Minimally invasive treatment for isolated internal iliac artery aneurysms preserving superior gluteal artery flow

• Published in: General thoracic and cardiovascular surgery Vol. 67; no. 10; pp. 835 - 840
• Main Authors: Domoto, Satoru, Azuma, Takashi, Yokoi, Yoshihiko, Isomura, Syogo, Takahashi, Ken, Niinami, Hiroshi
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01.10.2019; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Aneurysms; Angiography; Blood Vessel Prosthesis Implantation - methods; Buttocks - blood supply; Cardiac Surgery; Cardiology; Catheters; Embolization; Endovascular Procedures - methods; Female; Follow-Up Studies; Humans; Iliac Aneurysm - diagnosis; Iliac Aneurysm - physiopathology; Iliac Aneurysm - surgery; Iliac Artery - diagnostic imaging; Iliac Artery - surgery; Ischemia; Local anesthesia; Male; Medicine; Medicine & Public Health; Original Article; Patients; Regional Blood Flow - physiology; Retrospective Studies; Stents; Surgical Oncology; Thoracic Surgery; Time Factors; Tomography; Tomography, X-Ray Computed; Treatment Outcome; United States > US; Isolated internal iliac artery aneurysms; Superior gluteal artery; Local anesthesia
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-019-01096-5

Objectives To prevent buttock claudication, we performed endovascular aortic aneurysm repair (EVAR) for isolated internal iliac aneurysms (IIAAs) with selective preservation of the superior gluteal artery (SGA) flow. This study evaluates early clinical outcomes of this treatment. Methods and results We retrospectively evaluated 6 patients with isolated IIAA who underwent EVAR under local anesthesia between October 2017 and July 2018 at Tokyo Women’s Medical University Hospital. We used self-expanding stent grafts to exclude the IIAA while preserving SGA flow. If necessary, we occluded the inferior gluteal artery and other branches with vascular plugs to prevent type II endoleak. The mean proximal neck diameter and length of the IIAAs to be 9.4 ± 2.4 mm and 17.7 ± 11.3 mm. The mean diameter of the SGA was 6.5 ± 0.9 mm. There were no procedural complications, and the mean procedure time was 84 ± 24 min. All patients were free from buttock claudication at follow-up. Postoperative computed tomography demonstrated a 100% primary patency rate of the SGA stent graft: there was no case of migration or endoleak. Conclusion EVAR for IIAAs with SGA flow preservation shows favorable early clinical outcomes. To prevent buttock claudication, SGA flow is necessary and sufficient. This novel approach is less invasive compared to conventional IIAA repair.