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Hybrid Endovascular Aortic Aneurysm Repair: Preservation of Pelvic Perfusion with External to Internal Iliac Artery Bypass.
Ann Vasc Surg. 2017 Jul; 42:162-168.AV

Abstract

BACKGROUND

Diminished pelvic arterial flow as a result of intentional coverage/embolization of internal iliac arteries (IIA) during isolated endovascular common iliac artery aneurysm (CIAA) repair or endovascular repair of abdominal aortic aneurysms (EVAR) may result in symptomatic pelvic ischemia. Although generally well tolerated, in severe cases, pelvic ischemia may manifest as recalcitrant buttock claudication, vasculogenic impotence, or perineal, vesicle, rectal, and/or spinal cord ischemia. Branched graft technology has recently become available; however, many patients are not candidates for endovascular repair with these devices. Therefore, techniques to preserve pelvic arterial flow are needed. We reviewed our outcomes of isolated endovascular CIAA repair or EVAR in conjunction with unilateral external-internal iliac artery bypass.

METHODS

Single-center, retrospective review of 10 consecutive patients who underwent hybrid endovascular abdominal aortic aneurysm (AAA) or CIAA repair with concomitant external-internal iliac artery bypass between 2006 and 2015. Demographics, index procedural details, postoperative symptoms, hospital length of stay (LOS), follow-up imaging, and bypass patency were recorded.

RESULTS

The cohort of 10 patients was all men with a mean age of 71 years (range: 56-84). Hybrid repair consisted of contralateral IIA coil embolization followed by EVAR with external iliac artery-internal iliac artery (EIA-IIA) bypass. All EIA-IIA bypasses were performed via a standard lower quadrant retroperitoneal approach with a prosthetic bypass graft. Technical success was 100%, and there were no perioperative deaths. One patient developed transient paraplegia, 1 patient had buttock claudication on the side of his hypogastric embolization contralateral to his iliac bypass, and 1 developed postoperative impotence. 20% of patients sustained long-term complications (buttock claudication and postoperative impotence). Mean LOS was 2.8 days (range: 1-9 days). Postoperative imaging was obtained in 90% of patients, and mean follow-up was 10.8 months (range: 0.5-36 months). All bypasses remained patent.

CONCLUSIONS

Although branched graft technology continues to evolve, strategies to maintain adequate pelvic circulation are necessary to avoid the devastating complications of pelvic ischemia. We have demonstrated that a hybrid approach combining EVAR or isolated endovascular common iliac artery exclusion with a unilateral external-internal iliac bypass via a retroperitoneal approach is well tolerated with a short LOS and excellent patency rates.

Authors+Show Affiliations

Division of Vascular Surgery, Department of Surgery, Northwestern University, Chicago, IL.Division of Vascular Surgery, Department of Surgery, Northwestern University, Chicago, IL.Department of Surgery, Northwestern University, Chicago, IL.Division of Vascular Surgery, Department of Surgery, Northwestern University, Chicago, IL.Division of Vascular Surgery, Department of Surgery, Northwestern University, Chicago, IL.Division of Vascular Surgery, Department of Surgery, Northwestern University, Chicago, IL. Electronic address: meskanda@nm.org.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28286187

