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Hypogastric aneurysm

Neel A Mansukhani, George E Havelka, Irene B Helenowski, Heron E Rodriguez, Andrew W Hoel, Mark K Eskandari
INTRODUCTION: Diminished pelvic arterial flow as a result of intentional coverage/embolization of internal iliac arteries (IIA) during isolated endovascular common iliac artery aneurysm (CIAA) repair or endovascular repair of abdominal aortic aneurysms (EVAR) may result in symptomatic pelvic ischemia. While generally well tolerated, in severe cases pelvic ischemia may manifest as recalcitrant buttock claudication, vasculogenic impotence, or perineal, vesicle, rectal, and/or spinal cord ischemia...
March 7, 2017: Annals of Vascular Surgery
Behzad S Farivar, Richa Kalsi, Charles B Drucker, Carly B Goldstein, Rajabrata Sarkar, Shahab Toursavadkohi
OBJECTIVE: Hypogastric artery embolization (HAE) is associated with significant risk of ischemic complications. We assessed the impact of HAE on 30-day outcomes of endovascular aneurysm repair (EVAR) of infrarenal abdominal aortic aneurysms. METHODS: We queried the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2014 to identify and to compare clinical features, operative details, and 30-day outcomes of EVAR with those of concomitant HAE with EVAR (HAE + EVAR)...
February 16, 2017: Journal of Vascular Surgery
Kevin Lee, Sajjid Hossain, Maher Sabalbal, Luc Dubois, Audra Duncan, Guy DeRose, Adam H Power
OBJECTIVE: During endovascular aneurysm repair (EVAR), severely tortuous aortoiliac anatomy can alter the deployment and conformability of the endograft. The accuracy of treatment length measurements is commonly recognized to be affected by severe tortuosity. However, the exact mechanism of the postintervention length discrepancy is poorly understood. The objective of this study was to determine the mechanism of how severe aortoiliac tortuosity influences the endograft and native aorta during EVAR and its impact on the distal sealing zone...
November 19, 2016: Journal of Vascular Surgery
Andrew Barleben, Tazo Inui, Erik Owens, John S Lane, Dennis F Bandyk
Endovascular aneurysm repair (EVAR) has revolutionized the treatment of abdominal aortic aneurysm (AAA). However, persistent AAA sac endoleak following EVAR can result in sac diameter increase requiring re-intervention in up to one-third of cases and even result in aneurysm rupture. In this case review, we summarize and detail endovascular re-interventions for each type of endoleak. We also detail specific options including stent-graft relining for indeterminate, Type III, and Type IV endoleaks and perigraft arterial sac embolization to induce thrombosis and resolve acute Type I, II, or III endoleaks...
March 2016: Seminars in Vascular Surgery
Lazar B Davidovic, Milanko Maksic, Igor Koncar, Nikola Ilic, Marko Dragas, Nikola Fatic, Miroslav Markovic, Igor Banzic, Perica Mutavdzic
OBJECTIVE: To assess results of open repair (OR) of AAA in a single high volume center. METHODS: We analyzed prospectively collected data of 450 patients who underwent elective OR of AAA at the Clinic for Vascular and Endovascular Surgery of the Serbian Clinical Centre in the period between January 2013 and September 2014. RESULTS: Postoperative death occurred in seven patients (1. 55%) during the first 30 postoperative days. The mortality was caused by: uncontrolled bleeding-1, acute myocardial infarction-1, ischemic colitis-2, MOFS-2, sepsis due to infection and dehiscence of laparotomy wound-1...
November 1, 2016: World Journal of Surgery
Dainis K Krievins, Janis Savlovskis, Andrew H Holden, Kaspars Kisis, Andrew A Hill, Marcis Gedins, Natalija Ezite, Christopher K Zarins
OBJECTIVE: The purpose of this study was to determine the long-term effectiveness of endovascular aneurysm sealing (EVAS) in the treatment of complex aortoiliac aneurysms with preservation of hypogastric artery flow. METHODS: We reviewed all patients with abdominal aortic aneurysms (AAAs) and common iliac aneurysms (CIAs) enrolled and treated in prospective studies of EVAS using the Nellix endograft (Endologix, Irvine, Calif) at two centers from 2008 to 2014. Patients with 1 year or more of computed tomography follow-up underwent quantitative morphometric assessment by two independent vascular radiologists blinded to clinical outcome results...
November 2016: Journal of Vascular Surgery
Wassim Mansour, Laura Capoccia, Pasqualino Sirignano, Nunzio Montelione, Chiara Pranteda, Martina Formiconi, Enrico Sbarigia, Francesco Speziale
PURPOSE: Hypogastric artery (HA) revascularization during endovascular aneurysm repair (EVAR) is still open to debate. Moreover, exclusion-related complication rates reported in literature are not negligible. The aim of this study is to present and analyze the outcomes in patients undergoing EVAR with exclusion of 1 or both HAs at our academic center. METHODS: We retrospectively reviewed our results in patients submitted to EVAR and needing HA exclusion, in terms of perioperative (30-day) and follow-up rates of intestinal and spinal cord ischemia, buttock claudication, buttock skin necrosis, and sexual dysfunction...
