Korean Circ J.  2016 May;46(3):412-416. 10.4070/kcj.2016.46.3.412.

Preservation of Internal Iliac Artery after Endovascular Repair of Common Iliac Artery Dissection Using Modified Fenestrated Stent Graft

• Zha B
• Zhu H
• Liu B
• Ye Y
• Li J

• KMID: 2344455
• DOI: http://doi.org/10.4070/kcj.2016.46.3.412

Abstract

Standard endovascular repair of iliac/aortoiliac pathologies can lead to complications, such as buttock claudication, colon ischemia and erectile dysfunction. Branch grafts have been developed but require at least 6 weeks for customization and are not currently available in China; they are also quite expensive. To our knowledge, modified fenestrated stent grafts (MFSGs) are a safe and effective alternative for treating patients with juxtarenal aneurysms. Most MFSGs are used for the preservation of renal and left subclavian arteries. Few cases of MFSGs have been reported in the treatment of iliac pathologies. The use of an MFSG is decided on a case-by-case basis. This report presents our first clinical use of an MFSG for preservation of the internal iliac artery.

Keyword

Dissection; Iliac artery; Fenestrated stent-graft

MeSH Terms

Aneurysm
Blood Vessel Prosthesis*
Buttocks
China
Colon
Erectile Dysfunction
Humans
Iliac Artery*
Ischemia
Male
Pathology
Stents*
Subclavian Artery
Transplants

Figure

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  Fig. 1 Three-dimensional reconstructed images show a slightly dilated common iliac artery (CIA), as well as dissection from the CIA to the external iliac artery with intimal tears in the CIA, without dilation of the internal iliac artery.

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  Fig. 2 An ophthalmologic cautery was used to carefully burn the Dacron fabric to create the fenestration.

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  Fig. 3 A longitudinal radiopaque marker was sutured to the polyester graft for orientation just below the fenestrated ostium using 6-0 Prolene sutures.

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  Fig. 4 The aortogram revealed right iliac dissection with intimal tears in the common iliac artery, which was limited to the proximal end of the external iliac artery at the left anterior oblique 40°+caudal 15° projection angle.

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  Fig. 5 The aortogram revealed that the iliac dissection successfully excluded and preserved the flow of the internal iliac artery. Arrows show the endoleak Ib (down) and IV (up).

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  Fig. 6 Repeat angiography showed intact flow into the internal iliac artery, a narrowed endoleak IV, and the disappearance of endoleak Ib.

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  Fig. 7 Three-dimensional reconstructed images after 5 months revealed no endoleaks and showed a patent right internal iliac artery. The preplanned fenestration was closely aligned with the vessel ostia.

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