Perioperative and Late Outcomes after Endovascular Treatment for Isolated Iliac Artery Aneurysms

Massoni, Claudio Bianchini; Freyrie, Antonio; Gargiulo, Mauro; Tecchio, Tiziano; Mascoli, Chiara; Gallitto, Enrico; Faggioli, Gianluca; Pini, Rodolfo; Azzarone, Matteo; Perini, Paolo; Stella, Andréa

doi:10.1016/j.avsg.2017.03.194

Cited by 13 publications

(18 citation statements)

References 26 publications

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“…Two studies arose from a multicenter experience (2 centers for each paper). 11,14 One paper presented 2 different groups of patients, both eligible for inclusion, as separate data; thus, we considered these 2 groups as separate series during meta-analysis. 21 NO score range was 5–6, with median of 6 (Supplementary Table I).…”

Section: Resultsmentioning

confidence: 99%

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Surgical and Endovascular Management of Isolated Internal Iliac Artery Aneurysms: A Systematic Review and Meta-Analysis

Perini

Mariani

Fanelli

et al. 2020

Vasc Endovascular Surg

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Objectives: The purpose of this paper is to report the different modalities for the treatment of isolated internal iliac artery aneurysms (IIIAA), as well as their outcomes. Methods: We performed a systematic review of the literature (database searched: PubMed, Web of Science, Scopus, Cochrane Library; last search: April 2020). We included articles reporting on the outcomes for IIIAA interventions comprising at least 5 patients. Studies were included when presenting extractable outcome data regarding intraoperative and/or early results. We performed meta-analyses of proportions for different outcomes, using random effects model. Results: Thirteen non-randomized studies were included (192 patients with 202 IIIAA). IIIAA were symptomatic in the 18.1% (95%CI 9.3-26.9; I2 54.46%, P = .019). Estimated mean IIIAA diameter was 46.28 mm (95%CI 39.72-52.85; I2 88.85%, P < .001). Open repair was performed in 21/202 cases. Endovascular treatments were: embolization (81/181), embolization and hypogastric artery coverage (79/181), hypogastric artery coverage by stent-grafting (15/181), stent-grafting in the hypogastric artery (6/181). Overall estimated technical success (TS) rate was 91.6% (95% CI 86.8-95.5; I2 45.82%, P = .031). TS rate was 94.5% for open surgery (95%CI 85.3-100; I2 0%, P = .907), and 89.7% for endovascular repair (95%CI 83.8-95.6; I2 55.43%, P = .006). Estimated overall 30-day mortality was 3.1% (95%CI 0.8-5.4; I2 0%, P = .969). Mortality rates after open surgery and endovascular repair were 8.2% (95%CI 3.4-19.8; I2 0%, P = .545) and 2.8% (95%CI 0.5-5.1; I2 0%, P = .994), respectively. Estimated mean follow-up was 32.63 months (95%CI 21.74-43.53; I2 94.45%, P < .001). During this timeframe, IIIAA exclusion was preserved in 92.8% of the patients (95%CI 89.3-96.2; I2 0%, P = .797). Buttock claudication occurred in 13.9% of the patients (95%CI 8.7-19.2; I2 0%, P = .622). Conclusions: IIIAA are frequently large, and symptomatic at presentation. Several treatments are proposed in literature, open and endovascular, both with good results. The endovascular treatment is the preferred method of treatment in literature, since it offers good short- to mid-term results and low early mortality. Buttock claudication after hypogastric artery exclusion is a common complication.

