Επί ιδανικου κεντρικού και περιφερικού αυχένα συνιστάται η ενδοαυλική αντιμετώπιση

ΑΟΡΤΟΜΟΝΟΛΑΓΟΝΙΟΣ ΕΝΔΟΝΑΡΘΗΚΑΣ + ΜΗΡΟΜΗΡΙΑΙΑ ΠΑΡΑΚΑΜΨΗ ΤΥΠΙΚΗ ΑΝΤΙΜΕΤΩΠΙΣΗ ΑΟΡΤΟΜΟΝΟΛΑΓΟΝΙΟΣ ΕΝΔΟΝΑΡΘΗΚΑΣ + ΜΗΡΟΜΗΡΙΑΙΑ ΠΑΡΑΚΑΜΨΗ

Endovascular exclusion of symptomatic bilateral common lliac artery anueurysms with preservation of an aneurysmal internal lliac artery via a reverse-U stent-graft. Kotsis T, Tsanis A, Sfyroeras G, Lioupis C, Moulakakis K, Georgakis P. J Endovasc Ther. 2006 Apr;13(2):158-63.

Κ o t s i s

ΕΝΔΑΓΓΕΙΑΚΗ ΑΠΟΚΑΤΑΣΤΑΣΗ ΠΕΡΙΦΕΡΙΚΟΣ ΚΩΔΩΝΑΣ ΛΑΓΟΝΙΟΣ ΕΝΔΟΝΑΡΘΗΚΑΣ ΜΕ ΚΛΑΔΟ Tεχνικη καπνοδοχου/περιςκοπιου/τριπλη επαλληλια

ΠΕΡΙΦΕΡΙΚΟΣ ΚΩΔΩΝΑΣ

Bottom bell Διάμετρος<26χιλ. Περιφερική Ζώνη Πρόσφυσης >15-10 χιλ.

ΜΟΣΧΕΥΜΑ ΜΕ ΛΑΓΟΝΙΟ ΚΛΑΔΟ ANATOMIKΕΣ ΠΡΟΫΠΟΘΕΣΕΙΣ Μήκος περιφερικής ζώνης >15χιλ. Διάμετρος κοινής λαγονίου > 20χιλ. Μήκος κοινής λαγονίου >40χιλ. Περιφερικο τμήμα έσω λαγονίου >10χιλ

P P P P

LITERATURE Endovascular exclusion of symptomatic bilateral common lliac artery anueurysms with preservation of an aneurysmal internal lliac artery via a reverse-U stent-graft. Kotsis T, Tsanis A, Sfyroeras G, Lioupis C, Moulakakis K, Georgakis P.J Endovasc Ther. 2006 Apr;13(2):158-63 An alternative to aorto-uni-iliac EVAR and femoro-femoral crossover in a patient having an aorto-iliac aneurysm with an occluded external iliac artery. Serracino-Inglott F, Myers P. European Journal of Vascular and Endovascular Surgery 2007; 33: 575-577 EVAR in patients with common iliac artery aneurysms - Initial experience with the Zenith Bifurcated Iliac Side Branch Device. Serracino-Inglott F, Bray AE,Myers P. Journal of Vascular Surgery 2007; 46: 211-217 Branched endograft for aortoiliac artery aneurysms. Lee WA.Vascular. 2009 Nov-Dec;17 Suppl 3:S111-8.

