Korean Circ J.  2010 Jul;40(7):343-347. 10.4070/kcj.2010.40.7.343.

Endovascular Treatment of Isolated Common Iliac Artery Aneurysms With Short Necks Using Bifurcated Stent-Grafts

• Wi J
• Ko YG
• Kim JS
• Choi D
• Hong MK
• Lee DY
• Jang Y
• Shim WH

• KMID: 2225179
• DOI: http://doi.org/10.4070/kcj.2010.40.7.343

Abstract

Elective surgical repair has traditionally been considered to be the treatment of choice for the exclusion of isolated iliac artery aneurysms (IAAs). Recently, endovascular repair has evolved as an alternative to surgical repair, especially in patients at high surgical risk. However, in the absence of sufficient proximal necks, iliac artery aneurysms are not suitable for direct deployment of a tubular-shaped endograft. Here we report two cases of IAAs with short proximal necks that were excluded using an endovascular bifurcated stent-graft. The bifurcated stent-graft was successfully deployed with complete exclusion of the aneurysm. In neither case was there evidence of procedural failures. There were no signs of significant complications. We conclude that endovascular repair of IAAs with short proximal necks is feasible and efficient using an endovascular bifurcated stent-graft.

Keyword

Iliac aneurysm; Stent; Endoluminal repair

MeSH Terms

Aneurysm
Angioplasty
Humans
Iliac Aneurysm
Iliac Artery
Neck
Stents

Figure

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  Fig. 1 A 54-year-old man with renal cell carcinoma. A and C: preprocedural computed tomography and angiography show a 39-mm right common iliac artery aneurysm, which is partially thrombosed (arrows). B and D: postprocedural computed tomography and angiography show the complete exclusion of the aneurysm and accurate positioning of endografts.

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  Fig. 2 An 80-year-old man with prostate cancer. A and C: preprocedural computed tomography reconstruction and angiography reveal a 50-mm huge left common iliac artery aneurysm with a short proximal neck (*). B and D: postprocedural computed tomography reconstruction and angiography reveal that bifurcated stent-grafts are patent and aneurysm exclusion is successful with no signs of endoleak or graft migration.

Reference

1. Brunkwall J, Hauksson H, Bengtsson H, Bergqvist D, Takolander R, Bergentz SE. Solitary aneurysms of the iliac arterial system: an estimate of their frequency of occurrence. J Vasc Surg. 1989. 10:381–384.

2. Richardson JW, Greenfield LJ. Natural history and management of iliac aneurysms. J Vasc Surg. 1988. 8:165–171.

3. Bolin T, Lund K, Skau T. Isolated aneurysms of the iliac artery: what are the chances of rupture? Eur J Vasc Surg. 1988. 2:213–215.

4. Kasirajan V, Hertzer NR, Beven EG, O'Hara PJ, Krajewski LP, Sullivan TM. Management of isolated common iliac aneurysms. Cardiovasc Surg. 1998. 6:171–177.

5. Cardon JM, Cardon A, Joueux A, Vidal V, Noblet D. Endovascular repair of iliac artery aneurysm with endoprosystem I: a multicentric French study. J Cardiovasc Surg. 1996. 37:3 Suppl 1. 45–50.

6. Boules TN, Selzer F, Stanziale SF, et al. Endovascular management of isolated iliac artery aneurysms. J Vasc Surg. 2006. 44:29–37.

7. Lowry SF, Kraft RO. Isolated aneurysm of the iliac artery. Arch Surg. 1978. 113:1289–1293.

8. McCready RA, Paizolero PC, Gilmore JC, Kazmier FJ, Cherry KJ Jr, Hollier LH. Isolated iliac artery aneurysm. Surgery. 1983. 93:688–693.

9. van Sambeek MR, van Urk H. Endovascular treatment of isolated iliac artery aneurysms. Eur J Vasc Endovasc Surg. 1998. 15:91–92.

10. Shim WH, Choi D, Yoon YS, Lee DY, Jang BC. Bifurcated stent-graft (vanguard) for the endovascular treatment of abdominal aortic aneurysm. Korean Circ J. 1999. 29:907–912.

11. Kim BK, Park S, Ko YG, et al. Immediate and mid-term outcomes of the endovascular stent-graft treatment of abdominal aortic aneurysm. Korean Circ J. 2005. 35:583–590.

12. Dorros G, Cohn JM, Jaff MR. Percutaneous endovascular stent-graft repair of iliac artery aneurysms. J Endovasc Surg. 1997. 4:370–375.

13. Marin ML, Veith FJ, Lyon RT, Cynamon J, Sanchez LA. Transfemoral endovascular repair of iliac artery aneurysms. Am J Surg. 1995. 170:179–182.

14. Ziegler P, Avgerinos ED, Umscheid T, Perdikides T, Erz K, Stelter WJ. Branched iliac bifurcation: 6 years experience with endovascular preservation of internal iliac artery flow. J Vasc Surg. 2007. 46:204–210.

15. Yano OJ, Morrissey N, Eisen L, et al. Intentional internal iliac artery occlusion to facilitate endovascular repair of aortoiliac aneurysms. J Vasc Surg. 2001. 34:204–211.

16. Shim CY, Park S, Ko YG, Choi D, Jang Y, Shim WH. Percutaneous closure of femoral artery access sites in endovascular stent-graft treatment of aortic disease. Int J Cardiol. 2008. 130:251–254.