoral bypass, iliac aneurysmectomy with aorto-external iliac artery bypass, removal of aortoiliac foreign body, common iliac endarterectomy, aorto (ilio)-femeral bypass and common ilio-femo-popliteal bypass. Drainage tubes were placed retroperitoneally in 24 cases.
RESULTSAll operations in this group were successful without perioperative death. The volume of intra-operative bleeding was 100-400 ml (mean 240 ml). Blood transfusion were employed in 2 cases. Retroperitoneal drainage was 50-170 ml (mean 85 ml). Naso-gastric tubes were removed 28 h on average after operation. All patients recovered uneventfully except that cardiac insufficiency, stress ulcer and retroperitoneal hematoma were present in 3 patients respectively. Twenty-two patients were followed up from 3 months to 2.5 years. One patient died of AMI 2 years after operation. One patient receiving ilio-femo-popliteal bypass was found to have occlusion of femo-popliteal segment of prosthetic graft. One patient developed brain hemorrhage 1.5 years postoperatively. All the other followed-up patients were living well.
CONCLUSIONRetroperitoneal approach, not violating the peritoneal cavity, offers certain physiological advantages associated with minimal disturbance of gastrointestinal and respiratory function, thereby decreasing respiratory complications and postoperative ileus, avoiding intra-abdominal adhesions with their attendant risk of early and late small bowel obstruction. It proved to be a simple and safe alternative for surgical treatment of aortoiliac diseases.
Adult ; Aged ; Aorta, Abdominal ; surgery ; Aortic Aneurysm, Abdominal ; surgery ; Arterial Occlusive Diseases ; surgery ; Endarterectomy ; Female ; Femoral Artery ; surgery ; Humans ; Iliac Aneurysm ; surgery ; Iliac Artery ; surgery ; Male ; Middle Aged ; Retroperitoneal Space ; surgery ; Retrospective Studies ; Treatment Outcome ; Vascular Surgical Procedures ; methods
5.Surgeon Custom-Made Iliac Branch Device to Salvage Hypogastric Artery during Endovascular Aneurysm Repair.
Young Eun PARK ; Jae Hoon LEE ; Woo Sung YUN ; Ki Hyuk PARK
Journal of Korean Medical Science 2014;29(12):1678-1683
Endovascular salvage of the hypogastric artery using iliac branch device (IBD) during endovascular aortic aneurysm repair (EVAR), offers less invasive alternative solution to surgery to prevent pelvic ischemia. We have performed the first Korean surgeon custom-made IBD for this purpose to overcome the limitation of unavailability of the devices in Korea. Four patients with abdominal aortic aneurysm with bilateral common iliac artery aneurysm (CIAA) were treated using custom-made IBDs from October 2013 to December 2013. IBD was created in back table before EVAR operation using TFLE Zenith iliac limb stent graft (Cook Inc.). Three V12 (Atrium, Inc.) one Viabahn (Gore, Inc.) were used for bridging between IBD and target hypogastric artery. With this modification of IBD procedure, exteriorize the guide wire without snare device is possible which offers another benefit in terms of reducing medical costs comparing to commercial IBD. All operations were successful without any device related complications or postoperative endoleaks. During the mean follow up of 3 months, all IBD were patent without clinical complications. Surgeon custom made IBD is feasible and useful to preserve pelvic perfusion especially in the situation of limited commercial IBD availability in many countries. Long-term follow-up is needed to evaluate stent graft patency and IBD-related complications.
Aged
;
Aortic Aneurysm, Abdominal/*surgery
;
*Blood Vessel Prosthesis
;
Endovascular Procedures/*instrumentation
;
Equipment Design
;
Equipment Failure Analysis
;
Female
;
Humans
;
Iliac Aneurysm/*surgery
;
Iliac Artery/*surgery
;
Male
;
Salvage Therapy/*instrumentation/methods
;
*Stents
6.Suitability of Endovascular Repair with Current Stent Grafts for Abdominal Aortic Aneurysm in Korean Patients.
