Alexander Massmann1, Nilo Javier Mosquera Arochena2, Roushanak Shayesteh-Kheslat3, Arno Buecker4. 1. Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, 66421 Homburg, Saar, Germany. Electronic address: Alexander.Massmann@uks.eu. 2. Clinic for Vascular and Endovascular Surgery, CHUO Hospital, Ourense, Spain. Electronic address: nmarochena@me.com. 3. Clinic for Vascular and Endovascular Surgery, Saarland University Medical Center, 66421 Homburg, Saar, Germany. Electronic address: Roushanak.Shayesteh-Kheslat@uks.eu. 4. Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, 66421 Homburg, Saar, Germany. Electronic address: Arno.Buecker@uks.eu.
Abstract
OBJECTIVE: Endovascular anatomic reconstruction of iliac artery bifurcation in aorto-iliac aneurysms using commercial stentgrafts in sandwich-technique by bilateral transfemoral approach. METHODS: 24 patients (mean 73.8±standard deviation 6.8years) with complex aorto-iliac aneurysms (AAA): n=17; diameter 64±15 [48-100]mm; common-iliac-artery (CIA): n=27; 43±15 [30-87]mm; internal-iliac-artery (IIA): n=14; 28±8 [15-43]mm) were prospectively enrolled for EVAR with preservation of the IIA (n=31; bi-lateral n=7). Maintenance of antegrade flow to IIA by iliac reconstruction was performed in sandwich-technique prior to EVAR. Follow-up of 15.0±10.8 [1-40]months included contrast-enhanced ultrasound and computed-tomography after 1week, 3, 6 and every 12months. RESULTS: Initial technical success for anatomic reconstruction of the iliac arteries in 31 instances was 100%. Primary patency of iliac neo-bifurcations was 90.9% (20/22) at 6months and 84.2% (16/19) at 1year. Postprocedural gutter-endoleaks type 1b were obvious in 6.5% (2/31) of cases, which disappeared 3months later. Aortic/iliac aneurysm-size after 1year decreased (>5mm) in 61.5% of patients. No aneurysm-size increase or late rupture occurred. CONCLUSIONS: Endovascular reconstruction of the iliac bifurcation with commercial standard stentgrafts is safe and effective. Transfemoral approach allows extension of distal landing zone for EVAR while preserving the internal iliac artery blood-flow, even in unfavorable iliac anatomy.
OBJECTIVE: Endovascular anatomic reconstruction of iliac artery bifurcation in aorto-iliac aneurysms using commercial stentgrafts in sandwich-technique by bilateral transfemoral approach. METHODS: 24 patients (mean 73.8±standard deviation 6.8years) with complex aorto-iliac aneurysms (AAA): n=17; diameter 64±15 [48-100]mm; common-iliac-artery (CIA): n=27; 43±15 [30-87]mm; internal-iliac-artery (IIA): n=14; 28±8 [15-43]mm) were prospectively enrolled for EVAR with preservation of the IIA (n=31; bi-lateral n=7). Maintenance of antegrade flow to IIA by iliac reconstruction was performed in sandwich-technique prior to EVAR. Follow-up of 15.0±10.8 [1-40]months included contrast-enhanced ultrasound and computed-tomography after 1week, 3, 6 and every 12months. RESULTS: Initial technical success for anatomic reconstruction of the iliac arteries in 31 instances was 100%. Primary patency of iliac neo-bifurcations was 90.9% (20/22) at 6months and 84.2% (16/19) at 1year. Postprocedural gutter-endoleaks type 1b were obvious in 6.5% (2/31) of cases, which disappeared 3months later. Aortic/iliac aneurysm-size after 1year decreased (>5mm) in 61.5% of patients. No aneurysm-size increase or late rupture occurred. CONCLUSIONS: Endovascular reconstruction of the iliac bifurcation with commercial standard stentgrafts is safe and effective. Transfemoral approach allows extension of distal landing zone for EVAR while preserving the internal iliac artery blood-flow, even in unfavorable iliac anatomy.
Authors: Alexander Massmann; Peter Fries; Roushanak Shayesteh-Kheslat; Arno Buecker; Michael Stöckle; Christina Niklas Journal: J Vasc Surg Cases Innov Tech Date: 2020-04-14