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. 2014:2014:178610.
doi: 10.1155/2014/178610. Epub 2014 Sep 28.

Complex common and internal iliac or aortoiliac aneurysms and current approach: individualised open-endovascular or combined procedures

Thomas Kotsis  1 , Louizos Alexander Louizos  1 , Evangelos Pappas  1 , Kassiani Theodoraki  2
Affiliations

Complex common and internal iliac or aortoiliac aneurysms and current approach: individualised open-endovascular or combined procedures

Thomas Kotsis et al. Int J Vasc Med. 2014.

Abstract

Objective. Bilateral internal iliac artery aneurysms constitute the utmost configuration of infrarenal aortoiliac disease. We detail characteristic aortoiliac disease patterns and reconstructive techniques we have used, along with a visualized decision-making chart and a short review of the literature. Material and Methods. A retrospective, observational study of twelve clinical cases of patients with aortoiliac disease are described. Two patients had a common iliac artery aneurysm and were managed by the application of inversed stent-grafts; another case was repaired by the insertion of a standard bifurcated stent-graft flared in the right common iliac artery and with an iliac branched device in the left iliac arterial axis. Open approach was used in 5 cases and in 4 cases a combination of aortouniliac stent-grafting with femoral-femoral bypass was applied. Results. Technical success was 100%. One endoleak type Ib in a flared iliac limb was observed and corrected by internal iliac embolism and use of an iliac limb stent-graft extension. We report 100% patency rate during 26.3 months of followup. Conclusion. Individualized techniques for the management of isolated iliac or aortoiliac aneurismal desease with special concern in maintaining internal iliac artery perfusion lead to elimination of perioperative complications and long-term durability and patency rates.

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Figures

Figure 1
Figure 1
(a) Left common iliac artery aneurysm with large aneurysm's neck before and after implantation angiography; two concentric stents were inserted. (b) Right common iliac artery aneurysm with rich aortic collaterals and bilateral automatically thrombosed iliac artery aneurysms; an inverted stent-graft was implanted.
Figure 2
Figure 2
Two cases of complex aortoiliac aneurismal disease.
Figure 3
Figure 3
A 55-year-old patient with an AAA, bilateral common iliac, and left internal iliac artery aneurysms.
Figure 4
Figure 4
Intraoperative view of left common and internal iliac artery aneurysms and reconstruction.
Figure 5
Figure 5
Concurrent AAA and left common iliac artery occlusion; an aortouniliac stent-graft insertion and a femoral-femoral bypass were performed.
Figure 6
Figure 6
Migration and intense angulation of iliac graft limbs following EVAR, which necessitated the implantation of an aortouniliac stent-graft and a femoral-femoral bypass.
Figure 7
Figure 7
(a) A complex aortoiliac aneurismal pattern with bilateral CIAA and AAA. (b) Follow-up CT scan in one year showing endoleak type Ib in the flared right CIA and aneurysm sac expansion. (c) Completion angiography after right IIA embolization and extension stent grafts from right CIA to right EIA.
Figure 8
Figure 8
Two cases of complex open (a) and combined (b) reconstructions, respectively.
See this image and copyright information in PMC

References

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