Kay Hyun PARK ; Cheong LIM ; Jae Hang LEE ; Jae Suk YOO
Journal of Korean Medical Science 2011;26(8):1047-1051
Suitability rate of endovascular aneurysm repair (EVAR) and the anatomic features causing unsuitability have not been well determined in Asian patients who have abdominal aortic aneurysm (AAA). In a single Korean center, a total of 191 patients with abdominal aortic aneurysm (maximal diameter > or = 4 cm) were identified. Aortoiliac morphologic characteristics in contrast-enhanced computed tomography images were retrospectively reviewed to determine suitability for EVAR with four FDA-approved stent-grafts. AAA was considered ideally suitable for EVAR in 46.6% of patients. The most frequent causes for unsuitability were common iliac artery (CIA) aneurysm (61.8%) and excessive neck angulation (52.9%). Problems such as small and/or short neck and small access were found in minor incidences. If CIA aneurysm is dealt by overstenting with sacrifice of internal iliac artery, suitability rate can increase to 65%. Larger aneurysms were more frequently unsuitable for EVAR and had more chance of having multiple unfavorable features. In conclusion, the overall feasibility rate for EVAR in Korean patients was not different from that in Western patients. However, considering the difference in the major causes of unsuitability, more attention has to be paid to neck angulation and CIA aneurysm to provide EVAR for more Korean patients especially who have large aneurysm.
Aged
;
Aged, 80 and over
;
Aortic Aneurysm, Abdominal/*surgery
;
*Blood Vessel Prosthesis
;
Blood Vessel Prosthesis Implantation/*instrumentation
;
Female
;
Humans
;
Iliac Aneurysm/surgery
;
Iliac Artery
;
Male
;
Middle Aged
;
Republic of Korea
;
Retrospective Studies
;
*Stents
;
Tomography, Spiral Computed
7.Infectious Pseudoaneurysm Caused by Group A Streptococcus in a Child without Underlying Disease.
Kyoung Ha KIM ; Hyunju LEE ; Chi Eun OH
Pediatric Infection & Vaccine 2017;24(3):183-187
Group A streptococcus is a common cause of upper respiratory infection in children; however, it is a rare cause of pseudoaneurysm in pediatrics with only limited reports of cases associated with cardiac surgery and underlying disease. We report a case of infectious pseudoaneurysm of the right internal iliac artery caused by group A streptococcus in a previously healthy 5-year-old boy who presented with scarlet fever and group A streptococcal bacteremia. He was admitted to the hospital with fever, rash on the whole body, and sore throat, accompanied by severe leg pain. He was treated with surgical removal and antibiotics. Because a pseudoaneurysm may develop in children without vascularrelated underlying diseases, we should consider the possibility of this important clinical diagnosis in patients with scarlet fever.
Aneurysm, False*
;
Aneurysm, Infected
;
Anti-Bacterial Agents
;
Bacteremia
;
Child*
;
Child, Preschool
;
Diagnosis
;
Exanthema
;
Fever
;
Humans
;
Iliac Artery
;
Leg
;
Male
;
Pediatrics
;
Pharyngitis
;
Scarlet Fever
;
Streptococcus pyogenes
;
Streptococcus*
;
Thoracic Surgery
8.Infectious Pseudoaneurysm Caused by Group A Streptococcus in a Child without Underlying Disease.
Kyoung Ha KIM ; Hyunju LEE ; Chi Eun OH
Pediatric Infection & Vaccine 2017;24(3):183-187
Group A streptococcus is a common cause of upper respiratory infection in children; however, it is a rare cause of pseudoaneurysm in pediatrics with only limited reports of cases associated with cardiac surgery and underlying disease. We report a case of infectious pseudoaneurysm of the right internal iliac artery caused by group A streptococcus in a previously healthy 5-year-old boy who presented with scarlet fever and group A streptococcal bacteremia. He was admitted to the hospital with fever, rash on the whole body, and sore throat, accompanied by severe leg pain. He was treated with surgical removal and antibiotics. Because a pseudoaneurysm may develop in children without vascularrelated underlying diseases, we should consider the possibility of this important clinical diagnosis in patients with scarlet fever.
