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Published on: July 7, 2013
Use of aortic cuffs to exclude iliac artery aneurysms during AneuRx stent-graft placement: initial experience
D B Brown1, L A Sanchez, D M Hovsepian
1Mallinckrodt Institute of Radiology, Washington University Medical Center, 510 South Kingshighway Boulevard, St. Louis, Missouri 63110, USA. brownda@mir.wustl.edu
Insights
Aortic cuffs offer a solution for iliac artery ectasia during endografting, preserving internal iliac artery flow and avoiding buttock claudication. This technique allows for stent-graft placement without embolization, maintaining future treatment options.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Abdominal Aortic Aneurysm
Background:
- Iliac artery ectasia affects up to 39% of patients undergoing abdominal aortic aneurysm endografting.
- Internal iliac artery embolization to manage ectasia can lead to buttock claudication in 19%-41% of patients.
- Alternative techniques are needed to manage iliac artery ectasia during endografting.
Purpose of the Study:
- To evaluate the use of larger-sized aortic cuffs to seal iliac limbs during endografting.
- To assess the outcomes and short-term results of using aortic cuffs to preserve internal iliac artery flow.
- To determine if aortic cuffs can prevent buttock claudication associated with internal iliac artery embolization.
Main Methods:
- A retrospective review of 14 patients who received 15 aortic cuffs for iliac limb sealing between October 1999 and August 2000.
- Aortic cuffs were placed across distal iliac graft limbs to preserve internal iliac artery flow.
- Patients were followed with computed tomography (CT) at 1, 6, and 12 months for endoleak evaluation.
Main Results:
- One- and 6-month endoleak rates were 0% and 10%, respectively.
- A type II endoleak occurred at 9 months and resolved spontaneously by 15 months.
- Only one patient (out of five who underwent embolization) experienced claudication.
Conclusions:
- Aortic cuffs effectively seal dilated iliac arteries and preserve ipsilateral internal iliac artery flow.
- This technique allows for stent-graft placement in patients with bilateral iliac ectasia without embolization.
- Larger patient cohorts and longer follow-up are needed to confirm the durability of aortic cuff placement.
Purpose:
As many as 39% of patients who undergo aortic endografting for abdominal aortic aneurysm disease will have ectasia of the iliac arteries that will require intervention. Coil embolization of the internal iliac artery and extension of the graft to the external iliac artery is one solution to this problem. However, 19%-41% of these patients experience buttock claudication, which may be permanent, after unilateral embolization. The authors examined an alternative: the use of larger-sized aortic cuffs to seal the iliac limb. Outcomes and short-term results are presented in this article.
Materials And Methods:
From October 1999 to August 2000, 144 AneuRx stent-grafts were placed at the authors' institution. Among the population receiving stent-grafts, 14 patients had 15 aortic cuffs placed across the distal iliac graft limbs to seal them and preserve flow to the internal iliac artery. One patient had bilateral cuffs placed. Five patients had embolization of the contralateral internal iliac artery because of bilateral disease. Patients were followed with computed tomography (CT) at 1, 6, and 12 months to evaluate for endoleaks.
Results:
One- and 6-month endoleak rates, determined from only those patients with follow-up CT, were 0% and 10%, respectively. One type II endoleak was first discovered 9 months after graft placement. It sealed spontaneously at 15-month follow-up. One patient among the five who had internal iliac artery embolization had claudication. Mean CT follow-up was 7.8 months (range, 1-15). One patient declined CT but was alive and well 11 months after endografting. One patient moved across the country and declined follow-up.
Conclusion:
Placement of aortic cuffs in dilated iliac arteries can preserve flow to the ipsilateral internal iliac artery and provide an adequate seal. Additionally, the option of later treatment is maintained. Patients with bilateral iliac ectasia can undergo stent-graft placement without bilateral internal iliac artery embolization. Longer-term follow-up in larger numbers of patients will be important to determine the ultimate durability of this technique.
