Use of Reversed Iliac Leg Stent-Graft for the Treatment of Isolated Aneurysm of Internal Iliac Artery

Song, Kyung Sup; Lee, Hyunsil; Nam, Doo Hyun; Park, Ki Hyuk; Yun, So Yeon; Lee, Bae Young; Lee, Kang Hoon

doi:10.5758/vsi.2014.30.1.38

Cited by 4 publications

(7 citation statements)

References 9 publications

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“…4 The occlusion of the HA is usually performed using a vascular plug and/or coils, with high reported success rates. 5 Other authors [9][10][11][12] reported the off-label use of iliac limb stent grafts in an upside-down configuration to accommodate the mismatch between the diameters of the proximal and the distal sealing zone of IA, in cases when the former was larger than the latter.…”

Section: Resultsmentioning

confidence: 99%

The reversed bell‐bottom technique (ReBel‐B) for the endovascular treatment of iliac artery aneurysms

Mazzaccaro

Righini

Zuccon

et al. 2020

Cathet Cardio Intervent

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Objective: To describe the results of the reversed bell-bottom (ReBel-B) technique for the endovascular treatment of iliac aneurysms (IA) involving the origin of hypogastric artery (HA). Methods: The ReBel-B technique is a strategy for the occlusion of HA in selected patients presenting with IA, in whom the HA cannot be spared or safely occluded with coils or vascular plugs. When employing this technique, an iliac flared ("bell-bottom") extension is deployed in a reverse fashion, through a contralateral crossover femoral access that allows the occlusion of the HA at its origin, by exploiting the flared "bell" part of the reversed endograft. A second limb is then deployed to complete the implant, from the common iliac to the external iliac artery, inside the previous graft. Data of all consecutive patients treated with this technique in our experience were then retrospectively reviewed, and outcomes analyzed.

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Section: Resultsmentioning

confidence: 99%

The reversed bell‐bottom technique (ReBel‐B) for the endovascular treatment of iliac artery aneurysms

Mazzaccaro

Righini

Zuccon

et al. 2020

Cathet Cardio Intervent

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“…There are some reports on the upside-down technique using commercially available devices in patients with unsuitable anatomy [ 2 – 5 ]. For example, this technique has been used for saccular aneurysms of the abdominal aorta with a small reverse-tapered aortic diameter, as in our patient [ 2 , 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…For example, this technique has been used for saccular aneurysms of the abdominal aorta with a small reverse-tapered aortic diameter, as in our patient [ 2 , 4 ]. This technique has also been used for iliac artery aneurysms [ 3 – 5 ]. Endovascular repair by coverage of the iliac artery from the CIA to the EIA after the IIA embolization has been proven to be safe and effective for treatment of isolated iliac artery aneurysms.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast to the upside-down technique for other devices using deployment outside the body and a remounting process to the delivery device, the advantage of the Excluder device is that it can be removed from the catheter in a constrained manner within the sleeve and can be reintroduced into the delivery catheter [ 5 ]. This reduces the operating time and the theoretical risk of damaging the stent, fabric, or sheath, which could cause accelerated stent fatigue and fracture.…”

Section: Discussionmentioning

confidence: 99%

“…For example, in AAAs with a small aortic diameter combined with proximal and distal size discrepancy, conventional EVAR with a tubular stent graft will induce limb competition because of the small aortic diameter. To overcome this anatomic constraint, an upside-down technique using an Excluder limb (W. L. Gore and Associates Inc., Flagstaff, AZ, USA), Zenith leg (Cook Medical Inc., Bloomington, IN, USA), or Endurant limb (Medtronic Cardiovascular, Santa Rosa, CA, USA) has been used successfully in selected cases of AAA and iliac artery aneurysm [ 2 – 5 ]. In addition, the most appropriate endovascular approach for treatment of isolated common iliac artery (CIA) aneurysms without adequate sealing zone is currently a standard EVAR with a bifurcated endograft.…”

Section: Introductionmentioning

confidence: 99%

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The Upside-Down Gore Excluder Limb and Double-Barrel Sandwich Technique for Penetrating Aortic Ulcer and Iliac Aneurysm Exclusion

Kim

Song

Huh

2016

VSI

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Endovascular aneurysm repair has become the first-line treatment for abdominal aortic aneurysms and iliac artery aneurysms in recent years. However, the diameter of the infrarenal aorta is larger than that of the aortic bifurcation, especially with small aortic diameters, for which a reversed tapered device is necessary. We describe the off-label use of the upside-down Gore Excluder limb and double-barrel sandwich technique for the treatment of a penetrating abdominal aortic ulcer with a large common iliac artery aneurysm. These techniques offer an easy endovascular approach for excluding an aneurysm in selected patients. However, this technique is outside the standard instructions for use, therefore careful planning and long-term follow-up are mandatory.