October 2016: Vascular and Endovascular Surgery
Gustavo José Politzer Telles, Álvaro Razuk Filho, Walter Khegan Karakhanian, Paulo Fernandes Saad, Karen Ruggeri Saad, Jong Hun Park, Leticia Cristina Dalledone Siqueira, Roberto Augusto Caffaro
OBJECTIVE: Endovascular techniques to treat abdominal aortic aneurysms results in lower morbidity and mortality rates. However, dilation of the common iliac arteries prevents adequate distal sealing, which compromises the procedure success. The aim of this study is report the long-term outcomes of patients with abdominal aortic aneurysms associated with aneurysm of the common iliac artery following endovascular repair using a bifurcated bell-bottom stent graft. METHODS: This is a retrospective study that evaluated patients treated with bifurcated bell-bottom extension stent grafts to repair an infrarenal abdominal aortic aneurysm and who had at least one common iliac artery with dilatation > 1...
April 2016: Brazilian Journal of Cardiovascular Surgery
Spyridon N Mylonas, Gerhard Rümenapf, Hubert Schelzig, Jörg Heckenkamp, Marwan Youssef, Jost Philipp Schäfer, Wael Ahmad, Jan Sigge Brunkwall
OBJECTIVE: The aim of this study was to investigate the 1-year safety and efficacy of a new iliac side-branched device (IBD) for revascularization of the hypogastric arteries. METHODS: Patients receiving the E-liac (Jotec GmbH, Hechingen, Germany) side-branched device at six German vascular centers either as a stand-alone procedure or in combination with abdominal aortic aneurysm exclusion were included in a prospectively created data bank. Collected data were analyzed for baseline characteristics, procedural events, and clinical follow-up; variables included endoleaks, reinterventions, and internal iliac artery (IIA) patency...
December 2016: Journal of Vascular Surgery
Klaas H J Ultee, Sara L Zettervall, Peter A Soden, Jeremy Darling, Daniel J Bertges, Hence J M Verhagen, Marc L Schermerhorn
BACKGROUND: Bowel ischemia is a rare but devastating complication after abdominal aortic aneurysm (AAA) repair. Its rarity has prohibited extensive risk-factor analysis, particularly since the widespread adoption of endovascular AAA repair (EVAR); therefore, this study assessed the incidence of postoperative bowel ischemia after AAA repair in the endovascular era and identified risk factors for its occurrence. METHODS: All patients undergoing intact or ruptured AAA repair in the Vascular Study Group of New England (VSGNE) between January 2003 and November 2014 were included...
November 2016: Journal of Vascular Surgery
Giuseppe Panuccio, Giovanni F Torsello, Giovanni B Torsello, Konstantinos P Donas
Use of endovascular means is gaining ever greater acceptance in the treatment of aorto-iliac aneurysms. Especially, the treatment of patients with common iliac aneurysms (CIAs) may be very challenging due to the complexity of the underlying disease with often involvement of the hypogastric artery. Additionally, the variety of endovascular therapeutic options such as the use of iliac branch devices, parallel grafts, the bell-bottom technique or coil embolization of the hypogastric artery and overstenting of the origin represents significant limitation regarding the presentation of a clear and robust endovascular therapeutic algorithm...
October 2016: Journal of Cardiovascular Surgery
V Maus, P Kurz, C M Sommer, A Massmann, A Hatopp, S Erpenbach, K Thomas, T Saalmüller, H Meißner, T Hupp, G M Richter
PURPOSE: The aim of this study was to evaluate the technical feasibility and short-time patency rate of iliac side branch devices based on the authors' institution's experience. MATERIALS AND METHODS: Data of 17 patients (all men) with an aortoiliac aneurysm (median age 72.5 years) who underwent endovascular repair between October 2013 and June 2015 (20 months) at our institution was analyzed retrospectively. Primary endpoint was primary technical success, defined as adequate implantation of the iliac branch device with patency of the hypogastric side branch without the need of further re-interventions within 30 days...
August 2016: RöFo: Fortschritte Auf Dem Gebiete der Röntgenstrahlen und der Nuklearmedizin
A Duprey, B Chavent, V Meyer-Bisch, T Varin, J-N Albertini, J-P Favre, X Barral, J-B Ricco
OBJECTIVE/BACKGROUND: To evaluate the long-term outcome of renal revascularization by ex vivo renal artery reconstruction and autotransplantation for renal artery branch aneurysms (RABAs). METHODS: Between 1991 and 2015, 67 ex vivo renal artery reconstructions with kidney autotransplantation were performed in 55 adults (mean age 47 years) and 10 children to repair 87 RABAs. The main underlying disease was fibromuscular dysplasia in 34 patients. Other etiologies were systemic congenital disease in eight patients, spontaneous dissecting aneurysms in five, iatrogenic aneurysms in three, atheromatous aneurysms in two and unknown etiology in 13...
