Ann Surg Treat Res.  2015 Aug;89(2):107-110. 10.4174/astr.2015.89.2.107.

Endovascular aortic aneurysm repair using a bifurcated stent graft in a patient with femoro-femoral bypass

Affiliations
  • 1Division of Transplantation and Vascular Surgery, Department of Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea. wsyun@me.com

Abstract

A challenging iliac anatomy remains a major obstacle to successful endovascular aortic aneurysm repair. The authors experienced an abdominal aortic aneurysm with bilateral common iliac artery aneurysms in a patient that had undergone femoro-femoral bypass due to left external iliac artery (EIA) occlusion. To treat this patient in a totally endovascular manner, a bifurcated stent graft was used. One iliac limb was deployed in the right internal iliac artery (IIA) and the other in the right EIA; the left IIA was embolized with coils. Here, the authors describe the procedure used and provide technical tips.

Keyword

Abdominal aortic aneurysm; Endovascular aneurysm repair

MeSH Terms

Aneurysm
Aortic Aneurysm*
Aortic Aneurysm, Abdominal
Blood Vessel Prosthesis*
Extremities
Humans
Iliac Artery

Figure

  • Fig. 1 Preoperative computed tomography arteriography. Axial images (A, B) and volume rendering image (C).

  • Fig. 2 Preoperative anatomical measurements (A) and endovascular aortic aneurysm repair planning (B). Unit: mm.

  • Fig. 3 Procedural details. (A) The left right internal iliac artery (IIA) was embolized with coils through the left axillary artery. (B) The main body stent graft (Zenith, 24-82 mm) was deployed after aortography. (C) The contralateral gate of the main body was cannulated via the main body sheath. (D) A contralateral bridge iliac limb (Zenith, 8-54 mm) was deployed. (E) The contralateral iliac limb was extended to the right IIA using a 10 × 100-mm Viabahn stent graft. (F) Finally, the ipsilateral iliac limb (Zenith, 12-90 mm) was deployed to the right external iliac artery.

  • Fig. 4 Follow-up computed tomography arteriography 6 months after endovascular aortic aneurysm repair. Axial images (A, B) and volume rendering image (C).


Reference

1. Henretta JP, Karch LA, Hodgson KJ, Mattos MA, Ramsey DE, McLafferty R, et al. Special iliac artery considerations during aneurysm endografting. Am J Surg. 1999; 178:212–218.
2. Murray D, Ghosh J, Khwaja N, Murphy MO, Baguneid MS, Walker MG. Access for endovascular aneurysm repair. J Endovasc Ther. 2006; 13:754–761.
3. Cheng SW, Ting AC, Ho P, Poon JT. Aortic aneurysm morphology in Asians: features affecting stent-graft application and design. J Endovasc Ther. 2004; 11:605–612.
4. Park KH, Lim C, Lee JH, Yoo JS. Suitability of endovascular repair with current stent grafts for abdominal aortic aneurysm in Korean patients. J Korean Med Sci. 2011; 26:1047–1051.
5. Lobato AC. Sandwich technique for aortoiliac aneurysms extending to the internal iliac artery or isolated common/internal iliac artery aneurysms: a new endovascular approach to preserve pelvic circulation. J Endovasc Ther. 2011; 18:106–111.
6. Matteo J, Cunningham J. Size matters! A reliable endovascular method to avoid infolding and endoleaks when reconstructing aortic bifurcations using stent grafts. Vascular. 2012; 20:124–128.
7. Wong S, Greenberg RK, Brown CR, Mastracci TM, Bena J, Eagleton MJ. Endovascular repair of aortoiliac aneurysmal disease with the helical iliac bifurcation device and the bifurcated-bifurcated iliac bifurcation device. J Vasc Surg. 2013; 58:861–869.
8. Park YE, Lee JH, Yun WS, Park KH. Surgeon custom-made iliac branch device to salvage hypogastric artery during endovascular aneurysm repair. J Korean Med Sci. 2014; 29:1678–1683.
9. Torsello G, Schonefeld E, Osada N, Austermann M, Pennekamp C, Donas KP. Endovascular treatment of common iliac artery aneurysms using the bell-bottom technique: long-term results. J Endovasc Ther. 2010; 17:504–509.
10. Minion DJ, Xenos E, Sorial E, Saha S, Endean ED. The trifurcated endograft technique for hypogastric preservation during endovascular aneurysm repair. J Vasc Surg. 2008; 47:658–661.
Full Text Links
  • ASTR
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr