[Endovascular treatment of common iliac artery aneurisms]
S A Abugov1, R S Polyakov1, M V Puretsky1
1Petrovsky Russian Scientific Center of Surgery, Moscow, Russia.
Insights
Iliac branch devices offer a 100% technical success rate for endovascular repair of common iliac artery aneurysms, preserving internal iliac artery blood flow and avoiding ischemic complications.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Medical Device Technology
Background:
- Common iliac artery aneurysms (CIAs) often occur with abdominal aortic aneurysms (AAAs).
- Traditional endovascular repair of AAAs with CIAs frequently involved sacrificing the internal iliac artery (IIA), leading to potential ischemic complications.
- Advancements in endovascular techniques and device technology are crucial for managing complex iliac artery pathology.
Purpose of the Study:
- To demonstrate the efficacy of endovascular management for common iliac artery aneurysms using iliac branch devices (IBDs).
- To discuss technical aspects and outcomes of interventions involving IBDs, including bilateral procedures.
- To highlight the benefits of preserving IIA blood flow with IBDs compared to traditional methods.
Main Methods:
- A retrospective analysis of 9 patients undergoing endovascular abdominal aortic aneurysm repair with concomitant iliac branch device implantation between January 2019 and December 2020.
- Preoperative planning utilized 1 mm slice thickness CT data and Osirix 3D software for morphometric analysis.
- All patients had iliac artery aneurysms exceeding 4 cm, with 77.7% having concomitant AAAs and 33.3% presenting with isolated CIAs (Reber type I).
Main Results:
- Achieved a 100% technical success rate for endovascular repair of common iliac artery aneurysms with IBDs.
- No endoleaks, stent-graft thrombosis, or signs of pelvic/lower extremity ischemia were observed at follow-up.
- Preservation of internal iliac artery blood flow was successfully achieved, avoiding complications associated with IIA embolization.
Conclusions:
- Iliac branch devices provide a safe and effective endovascular solution for managing common iliac artery aneurysms, including those associated with abdominal aortic aneurysms.
- This approach allows for the preservation of internal iliac artery perfusion, mitigating the risk of ischemic complications.
- The development and application of IBDs represent a significant advancement in the endovascular treatment of complex iliac artery aneurysms.
Objective:
To demonstrate endovascular management of common iliac artery aneurysms with iliac branch devices and to discuss some technical aspects of these interventions including bilateral procedures.
Material And Methods:
Endovascular abdominal aortic aneurysm repair with concomitant implantation of iliac branch devices was performed in 9 patients at the Petrovsky National Research Center of Surgery for the period from January 2019 to December 2020. Mean age of patients was 64.8± years (min 52; max 72 years). Preoperative planning and morphometric analysis were based on CT data with a slice thickness of 1 mm. Angiographic reconstruction was made using Osirix 3D software (OsiriX Foundation, Geneva, Switzerland). Abdominal aortic aneurysm was combined with common iliac artery aneurysm in 7 patients (77.7%). Three (33.3%) patients had isolated common iliac artery aneurysm without significant abdominal aorta enlargement (Reber type I). Bilateral common iliac artery aneurysms were detected in 1 (11.1%) patient. All patients had iliac artery aneurysms over 4 cm. Iliac branch device implantation was accompanied by endovascular abdominal aneurysm repair in all patients.
Results:
Technical success rate was 100%. Six-month results were followed-up in 5 patients (55.5%), annual outcomes - in 2 patients (22.2%). Control examination consisted of a telephone interview, ultrasound of abdominal aorta, pelvic and lower limb arteries and computed tomography. All patients had no endoleaks, stent-graft thrombosis, as well as signs of ischemia of pelvic organs and lower extremities. Incidence of iliac artery aneurysm combined with abdominal aortic aneurysms is about 20%. Until recently, treatment of these patients was performed exclusively with covering of internal iliac artery. Improvement of technologies and development of iliac branch devices made it possible to preserve blood flow in internal iliac artery after endovascular management. This approach allowed avoiding of ischemic complications associated with embolization of internal iliac arteries.
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