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Surgical internal iliac artery preservation associated with endovascular repair of infrarenal aortoiliac aneurysms to avoid buttock claudication and distal type I endoleaks.
J Vasc Surg. 2018 12; 68(6):1736-1743.JV

Abstract

OBJECTIVE

The objective of this study was to assess outcomes of a hybrid technique for treatment of abdominal aortic aneurysm (AAA) associated with iliac aneurysm without distal neck by combining an AAA endovascular repair approach with open surgery for preservation of the internal iliac artery (IIA).

METHODS

The files of 51 patients operated on between 1998 and 2017 in a single vascular surgery department were retrospectively analyzed. Inclusion criteria were patients with AAA associated with uni-iliac or bi-iliac aneurysm without suitable distal sealing zone. Surgery consisted of deployment of an aortouni-iliac stent graft combined with an extra-anatomic crossover prosthetic bypass. With use of a limited retroperitoneal approach, the contralateral proximal common iliac aneurysm was surgically excluded and the IIA revascularized by direct ilioiliac anastomosis or terminal common iliac suture, preserving the iliac bifurcation.

RESULTS

The patients' mean age was 74 years (58-88 years), and 92% were men. The mean follow-up was 5.8 years (0.1-18 years). Twenty-nine patients (57%) had one or more high-risk criteria for open surgery. Nineteen patients (37.3%) had aortouni-iliac aneurysms, 19 (37.3%) aortobi-iliac aneurysms, 5 (10%) isolated iliac aneurysms, and 8 (15.7%) bi-iliac aneurysms without aortic location. Four patients (7.8%) also had IIA aneurysms. Surgery was successful in all cases. Two patients (4%) died during the 30 days after surgery. One surgically preserved IIA occluded within the first month, resulting in buttock claudication. The 5-year IIA primary patency rate was 96%. Type I proximal endoleaks occurred in two patients, requiring additional surgery 3 years and 13 years after the initial surgery, respectively.

CONCLUSIONS

This hybrid technique, consisting of AAA endovascular exclusion combined with open IIA revascularization, is safe and effective for preservation of pelvic vascularization. It is associated with long-term patency and low morbidity rates. We have been using this technique since before the advent of branched dedicated devices, allowing preservation of the IIA with good results. This technique should continue to be proposed, especially in patients not eligible for endovascular iliac branch repair because of anatomic contraindications, to avoid pelvic ischemia if the IIA has to be sacrificed.

Authors+Show Affiliations

Department of Vascular Surgery, Pitié-Salpêtrière Hospital, UPMC Paris 06, Paris, France. Electronic address: jgaudric@gmail.com.Department of Vascular Surgery, Pitié-Salpêtrière Hospital, UPMC Paris 06, Paris, France.Department of Vascular Surgery, Pitié-Salpêtrière Hospital, UPMC Paris 06, Paris, France.Biostatistics Department, Pitié-Salpêtrière Hospital, UPMC Paris 06, Paris, France; INSERM UMR_S1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.Department of Vascular Surgery, Pitié-Salpêtrière Hospital, UPMC Paris 06, Paris, France.Department of Vascular Surgery, Pitié-Salpêtrière Hospital, UPMC Paris 06, Paris, France.Department of Vascular Surgery, Pitié-Salpêtrière Hospital, UPMC Paris 06, Paris, France.Department of Vascular Surgery, Pitié-Salpêtrière Hospital, UPMC Paris 06, Paris, France.Department of Vascular Surgery, Pitié-Salpêtrière Hospital, UPMC Paris 06, Paris, France.Department of Vascular Surgery, Pitié-Salpêtrière Hospital, UPMC Paris 06, Paris, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29937285

