Endovascular management of iliac rupture during endovascular aneurysm repair

Abstract

Iliac rupture during EVAR or TEVAR can be successfully managed with endovascular stent grafting. Higher mortality and length of stay associated with iliac artery rupture confirm that there is no substitute for prevention. Access vessels of all patients undergoing EVAR should be examined closely for suitability. The threshold for using an iliac conduit, especially in women undergoing TEVAR, should be low.

Women derive less benefit from elective endovascular aneurysm repair than men

“…While there are few, if any, other reports detailing the consequences of aortic neck rupture in higher risk EVAR patients, iliac artery rupture during endovascular aneurysm repair is a recognized risk. In 2009, Fernandez and colleagues 16 reported 18 ruptured iliac arteries in 17 patients. As in our series, most were dealt with endovascularly and most were in women (n ϭ 13).…”

Successful Endovascular Management of Intraoperative Graft Limb Occlusion and Iliac Artery Rupture Occurred during Endovascular Abdominal Aortic Aneurysm Repair

“…We experienced combined iliac artery rupture and graft limb thrombosis, which would cause a fatal outcome unless addressed immediately. Although the main cause of the iliac artery perforation in this case was the fact that the push of the introducer sheath was careless and jerky, one of the keys for successful endovascular repair of aortic aneurysm is adequate vascular access through the femoral and iliac arteries [4]. Calcification, diminished diameter, and severe tortuosity of the iliac arteries have been associated with an increased incidence of iliac injury during EVAR [4].…”

“…Although the main cause of the iliac artery perforation in this case was the fact that the push of the introducer sheath was careless and jerky, one of the keys for successful endovascular repair of aortic aneurysm is adequate vascular access through the femoral and iliac arteries [4]. Calcification, diminished diameter, and severe tortuosity of the iliac arteries have been associated with an increased incidence of iliac injury during EVAR [4]. However, even after careful preoperative assessment, inadvertent iliac rupture can occur and be a source of morbidity and mortality [4].…”

“…Calcification, diminished diameter, and severe tortuosity of the iliac arteries have been associated with an increased incidence of iliac injury during EVAR [4]. However, even after careful preoperative assessment, inadvertent iliac rupture can occur and be a source of morbidity and mortality [4]. This case calls attention to the importance of a careful manipulation of wires and catheters during the endovascular procedure.…”

“…With respect to the management of acute iliac artery rupture, endovascular repair with a stent graft has already been demonstrated with satisfactory short-term and midterm results [5]. Intraoperative invasive arterial blood pressure monitoring, maintenance of stiff wire access, readily available intra-aortic occlusion balloons, and an inventory of iliac stent grafts are the prerequisites for the prompt endovascular management of a ruptured iliac artery during EVAR [4]. …”