Endovascular repair with contralateral external-to-internal iliac artery bypass grafting: a case series
Yasuhiko Kobayashi1, Masayuki Sakaki2, Takashi Yasuoka3
1Department of Cardiovascular Surgery, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan. bw100kg@hotmail.co.jp.
Insights
This study presents a novel technique for abdominal aortic aneurysm repair, preserving blood flow to one internal iliac artery using an external-to-internal artery bypass. This method proves safe and effective for endovascular repair, reducing complications.
Area of Science:
- Vascular Surgery
- Endovascular Repair
- Aneurysm Treatment
Background:
- Abdominal aortic aneurysms (AAAs) pose significant risks, necessitating advanced repair techniques.
- Maintaining internal iliac artery (IIA) blood flow is crucial during endovascular AAA repair (EVAR).
- This study introduces a novel technique for unilateral IIA preservation during EVAR.
Observation:
- A cohort of 6 Japanese patients with infra-renal AAAs underwent EVAR using a retroperitoneal approach.
- A key component involved creating an external-to-internal artery bypass to maintain flow in one IIA.
- The contralateral IIA was coil-embolized, and EVAR was performed approximately 29 days later.
Findings:
- The described technique of external-to-internal artery bypass for unilateral IIA preservation during EVAR was successfully implemented.
- No postoperative complications were observed during a mean follow-up of 17.5 months.
- Computed tomography angiography confirmed patent grafts in all patients at 1-3 months post-procedure.
Implications:
- This approach offers a feasible and safe strategy for EVAR in patients requiring IIA management.
- Unilateral IIA embolization combined with external-to-internal artery bypass may reduce postoperative complications.
- This technique expands options for complex AAA cases requiring preservation of pelvic perfusion.
Background:
To report a technique of keeping unilateral blood flow in the internal iliac artery in cases of an abdominal aortic aneurysm in achieving successful Endovascular abdominal aortic aneurysm repair using an external-to-internal artery bypass.
Case Presentation:
6 japanese patients with infra-renal abdominal aortic aneurysms were treated using the retroperitoneal approach via a left (right) paramedian incision followed by an external-to-internal artery bypass. Endovascular abdominal aortic aneurysm repair was conducted on mean postoperative day 29 ± 18 and was performed because the contralateral internal iliac artery, which was not involved in the external-to-internal artery bypass, was treated with a coil embolization. No complications developed during the postoperative follow-up period (17 ± 1.5 months). In all 6 patients, patent grafts were evident on computed tomography angiography scans even after 1-3 months.
Conclusions:
Endovascular abdominal aortic aneurysm repair with unilateral internal iliac artery embolization and contralateral external-to-internal artery bypass is feasible with a relatively low risk. It is a safe procedure and reduces the incidence of postoperative complications.