Citation

Gaudric, Julien, et al. "Surgical Internal Iliac Artery Preservation Associated With Endovascular Repair of Infrarenal Aortoiliac Aneurysms to Avoid Buttock Claudication and Distal Type I Endoleaks." Journal of Vascular Surgery, vol. 68, no. 6, 2018, pp. 1736-1743.
Gaudric J, Tresson P, Derycke L, et al. Surgical internal iliac artery preservation associated with endovascular repair of infrarenal aortoiliac aneurysms to avoid buttock claudication and distal type I endoleaks. J Vasc Surg. 2018;68(6):1736-1743.
Gaudric, J., Tresson, P., Derycke, L., Tezenas Du Montcel, S., Couture, T., Davaine, J. M., Kashi, M., Lawton, J., Chiche, L., & Koskas, F. (2018). Surgical internal iliac artery preservation associated with endovascular repair of infrarenal aortoiliac aneurysms to avoid buttock claudication and distal type I endoleaks. Journal of Vascular Surgery, 68(6), 1736-1743. https://doi.org/10.1016/j.jvs.2018.03.416
Gaudric J, et al. Surgical Internal Iliac Artery Preservation Associated With Endovascular Repair of Infrarenal Aortoiliac Aneurysms to Avoid Buttock Claudication and Distal Type I Endoleaks. J Vasc Surg. 2018;68(6):1736-1743. PubMed PMID: 29937285.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical internal iliac artery preservation associated with endovascular repair of infrarenal aortoiliac aneurysms to avoid buttock claudication and distal type I endoleaks. AU - Gaudric,Julien, AU - Tresson,Philippe, AU - Derycke,Lucie, AU - Tezenas Du Montcel,Sophie, AU - Couture,Thibault, AU - Davaine,Jean-Michel, AU - Kashi,Mahine, AU - Lawton,James, AU - Chiche,Laurent, AU - Koskas,Fabien, Y1 - 2018/06/21/ PY - 2017/11/18/received PY - 2018/03/05/accepted PY - 2018/6/26/pubmed PY - 2019/3/15/medline PY - 2018/6/26/entrez KW - Buttock claudication KW - Hybrid technique KW - Iliac aneurysm KW - Internal iliac artery SP - 1736 EP - 1743 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 68 IS - 6 N2 - OBJECTIVE: The objective of this study was to assess outcomes of a hybrid technique for treatment of abdominal aortic aneurysm (AAA) associated with iliac aneurysm without distal neck by combining an AAA endovascular repair approach with open surgery for preservation of the internal iliac artery (IIA). METHODS: The files of 51 patients operated on between 1998 and 2017 in a single vascular surgery department were retrospectively analyzed. Inclusion criteria were patients with AAA associated with uni-iliac or bi-iliac aneurysm without suitable distal sealing zone. Surgery consisted of deployment of an aortouni-iliac stent graft combined with an extra-anatomic crossover prosthetic bypass. With use of a limited retroperitoneal approach, the contralateral proximal common iliac aneurysm was surgically excluded and the IIA revascularized by direct ilioiliac anastomosis or terminal common iliac suture, preserving the iliac bifurcation. RESULTS: The patients' mean age was 74 years (58-88 years), and 92% were men. The mean follow-up was 5.8 years (0.1-18 years). Twenty-nine patients (57%) had one or more high-risk criteria for open surgery. Nineteen patients (37.3%) had aortouni-iliac aneurysms, 19 (37.3%) aortobi-iliac aneurysms, 5 (10%) isolated iliac aneurysms, and 8 (15.7%) bi-iliac aneurysms without aortic location. Four patients (7.8%) also had IIA aneurysms. Surgery was successful in all cases. Two patients (4%) died during the 30 days after surgery. One surgically preserved IIA occluded within the first month, resulting in buttock claudication. The 5-year IIA primary patency rate was 96%. Type I proximal endoleaks occurred in two patients, requiring additional surgery 3 years and 13 years after the initial surgery, respectively. CONCLUSIONS: This hybrid technique, consisting of AAA endovascular exclusion combined with open IIA revascularization, is safe and effective for preservation of pelvic vascularization. It is associated with long-term patency and low morbidity rates. We have been using this technique since before the advent of branched dedicated devices, allowing preservation of the IIA with good results. This technique should continue to be proposed, especially in patients not eligible for endovascular iliac branch repair because of anatomic contraindications, to avoid pelvic ischemia if the IIA has to be sacrificed. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/29937285/Surgical_internal_iliac_artery_preservation_associated_with_endovascular_repair_of_infrarenal_aortoiliac_aneurysms_to_avoid_buttock_claudication_and_distal_type_I_endoleaks_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(18)30909-1 DB - PRIME DP - Unbound Medicine ER -