Iliac branch device to treat type Ib endoleak with a brachial access or an “up-and-over” transfemoral technique

Mesnard, Thomas; Patterson, Benjamin O.; Azzaoui, Richard; Pruvot, Louis; Haulon, Stéphan; Sobocinski, Jonathan

doi:10.1016/j.jvs.2022.06.025

Cited by 3 publications

(1 citation statement)

References 26 publications

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“…Type IB endoleaks are treated with distal endograft extension into the iliac bifurcation or the external iliac artery with internal iliac embolization or using an iliac branch device for hypogastric artery preservation, depending on anatomy (Figure 4). This technique allows for a more extended sealing area, excluding ectatic or aneurysmal common iliac arteries . Early imaging is imperative to assess persistence if a type I endoleak is noted at EVAR completion and not corrected.…”

Section: Type I Endoleaksmentioning

confidence: 99%

Management of Endoleaks After Elective Infrarenal Aortic Endovascular Aneurysm Repair

et al. 2023

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ImportanceEndovascular aneurysm repair (EVAR) is the dominant treatment strategy for abdominal aortic aneurysms, encompassing 80% of all repairs in the United States. Endoleaks are ubiquitous and affect 30% of patients treated by EVAR, potentially leading to sac enlargement and increased risk of rupture. The care of EVAR patients requires long-term surveillance by a multidisciplinary team. Accordingly, physicians should be familiar with the fundamentals of endoleak management to achieve optimal outcomes, including timely referral for remediation or providing counseling and reassurance when needed.ObservationsPubMed and the Cochrane database were searched for articles published between January 2002 and December 2022 in English, addressing epidemiology, diagnosis, and management of endoleaks after EVAR. Endoleaks can be detected intraoperatively or years later, making lifelong surveillance mandatory. Type I and III have the highest risk of rupture (7.5% at 2 years and 8.9% at 1 year, respectively) and should be treated when identified. Intervention should be considered for other types of endoleak when associated with aneurysm sac growth larger than 5 mm based on current guidelines. Type II endoleaks are the most common, accounting for 50% of all endoleaks. Up to 90% of type II endoleaks resolve spontaneously or are not associated with sac enlargement, requiring only observation. Although the risk of rupture is less than 1%, cases that require reintervention are challenging. Recurrence is common despite endovascular treatment, and rupture can occur without evidence of sac growth. Type IV endoleaks and endotension are uncommon, are typically benign, and primarily should be observed.Conclusions and RelevanceEndoleak management depends on the type and presence of sac expansion. Type I and III endoleaks require intervention. Type II endoleaks should be observed and treated selectively in patients with significant sac expansion. Since endoleaks can appear any time after EVAR, at least 1 contrast-enhanced computed tomographic angiogram or duplex ultrasound by an experienced laboratory is recommended every 5 years.

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Section: Type I Endoleaksmentioning

confidence: 99%

Management of Endoleaks After Elective Infrarenal Aortic Endovascular Aneurysm Repair

et al. 2023

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Radiological diagnosis and emergency endovascular management, and follow-up of an unruptured right subclavian artery aneurysm in an elderly patient: A case report

Adhikari

2024

Radiology Case Reports

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Transfemoral Access to Implant Iliac Branch Devices After Previous Aortic Grafts

Torrealba,

Grandi,

Nana

et al. 2023

J Endovasc Ther

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Objective: To report on the outcomes of patients undergoing an iliac branch device implantation after previous open or endovascular aorto-biliac repair, using exclusively femoral access for catheterization and delivery of the covering stent to the hypogastric artery. Methods: Single-center retrospective study in which all patients in whom an iliac branch device was implanted after previous open or endovascular aorto-biliac repair were identified. Patients in whom the hypogastric artery catheterization and delivery of the bridging cover stent were achieved via exclusive femoral access were included. Different techniques were used based on surgeon preference. Technical success and access-related complications, as well as iliac branch device endoleak or occlusions during follow-up, were evaluated. Results: From 2015 to 2021, 28 patients with a prior open or endovascular aorto-biliac repair underwent 34 iliac branch device implantations. Most (71%) had juxtarenal or thoracoabdominal aortic aneurysms, 82% had common iliac artery aneurysms, and 25% had hypogastric artery aneurysms. Bilateral iliac branch device implantations were performed in 21% of the patients, and in 26% of cases, landing in the superior gluteal artery was obtained. An “up-and-over” technique from the contralateral groin was used in 65% of the cases, and a steerable sheath in 35%. Technical success was 94%, with no complications related to access or technique to catheterize and deliver the stents in the hypogastric artery. The cohort had 20% of major complications, with 3 perioperative deaths. Kaplan–Meier estimated an iliac branch device freedom from occlusion and endoleak was 92% and 83% at 2 years. Conclusions: The implantation of an iliac branch device over previous aortic or open endografts involving the aortic bifurcation is feasible and safe. We suggest using a femoral approach as the primary access of choice. Clinical Impact In this study we present 28 patients with previous aortoiliac grafts in which iliac branch devices were performed as a subsequent step.We demonstrated the feasibility of the technique despite the difficulty of crossing a neobifurcation, with a steep angle, without complications associated with the technique. Based on our experience, we recommend transfemoral access as the first option for bypassing the hypogastric artery stent, preserving upper extremity access and its possible complications.

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Iliac branch device to treat type Ib endoleak with a brachial access or an “up-and-over” transfemoral technique

Cited by 3 publications

References 26 publications

Management of Endoleaks After Elective Infrarenal Aortic Endovascular Aneurysm Repair

Management of Endoleaks After Elective Infrarenal Aortic Endovascular Aneurysm Repair

Radiological diagnosis and emergency endovascular management, and follow-up of an unruptured right subclavian artery aneurysm in an elderly patient: A case report

Transfemoral Access to Implant Iliac Branch Devices After Previous Aortic Grafts

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