Wong S1, Greenberg RK, Brown CR, Mastracci TM, Bena J, Eagleton MJ. Endovascular repair of aortoiliac aneurysmal disease with the helical iliac bifurcation device and the bifurcated-bifurcated iliac bifurcation device. Wong S1, Greenberg RK, Brown CR, Mastracci TM, Bena J, Eagleton MJ. 2013 Iliac branch device (IBD) treatment of common and internal iliac artery (CIA and IIA) aneurysms has been controversial in the context of available embolization techniques or off-label adjunctive procedures. Two devices exist, a straight IBD (S-IBD) and a helical IBD (H-IBD). We report our midterm results with the latter and present outcomes with a third device intended to treat disease in the presence of short CIAs termed the bifurcated-bifurcated IBD (BB-IBD). METHODS: Data were prospectively collected from IBD-treated patients with infrarenal aortoiliac or thoracoabdominal aortoiliac aneurysms. Preoperative aneurysmal characteristics were collected in accordance with the endovascular reporting standards document, including presence of IIA stenosis, CIA diameters, and the presence of an IIA aneurysm. Technical success was defined as IBD device placement, branch placement, and patency without type I or III endoleak at implantation in addition to 24 hours survival. Follow-up computed tomography scans at 1, 6 (optional), 12 months, and annually thereafter were performed and reinterventions, sac morphology changes, and endoleaks noted. Survival and patency were evaluated with life-table analyses, and differences among anatomic groups were compared with log-rank tests, whereas t-tests and Fisher exact tests were used to compare simple variables. RESULTS: Between 2003 and 2012, 138 IBD devices were placed into 130 patients (98 H-IBD and 40 BB-IBD). Median follow-up was 20.3 months (range, 1-72 months) with 30- day, 12-month, 3- and 5-year survival rates of 99%, 90%, 79%, and 62%, respectively. Technical success was 94%, and branch patency was 94.6% at 30 days and 81.8% at 5 years. Thirty-five percent (35%) of branches were placed into patients with IIA aneurysms (in addition to their proximal disease), 20% into stenotic IIAs, and 46% into iliac systems with narrow (<16 mm) CIAs. Technical success was significantly lower in patients with IIA stenosis (81.5 vs 96.4%; Fisher exact test, P = .015) but not affected by the presence of an IIA aneurysm or narrow CIA. Branch patency was similar in all groups throughout follow-up. No stent fractures or component separations were noted in the IBDs or mating devices throughout the study period. CONCLUSIONS: The H-IBD and BB-IBD configurations have high technical success and acceptable long-term patency for the treatment of CIA and IIA aneurysms, including those with challenging anatomy difficult to treat with the straight branch design. J Vasc Surg. 2013 Oct;58(4):861-9

2013 Technical considerations and performance of bridging stent-grafts for iliac side branched devices based on a pooled analysis of single-center experiences. Donas KP1, Bisdas T, Torsello G, Austermann M. Abstract PURPOSE: To report a pooled analysis of single-center experiences designed to determine the performance of self-expanding vs. balloon-expandable bridging stent-grafts used in iliac branch devices (IBDs) for the repair of iliac artery aneurysms. METHODS: The English-language literature in the MEDLINE and EMBASE databases was searched for articles published between 2006 and 1 March 2012 on the performance of bridging stent-grafts in the internal iliac artery. Studies were eligible for the analysis if they contained the type of bridging stent-grafts used and the time and cause of any occlusion of the bridging devices. Eight of the 13 studies published between 2006 and 2011 fulfilled the eligibility criteria. The outcome measure was the patency of bridging stent-grafts defined as absence of occlusion of the side branch in the internal iliac artery. Additionally, the performance of the self-expanding stent-grafts vs. balloon-expandable stent-grafts used in conjunction with the IBDs was compared. RESULTS: In the 8 studies, 100 (42%) self-expanding stent-grafts and 136 (58%) balloon-expandable stent-grafts were placed in 185 patients. Of these 236 bridging stent-grafts, 15 (6%) occluded in 13 (7%) patients: 10 within 30 days after the intervention [2 (1.5%) balloon-expandable and 8 (8%) self-expanding stent-grafts] and 5 beyond 30 days [2 (1.5%) balloon-expandable and 3 (3%) self-expanding stent-grafts]. Symptomatic presentation (hip and/or buttock claudication) of the occluded iliac branch was recorded in 7 of the 13 patients. CONCLUSION: The current literature does not support robust conclusions about the performance of bridging endografts of IBDs due to the heterogeneity of the studies. However, the occlusion rate of the bridging stent-grafts was low, especially for balloon-expandable stent-grafts compared to self-expanding devices. J Endovasc Ther. 2012 Oct;19(5):667-71.