Aneurysm, False*
;
Aneurysm, Infected
;
Anti-Bacterial Agents
;
Bacteremia
;
Child*
;
Child, Preschool
;
Diagnosis
;
Exanthema
;
Fever
;
Humans
;
Iliac Artery
;
Leg
;
Male
;
Pediatrics
;
Pharyngitis
;
Scarlet Fever
;
Streptococcus pyogenes
;
Streptococcus*
;
Thoracic Surgery
9.Hybrid endovascular aorta repair with simultaneous supra-aortic branch or iliac branch revascularization.
Yue-Hong ZHENG ; Nim CHOI ; Hong-Ru DENG ; Cu KOUK ; Kun YU ; Furtado RUI
Chinese Medical Sciences Journal 2009;24(3):182-185
OBJECTIVETo describe a hybrid endovascular procedure for aorta repair with different kinds of bypass followed by concomitant placement of stent graft in the aorta.
METHODSFrom June 2007 to May 2008, 5 consecutive patients who presented with aortic aneurysm or dissection were treated with a new hybrid aorta repair technique. Complete surgical rerouting of supra-aortic vessels was simultaneously created by endovascular repair of aortic arch aneurysm with stent graft. Hybrid left carotid-subclavian bypass with stent graft deployment covering the ostium of the left subclavian artery was performed in a Debakey type III aortic dissection case. The supra-aortic branch was revascularized in 2 cases from ascending aorta to bilateral common carotid arteries using a 16-8 mm bifurcated graft, then total aortic arch and descending artery was occluded with stent-graft. The left carotid artery to the left subclavian artery bypass was created in 1 case, followed by stent-graft deployment. Two cases of infrarenal abdominal aortic aneurysm underwent left external iliac artery to left internal iliac artery bypass by a retroperineal route, then hybrid procedure was performed with bifurcated stent-graft. All stent grafts were deployed via a retrograde femoral artery approach in 5 patients.
RESULTSTechnical success with complete aneurysmal exclusion was achieved in all patients. There was no incidence of endoleak. During a follow-up period of 2 to 10 months, documented perioperative neurologic events did not occur in all patients. One patient suffered from adult respiratory distress syndrome. After received tracheostomy, he recovered later. There was one death resulting from a postoperative myocardial infarction.
CONCLUSIONHybrid arch repair provides an alternative therapy to patients otherwise considered prohibitively high risk for traditional open arch and thoracoabdominal aorta repair.
Aged ; Aorta ; surgery ; Aortic Aneurysm ; diagnostic imaging ; surgery ; Blood Vessel Prosthesis Implantation ; methods ; Humans ; Iliac Artery ; surgery ; Male ; Tomography, X-Ray Computed ; Vascular Surgical Procedures ; methods
10.Clinical Analysis of the Treatment of Iliac Limb Occlusion Following Endovascular Abdominal Aortic Aneurysm Repair.
Jiang SHAO ; Zhi-Chao LAI ; Xiao-Jun SONG ; Zhi-Li LIU ; Rong ZENG ; Yue-Xin CHEN ; Yue-Hong ZHENG ; Bao LIU
Acta Academiae Medicinae Sinicae 2021;43(6):917-921
Objective To explore the cause and the treatment strategies of iliac limb occlusion after endovascular abdominal aortic aneurysm repair(EVAR). Methods The patients receiving EVAR in PUMC Hospital from January 2015 to December 2020 were retrospectively analyzed.Sixteen(2.7%)cases of iliac limb occlusion were identified,among which 6,9,and 1 cases underwent surgical bypass,endovascular or hybrid procedure,and conservative treatment,respectively. Results Fifteen cases were successfully treated.During the 10.6-month follow-up,2 cases receiving hybrid treatment underwent femoral-femoral bypass due to re-occlusion of the iliac limb. Conclusions Iliac limb occlusion mostly occurs in the acute phase after EVAR,and endovascular or hybrid treatment can be the first choice for iliac limb occlusion.It is suggested to focus on the risk factors for prevention.
Aortic Aneurysm, Abdominal/surgery*
;
Blood Vessel Prosthesis
;
Blood Vessel Prosthesis Implantation/adverse effects*
;
Endovascular Procedures
;
Humans
;
Iliac Artery/surgery*
;
Retrospective Studies
;
Risk Factors
;
Stents
;
Treatment Outcome