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Internal iliac artery revascularization as an adjunct to endovascular repair of aortoiliac aneurysms.
J Vasc Surg. 2001 Nov; 34(5):892-9.JV

Abstract

PURPOSE

Endovascular repair of aortoiliac aneurysms may be limited by extension of the aneurysm to the iliac bifurcation, necessitating endpoint implantation in the external iliac artery. In such cases the circulation to the internal iliac artery is interrupted. Bilateral internal iliac artery occlusion during endovascular repair may be associated with significant morbidity, including gluteal claudication, erectile dysfunction, and ischemia of the sigmoid colon and perineum. We have employed internal iliac artery revascularization (IIR) to allow endograft implantation in the external iliac artery while preserving flow to the internal iliac artery in patients with aneurysms involving the iliac bifurcation bilaterally.

METHODS

A total of 11 IIR procedures were performed in 10 patients undergoing endovascular abdominal aortic aneurysm (AAA) repair (9 men, 1 woman; mean age, 74 years). IIR was accomplished via a retroinguinal incision in 9 cases and a retroperitoneal incision in 2 cases. Six-mm polyester grafts were used for external-to-internal iliac artery bypass in 10 cases and internal iliac artery transposition onto the external iliac artery was used in one case. Endovascular AAA repair was performed using a modular bifurcated device (Talent-LPS, Medtronics, Minneapolis, Minn) after IIR. Bypass graft patency was determined immediately after the surgery, at 1 month, and every 3 months thereafter, using duplex ultrasound scanning and computed-tomography angiography. Mean aneurysm diameters were as follows: AAA, 6.4 +/- 0.7 cm; ipsilateral common iliac, 3.7 +/- 1.0 cm; contralateral common iliac, 3.9 +/- 0.8 cm.

RESULTS

Successful IIR and endovascular AAA repair were accomplished in all cases. No proximal, distal, or graft junction endoleaks occurred. Two patients demonstrated retrograde aneurysm side-branch endoleaks originating from the lumbar arteries. One thrombosed spontaneously within 3 months. One perioperative myocardial infarction occurred. Reduction in aneurysm size was documented in 5 aortic, 5 ipsilateral iliac, and 3 contralateral iliac aneurysms. Gluteal claudication, erectile dysfunction, colon and perineal ischemia, and mortality did not occur. All IIRs have remained patent during a follow-up period of 4 to 15 months (mean, 10.1 months).

CONCLUSIONS

IIR may be used with good short-term to intermediate-term patency to prevent pelvic ischemia in patients whose aneurysm anatomy requires extension of the endograft into the external iliac artery. This may allow endovascular AAA repair to be performed in patients who might otherwise be at risk for developing complications associated with bilateral internal iliac artery occlusion.

Authors+Show Affiliations

Division of Vascular Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, NY 10029, USA. peter.faries@mssm.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11700492

Citation

Faries, P L., et al. "Internal Iliac Artery Revascularization as an Adjunct to Endovascular Repair of Aortoiliac Aneurysms." Journal of Vascular Surgery, vol. 34, no. 5, 2001, pp. 892-9.
Faries PL, Morrissey N, Burks JA, et al. Internal iliac artery revascularization as an adjunct to endovascular repair of aortoiliac aneurysms. J Vasc Surg. 2001;34(5):892-9.
Faries, P. L., Morrissey, N., Burks, J. A., Gravereaux, E., Kerstein, M. D., Teodorescu, V. J., Hollier, L. H., & Marin, M. L. (2001). Internal iliac artery revascularization as an adjunct to endovascular repair of aortoiliac aneurysms. Journal of Vascular Surgery, 34(5), 892-9.
Faries PL, et al. Internal Iliac Artery Revascularization as an Adjunct to Endovascular Repair of Aortoiliac Aneurysms. J Vasc Surg. 2001;34(5):892-9. PubMed PMID: 11700492.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Internal iliac artery revascularization as an adjunct to endovascular repair of aortoiliac aneurysms. AU - Faries,P L, AU - Morrissey,N, AU - Burks,J A, AU - Gravereaux,E, AU - Kerstein,M D, AU - Teodorescu,V J, AU - Hollier,L H, AU - Marin,M L, PY - 2001/11/9/pubmed PY - 2002/1/5/medline PY - 2001/11/9/entrez SP - 892 EP - 9 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 34 IS - 5 N2 - PURPOSE: Endovascular repair of aortoiliac aneurysms may be limited by extension of the aneurysm to the iliac bifurcation, necessitating endpoint implantation in the external iliac artery. In such cases the circulation to the internal iliac artery is interrupted. Bilateral internal iliac artery occlusion during endovascular repair may be associated with significant morbidity, including gluteal claudication, erectile dysfunction, and ischemia of the sigmoid colon and perineum. We have employed internal iliac artery revascularization (IIR) to allow endograft implantation in the external iliac artery while preserving flow to the internal iliac artery in patients with aneurysms involving the iliac bifurcation bilaterally. METHODS: A total of 11 IIR procedures were performed in 10 patients undergoing endovascular abdominal aortic aneurysm (AAA) repair (9 men, 1 woman; mean age, 74 years). IIR was accomplished via a retroinguinal incision in 9 cases and a retroperitoneal incision in 2 cases. Six-mm polyester grafts were used for external-to-internal iliac artery bypass in 10 cases and internal iliac artery transposition onto the external iliac artery was used in one case. Endovascular AAA repair was performed using a modular bifurcated device (Talent-LPS, Medtronics, Minneapolis, Minn) after IIR. Bypass graft patency was determined immediately after the surgery, at 1 month, and every 3 months thereafter, using duplex ultrasound scanning and computed-tomography angiography. Mean aneurysm diameters were as follows: AAA, 6.4 +/- 0.7 cm; ipsilateral common iliac, 3.7 +/- 1.0 cm; contralateral common iliac, 3.9 +/- 0.8 cm. RESULTS: Successful IIR and endovascular AAA repair were accomplished in all cases. No proximal, distal, or graft junction endoleaks occurred. Two patients demonstrated retrograde aneurysm side-branch endoleaks originating from the lumbar arteries. One thrombosed spontaneously within 3 months. One perioperative myocardial infarction occurred. Reduction in aneurysm size was documented in 5 aortic, 5 ipsilateral iliac, and 3 contralateral iliac aneurysms. Gluteal claudication, erectile dysfunction, colon and perineal ischemia, and mortality did not occur. All IIRs have remained patent during a follow-up period of 4 to 15 months (mean, 10.1 months). CONCLUSIONS: IIR may be used with good short-term to intermediate-term patency to prevent pelvic ischemia in patients whose aneurysm anatomy requires extension of the endograft into the external iliac artery. This may allow endovascular AAA repair to be performed in patients who might otherwise be at risk for developing complications associated with bilateral internal iliac artery occlusion. SN - 0741-5214 UR - https://www.unboundmedicine.com/medline/citation/11700492/Internal_iliac_artery_revascularization_as_an_adjunct_to_endovascular_repair_of_aortoiliac_aneurysms_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(01)65788-4 DB - PRIME DP - Unbound Medicine ER -