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Endovascular treatment of aortoiliac aneurysms: From intentional occlusion of the
internal iliac artery to branch iliac stent graft
#MMPMID27027393
Duvnjak S
World J Radiol
2016[Mar]; 8
(3
): 275-80
PMID27027393
show ga
Approximately 20%-40% of patients with abdominal aortic aneurysms can have
unilateral or bilateral iliac artery aneurysms and/or ectasia. This influences
and compromises the distal sealing zone during endovascular aneurysm repair.
There are a few endovascular techniques that are used to treat these types of
aneurysms, including intentional occlusion/over-stenting of the internal iliac
artery on one or both sides, the "bell-bottom" technique, and the more recent
method of using an iliac branch stent graft. In some cases, other options include
the "snorkel and sandwich" technique and hybrid interventions. Pelvic ischemia,
represented as buttock claudication, has been reported in 16%-55% of cases; this
is followed by impotence, which has been described in 10%-17% of cases following
internal iliac artery occlusion. The bell-bottom technique can be used for a
common iliac artery up to 24 mm in diameter given that the largest diameter of
the stent graft is 28 mm. There is a paucity of data and evidence regarding the
"snorkel and sandwich" technique, which can be used in a few clinical scenarios.
The hybrid intervention is comprised of a surgical operation, and is not purely
endovascular. The newest branch stent graft technology enables preservation of
the anterograde flow of important side branches. Technical success with the
newest technique ranges from 85%-96.3%, and in some small series, technical
success is 100%. Buttock claudication was reported in up to 4% of patients
treated with a branch stent graft at 5-year follow-up. Mid- and short-term
follow-up results showed branch patency of up to 88% during the 5-6-year period.
Furthermore, branch graft occlusion is a potential complication, and it has been
described to occur in 1.2%-11% of cases. Iliac branch stent graft placement
represents a further development in endovascular medicine, and it has a high
technical success rate without serious complications.
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