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Section: Resultsmentioning

confidence: 99%

“…The indication for IIIAA repair was specified in 5 papers: each of these papers gave a threshold diameter of 30mm. 11,13,14,16,17 Muradi et al specified they repaired also rapid growing IIIAA, if a 5 mm enlargement occurred over 6 months. 16 Symptomatic IIIAA were treated regardless of their diameter.…”

Section: Resultsmentioning

confidence: 99%

Surgical and Endovascular Management of Isolated Internal Iliac Artery Aneurysms: A Systematic Review and Meta-Analysis

Perini

Mariani

Fanelli

et al. 2020

Vasc Endovascular Surg

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“…These findings demonstrate that the rectum was not relieved from compression by the aneurysm immediately after embolization. In a previous study of endovascular repair for isolated IIAAs, aneurysmal diameter decreased in 59.4% of cases but remained unchanged in 37.5% of cases [12]. This seems to be the greatest disadvantage of endovascular repair for IIAAs, especially in cases involving large aneurysms that compress adjacent organs.…”

Section: Discussionmentioning

confidence: 99%

Isolated internal iliac artery aneurysm causing rectal necrosis due to compression early after endovascular repair: A case report

Imagami

Takayama

Hattori

et al. 2019

International Journal of Surgery Case Reports

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Highlights Many advantages of endovascular repair for aneurysms have been reported. The compression by aneurysms was not resolved early after endovascular repair. Rectal necrosis caused by residual aneurysms early after endovascular repair is rare. Aneurysm reduction and intestinal resection after embolization was a useful method. Embolization performed earlier assisted surgical decompression of aneurysms.

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“…[38][39][40] Besides, it was reported that type II endoleak could be seen in up to 10% patients after ET of IIAA. 9 Based on the recommendations of EVAR, the IIAA patients underwent ET might need closer surveillance to detect and monitor endoleak and possible aneurysm sac enlargement. 41 Primary patency was reported in one included study, 14 which showed similar rates at 1-year and midterm.…”

Section: Discussionmentioning

confidence: 99%

“…In recent decades, endovascular treatments (ETs) had been established as an alternative to open surgeries and had been more common in clinical practice. [6][7][8][9] The common or external iliac artery aneurysms could be excluded with stent grafting, and the internal iliac artery aneurysms could be occluded with coil embolization.…”

Section: Introductionmentioning

confidence: 99%

Endovascular Treatment Versus Open Surgery for Isolated Iliac Artery Aneurysms: A Systematic Review and Meta-Analysis

Xiang

Chen

Zhao

et al. 2019

Vasc Endovascular Surg

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Objective: The aim of this review was to compare the outcomes of endovascular treatment (ET) versus open surgery (OS) for patients with isolated iliac artery aneurysms (IIAAs). Methods: Studies that reported ET and OS for IIAAs were searched in databases until December 5, 2018. Studies were included for reporting both ET and OS for patients with IIAAs, and at least one of the following outcomes: postoperative mortality, postoperative ischemic complications (PIC), wound complications, blood transfusion, and length of hospital stay (LHS). We adopted Inverse Variance method to calculate the mean difference (MD) of LHS, and adopted Mantel–Haenszel method for odds ratios (ORs) of postoperative mortality, PICs, wound complications, and blood transfusion. Results: Nine studies were included, and all of them were observational studies, 7 studies were available for meta-analysis. When compared with OS, ET was associated with a higher risk of PICs (OR: 3.24, 95% confidence interval [CI]: 1.05-10.02), a lower risk of blood transfusion (OR: 0.22, 95% CI: 0.08-0.58), and a much shorter LHS (MD: −4.39, 95% CI: −6.18 to −2.60). The postoperative mortality and wound complication were similar between groups. Conclusion: Both ET and OS were safe and effective methods to repair IIAAs with similar postoperative mortality. Compared with OS, ET can reduce the need for transfusion and the time of LHS, but it was associated with a higher risk of PICs. The comparisons of primary patency and reintervention rates were still unclear between the 2 groups.

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Perioperative and Late Outcomes after Endovascular Treatment for Isolated Iliac Artery Aneurysms

Cited by 13 publications

References 26 publications

Surgical and Endovascular Management of Isolated Internal Iliac Artery Aneurysms: A Systematic Review and Meta-Analysis

Surgical and Endovascular Management of Isolated Internal Iliac Artery Aneurysms: A Systematic Review and Meta-Analysis

Isolated internal iliac artery aneurysm causing rectal necrosis due to compression early after endovascular repair: A case report

Endovascular Treatment Versus Open Surgery for Isolated Iliac Artery Aneurysms: A Systematic Review and Meta-Analysis

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