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Kezdeti tapasztalataink az orvos által módosított sztentgraftok alkalmazásával

Borzsák

Péter

Suhai

et al. 2022

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Összefoglaló. Bevezetés: Az aortabetegségek kezelése során az orvos által módosított sztentgraftok alkalmazása vitatott. Döntően sürgősségi esetben, nagy rizikójú nyitott műtét alternatívájaként vagy nehéz anatómiai konfigurációk esetén alkalmazzák őket. Módszer: Cikkünkben három eseten keresztül klinikánk kezdeti tapasztalatait mutatjuk be az orvos által a műtét során módosított sztentgraftokkal kapcsolatosan. Eredmények: Első esetünkben egy 75 éves férfi beteg 50 mm-es saccularis infrarenalis aortaaneurysma miatt került felvételre. A rövid infrarenalis tágulat proximalis rögzítési zónájának átmérője lényegesen nagyobb volt, mint a terminális aortaszakasz. A kaliberdiszkrepancia megoldására a legalkalmasabb egy reverz helyzetű iliacagraftszár volt, így egy graftszárat a felvezetőrendszeréről eltávolítottunk, majd megfordítva az aorta tágulatába deponáltuk. Hasonló megoldást választottunk egy 67 éves férfi beteg jobb oldali, 65 mm-es arteria iliaca communis aneurysmájának kezelése során. Egy 81 éves nőbeteg hasi aortaaneurysma tartott rupturája miatt korábban behelyezett unilateralis graft proximalis endoleakjének megoldása miatt érkezett. Az ectaticus aorta, valamint az arteria mesenterica superior és a primer intervenció során bekerült unilateralis graft elkeskenyedő része közti rövid távolság miatt konvencionális sztentgraft beültetése nem volt lehetséges. A szituáció egy rövid thoracalis sztentgrafttal volt megoldható: egy thoracalis sztentgraft distalis végéből 3 cm-t kauter segítségével levágtunk, majd az eszközt a felvezetőrendszerbe visszatöltöttük. A módosított sztentgraftot az arteria mesenterica superior alá pozicionáltuk, egy ’chimney’ sztentgraft segítségével biztosítottuk a jobb vese perfúzióját. Technikailag mindhárom beavatkozásunk sikeres volt. Következtetés: Az endovascularis aortaműtétek azonnal elérhető eszközparkja a típusos anatómiájú betegek megoldására általában alkalmas. A szokatlan anatómiával rendelkező elektív esetek, illetve a sürgető beavatkozást igénylő komplex endovascularis műtétek során az orvos által módosított sztentgraftok hatékonyan alkalmazhatók. Alkalmazásuk nagy forgalmú aortacentrumokban javasolt. Orv Hetil. 2022; 163(3): 109–115. Summary. Introduction: Physician-modified endografts are mainly used in urgent cases of aortic disease as an alternative to high-risk open surgical repair or in difficult anatomical configurations. Method: We present our initial experiences with physician-modified stent graft implantation. Results: A 75-year-old male patient was admitted with a 50 mm saccular infrarenal aortic aneurysm. However, the diameter of the proximal sealing zone was significantly larger than that of the distal sealing zone, so we decided to use an iliac limb stent graft with reverse mounting resulting in an upside-down configuration to accommodate this diameter mismatch. A similar approach was used to treat a 67-year-old male patient with a 65 mm right common iliac artery aneurysm. An 81-year-old female patient was admitted with a type I endoleak associated with an aorto-uni-iliac endograft. The wide juxtarenal aortic diameter together with the short distance between the superior mesenteric artery and the proximal end of the previously deployed uni-iliac graft made the patient unsuitable for conventional endovascular repair, thus the distal 3 cm was cut from a standard thoracic stent graft and the device was reloaded. The modified graft was positioned below the superior mesenteric artery, while renal perfusion was secured by a chimney graft. Technical success was obtained in all three cases. Conclusion: The available toolkit of endovascular aortic surgery is generally suitable for the treatment of patients with typical anatomy. In elective cases of patients with unusual anatomy, or in urgent cases with complex aortic pathologies, physician-modified endovascular graft implantation can be used effectively. Orv Hetil. 2022; 163(3): 109–115.

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Use of Reversed Iliac Leg Stent-Graft for the Treatment of Isolated Aneurysm of Internal Iliac Artery

Cited by 4 publications

References 9 publications

The reversed bell‐bottom technique (ReBel‐B) for the endovascular treatment of iliac artery aneurysms

The reversed bell‐bottom technique (ReBel‐B) for the endovascular treatment of iliac artery aneurysms

The Upside-Down Gore Excluder Limb and Double-Barrel Sandwich Technique for Penetrating Aortic Ulcer and Iliac Aneurysm Exclusion

Kezdeti tapasztalataink az orvos által módosított sztentgraftok alkalmazásával

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