Citation

Mansukhani, Neel A., et al. "Hybrid Endovascular Aortic Aneurysm Repair: Preservation of Pelvic Perfusion With External to Internal Iliac Artery Bypass." Annals of Vascular Surgery, vol. 42, 2017, pp. 162-168.
Mansukhani NA, Havelka GE, Helenowski IB, et al. Hybrid Endovascular Aortic Aneurysm Repair: Preservation of Pelvic Perfusion with External to Internal Iliac Artery Bypass. Ann Vasc Surg. 2017;42:162-168.
Mansukhani, N. A., Havelka, G. E., Helenowski, I. B., Rodriguez, H. E., Hoel, A. W., & Eskandari, M. K. (2017). Hybrid Endovascular Aortic Aneurysm Repair: Preservation of Pelvic Perfusion with External to Internal Iliac Artery Bypass. Annals of Vascular Surgery, 42, 162-168. https://doi.org/10.1016/j.avsg.2016.10.052
Mansukhani NA, et al. Hybrid Endovascular Aortic Aneurysm Repair: Preservation of Pelvic Perfusion With External to Internal Iliac Artery Bypass. Ann Vasc Surg. 2017;42:162-168. PubMed PMID: 28286187.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hybrid Endovascular Aortic Aneurysm Repair: Preservation of Pelvic Perfusion with External to Internal Iliac Artery Bypass. AU - Mansukhani,Neel A, AU - Havelka,George E, AU - Helenowski,Irene B, AU - Rodriguez,Heron E, AU - Hoel,Andrew W, AU - Eskandari,Mark K, Y1 - 2017/03/08/ PY - 2016/05/02/received PY - 2016/08/02/revised PY - 2016/10/19/accepted PY - 2017/3/14/pubmed PY - 2018/4/3/medline PY - 2017/3/14/entrez SP - 162 EP - 168 JF - Annals of vascular surgery JO - Ann Vasc Surg VL - 42 N2 - BACKGROUND: Diminished pelvic arterial flow as a result of intentional coverage/embolization of internal iliac arteries (IIA) during isolated endovascular common iliac artery aneurysm (CIAA) repair or endovascular repair of abdominal aortic aneurysms (EVAR) may result in symptomatic pelvic ischemia. Although generally well tolerated, in severe cases, pelvic ischemia may manifest as recalcitrant buttock claudication, vasculogenic impotence, or perineal, vesicle, rectal, and/or spinal cord ischemia. Branched graft technology has recently become available; however, many patients are not candidates for endovascular repair with these devices. Therefore, techniques to preserve pelvic arterial flow are needed. We reviewed our outcomes of isolated endovascular CIAA repair or EVAR in conjunction with unilateral external-internal iliac artery bypass. METHODS: Single-center, retrospective review of 10 consecutive patients who underwent hybrid endovascular abdominal aortic aneurysm (AAA) or CIAA repair with concomitant external-internal iliac artery bypass between 2006 and 2015. Demographics, index procedural details, postoperative symptoms, hospital length of stay (LOS), follow-up imaging, and bypass patency were recorded. RESULTS: The cohort of 10 patients was all men with a mean age of 71 years (range: 56-84). Hybrid repair consisted of contralateral IIA coil embolization followed by EVAR with external iliac artery-internal iliac artery (EIA-IIA) bypass. All EIA-IIA bypasses were performed via a standard lower quadrant retroperitoneal approach with a prosthetic bypass graft. Technical success was 100%, and there were no perioperative deaths. One patient developed transient paraplegia, 1 patient had buttock claudication on the side of his hypogastric embolization contralateral to his iliac bypass, and 1 developed postoperative impotence. 20% of patients sustained long-term complications (buttock claudication and postoperative impotence). Mean LOS was 2.8 days (range: 1-9 days). Postoperative imaging was obtained in 90% of patients, and mean follow-up was 10.8 months (range: 0.5-36 months). All bypasses remained patent. CONCLUSIONS: Although branched graft technology continues to evolve, strategies to maintain adequate pelvic circulation are necessary to avoid the devastating complications of pelvic ischemia. We have demonstrated that a hybrid approach combining EVAR or isolated endovascular common iliac artery exclusion with a unilateral external-internal iliac bypass via a retroperitoneal approach is well tolerated with a short LOS and excellent patency rates. SN - 1615-5947 UR - https://www.unboundmedicine.com/medline/citation/28286187/Hybrid_Endovascular_Aortic_Aneurysm_Repair:_Preservation_of_Pelvic_Perfusion_with_External_to_Internal_Iliac_Artery_Bypass_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0890-5096(17)30352-7 DB - PRIME DP - Unbound Medicine ER -