Special iliac artery considerations during aneurysm endografting

• Published in: The American journal of surgery Vol. 178; no. 3; pp. 212 - 218
• Main Authors: Henretta, John P, Karch, Laura A, Hodgson, Kim J, Mattos, Mark A, Ramsey, Don E, McLafferty, Robert, Sumner, David S
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.09.1999; Elsevier; Elsevier Limited
• Subjects: Abdomen; Anatomy; Aorta; Aortic Aneurysm, Abdominal - surgery; Aortic aneurysms; Arteries; Arteriosclerosis; Atherosclerosis; Bifurcations; Biological and medical sciences; Blood Vessel Prosthesis Implantation - methods; Cardiovascular system; Cuffs; Embolization; Embolization, Therapeutic; Endovascular coiling; Humans; Iliac Aneurysm - surgery; Iliac Artery - pathology; Kinking; Medical sciences; Patients; Prospective Studies; Prosthesis Design; Stenosis; Stents; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical equipment; Tortuosity; Tracking devices; Ultrasonic imaging; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Veins & arteries; Arterial disease; Vascular disease; Abdominal aorta; Human; Treatment; Surgery; Aneurysm; Cardiovascular disease; Graft; Technique; Aortic disease; Iliac artery
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(99)00156-7

Background: The feasibility of endograft exclusion of abdominal aortic aneurysms (AAA) has been established. However, the technical challenges of graft delivery through tortuous or diseased iliac arteries and the treatment of associated iliac aneurysmal disease have received little attention. Methods: Over 19 months, 74 patients underwent endoluminal repair of AAA and/or iliac artery aneurysms. Iliac anatomy that required special consideration during endografting was reviewed. Results: Of the 74 patients, 35 (47%) had iliac anatomy that required special attention. Thirteen patients (18%) had aneurysmal involvement of a common iliac artery. Eleven of these patients required endograft extension into the external iliac artery (EIA) and hypogastric coil embolization due to the proximity of the aneurysm to the hypogastric origin. Eleven patients with ectatic, nonaneurysmal iliac arteries required aortic cuffs to achieve a distal seal in these oversized vessels. Iliac artery tortuosity or stenosis were complicating factors in 27 of the 74 patients (36%), requiring the use of brachial guidewire tension in 2 patients to facilitate tracking of the delivery device. Five patients with severely splayed aortic bifurcations required crossed placement of the iliac limbs to prevent kinking of the endograft. Occlusive atherosclerotic disease of the EIA mandated preprocedural dilatation and stenting in 3 patients and postprocedural surgical EIA reconstruction in another 5 patients. Three patients who underwent successful endograft placement required subsequent endovascular repair of traumatized EIAs. Conclusions: Iliac artery anatomy plays a significant role in the endoluminal treatment of infrarenal abdominal aortic aneurysms, complicating the procedure in up to 47% of patients with otherwise suitable anatomy. A variety of supplemental procedures, both surgical and endovascular, may be required to facilitate endograft placement. A special understanding of these constraints and proper planning is required for optimal therapy.