June 2016: European Journal of Vascular and Endovascular Surgery
Klaas H J Ultee, Sara L Zettervall, Peter A Soden, Jeremy Darling, Jeffrey J Siracuse, Matthew J Alef, Hence J M Verhagen, Marc L Schermerhorn
BACKGROUND: Concomitant procedures during endovascular aneurysm repair (EVAR) of an abdominal aortic aneurysm are performed to facilitate endograft delivery, to simultaneously treat unrelated conditions, or to resolve intraoperative pitfalls. The frequency and perioperative impact of these procedures are not well described. This study aimed to assess the frequency and perioperative impact of various concomitant procedures performed at the time of EVAR. METHODS: We included all elective EVARs in the Vascular Study Group of New England between January 2003 and November 2014 and identified those with and those without concomitant procedures...
June 2016: Journal of Vascular Surgery
Ruby C Lo, Dominique B Buck, Jeremy Herrmann, Allen D Hamdan, Mark Wyers, Virendra I Patel, Mark Fillinger, Marc L Schermerhorn
OBJECTIVE: Type II endoleaks are common after endovascular aneurysm repair (EVAR), but their clinical significance remains undefined and their management controversial. We determined risk factors for type II endoleaks and associations with adverse outcomes. METHODS: We identified all EVAR patients in the Vascular Study Group of New England abdominal aortic aneurysm database. Patients were subdivided into two groups: (1) those with no endoleak or transient type II endoleak and (2) persistent type II endoleak or new type II endoleak (no endoleak at completion of case)...
April 2016: Journal of Vascular Surgery
C S Lim, Y Naji, S T Hussain, E Pleban, A Wiszniewski, S Onida, N J Mosquera Arochena, P Szopinski
OBJECTIVE: The aim was to assess the early and mid-term safety and clinical outcomes of a modified sandwich-graft technique (MSGT) that employed the Aorfix and Viabahn stent-grafts to preserve hypogastric flow in cases of complex aortoiliac and isolated common iliac artery (CIA) aneurysms including internal iliac artery (IIA) ostium who were not suitable for an iliac branch device (IBD). METHODS: A review of prospective collected data of all consecutive cases of treatment of complex aortoiliac or isolated CIA aneurysms including IIA ostium using the MSGT to preserve the hypogastric flow in three European centres between April 1, 2010, and December 31, 2013, was performed...
March 2016: European Journal of Vascular and Endovascular Surgery
Jan Peter Goltz, Julia Loesaus, Alex Frydrychowicz, Jörg Barkhausen, Marcus Wiedner
We report an endovascular technique for the treatment of type Ia endoleak after a plain tubular stentgraft had been implanted for a large common iliac artery aneurysm with an insufficient proximal landing zone and without occlusion of the hypogastric in another hospital. CT follow-up showed an endoleak with continuous sac expansion over 12 months. This was classified as type Ia by means of dynamic contrast-enhanced MRI. Before a bifurcated stentgraft was implanted to relocate the landing zone more proximally, the still perfused ipsilateral hypogastric artery was embolized to prevent a type II endoleak...
February 2016: Cardiovascular and Interventional Radiology
A Rezziki, A Ouledtaib, A Elhoumaidi, A Boutaouer, A Benzirar, O Elmahi
OBJECTIVES: This case illustrates a very rare localization of false aneurysm in Behçet's disease and demonstrates the importance of monitoring treated patients. CASE REPORT: The diagnosis of severe Behçet's disease was established in a young man after discovery of a cerebral venous thrombosis. One year later, the patient required emergency surgery for a symptomatic pseudoaneurysm of the internal iliac artery. RESULTS: Performed after a 3-day regimen of corticosteroid boluses, the pseudoaneurysm was treated by ligation of the hypogastric artery...
May 2015: Journal des Maladies Vasculaires
Chris Y Wu, John E Rectenwald
Chronic spontaneously thrombosed abdominal aortic aneurysms (AAAs) are rare. We present a patient with a completely thrombosed abdominal aortic aneurysm found incidentally on imaging for evaluation of unrelated abdominal pain. The patient was asymptomatic with regards to the aneurysm due to extensive collateralization of the intercostal and lumbar arteries to the bilateral hypogastric and internal mammary arteries to the common femoral arteries bilaterally. Follow-up imaging after 10 months showed no aneurysmal change...
July 2015: Annals of Vascular Surgery
Michele Marconi, Sabrina Ceragioli, Davide M Mocellin, Aldo Alberti, Francesca Tomei, Daniele Adami, Raffaella N Berchiolli, Mauro Ferrari
BACKGROUND: Abdominal aortic aneurysm (AAA) is associated with 43% of cases with common iliac artery aneurysms and an extension of prosthetic replacement distal to the iliac bifurcation is needed. The decision about preserving the hypogastric artery (HA) is a source of discussion, in particular when only one HA is interested. The low risk of pelvic ischemia, even if existing, has to be compared with the greater technical difficulty of the vascular reconstruction. The aim of this study is to evaluate retrospectively the perioperative results in patients who underwent ligation or reconstruction of the HA during open surgical procedures for AAA...
2015: Annals of Vascular Surgery
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