Eur J Vasc Endovasc Surg. 2012 Mar;43(3):287-92.   Department of Radiology, University of Bonn, Bonn, Germany. 2012 Long-term results of iliac aneurysm repair with iliac branched endograft: a 5-year experience on 100 consecutive cases. Parlani G1, Verzini F, De Rango P, Brambilla D, Coscarella C, Ferrer C, Cao P. There were 96 males, mean age 74.1 years. Preoperative median common iliac aneurysm diameter was 40 mm (interquartile range (IQR): 35-44 mm). Sixty-seven patients had abdominal aortic aneurysm >35 mm (IQR: 40-57 mm) associated with iliac aneurysm. Eleven patients presented hypogastric aneurysm. Twelve patients underwent isolated iliac repair with IBD and 88 patients received associated endovascular aortic repair. Periprocedural technical success rate was 95%, with no mortality. Two patients experienced external iliac occlusion in the first month. At a median follow-up of 21 months (range 1-60) aneurysm growth >3 mm was detected in four iliac (4%) arteries. Iliac endoleak (one type III and two distal type I) developed in three patients and buttock claudication in four patients. Estimated patency rate of internal iliac branch was 91.4% at 1 and 5 years. Freedom from any reintervention rate was 90% at 1 year and 81.4% at 5 years. No late ruptures occurred. Eur J Vasc Endovasc Surg. 2012 Mar;43(3):287-92. ? Using the multilayer stent as a supplement to EVAR in combined abdominal aortic aneurysm and iliac artery aneurysm with inadequate distal landing zone--a case report. Vasc Endovascular Surg.  2012; 46(7):565-9 Pieper CC; Meyer C; Verrel F; Schild HH; Wilhelm KE   

Papazoglou KO1, Sfyroeras GS, Zambas N, Konstantinidis K, Kakkos SK, Mitka M. Outcomes of endovascular aneurysm repair with selective internal iliac artery coverage without coil embolization. J Vasc Surg. 2012 Aug;56(2):298-303. Abstract OBJECTIVE: Endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs) that also involve the common iliac artery (CIA) typically is accomplished by endograft limb extension into the external iliac artery (EIA). In order to prevent endoleak, the internal iliac artery (IIA) is usually embolized, or alternatively a branched limb is deployed. However, IIA embolization is associated with longer operative time and increased use of contrast and radiation. It has been our practice not to routinely coil embolize the IIA. The purpose of this study was to present the midterm outcomes of this approach. METHODS: Between April 1997 and June 2010, 137 patients (130 men; mean age, 70.9 years; range, 45-92 years) underwent EVAR of their AAA and had IIA coverage without coil embolization in 112 patients (no embolization [NE] group) and after coil embolization in 25 patients (coil embolization [CE] group). Anatomic indications for coverage of the IIA without coil embolization included presence of adequate sealing in the distal 5 mm of the CIA, or sealing ring at the origin of the CIA, or IIA diameter <5 mm. Preoperative mean AAA size was 60 ± 14 mm, and mean CIA diameter was 38 ± 13 mm. Postoperative computed tomography (CT) scanning was performed at 1, 6, and 12 months, and yearly thereafter. RESULTS: Thirty-day mortality was 0.7% (1 of 137 patients). A patient presented with gluteal skin necrosis (0.7%). The incidence of postoperative buttock claudication was not different between the two groups (NE: 15 of 112 patients; CE: 3 of 25 patients; P = .852). Procedure and fluoroscopy time, contrast use, and hospital stay were significantly reduced in the NE group. Patients were followed up for 33 ± 30 months. During follow-up, 44 patients died (32.1%) and in 3 of them (2.2%), death was AAA-related. There was no difference in cumulative survival between the two groups at 1, 2, 3, and 4 years, respectively. Secondary interventions were performed in 20 of 137 patients (14.5%), including three conversions for proximal endoleak. There was no difference between the two groups in the incidence of secondary interventions (NE: 18 of 112 patients; CE: two of 25 patients; P = .301) and freedom from reintervention at 1, 2, 3, and 4 years, respectively. Ten patients (8.9%) from the NE group presented a type II endoleak during follow-up. Seven of them were associated with the covered IIA; none required reintervention.

Complications associated with EVAR All cardiac (heart problems) 5 % Pulmonary (breathing problems) 3 % Renal failure (kidney problems) 3 % Access/deployment failure (problems getting the EVAR device up the arteries in the groins or positioning it into place)0 -5 % Thrombotic/embolic 2 % Gastrointestinal (bowel problems) 2 % Wound healing/infection 3 % Secondary procedures 30% Complications from open surgical repair All cardiac (heart problems) 12 % Pulmonary (breathing problems) 9 % Renal failure (kidney problems) 5 % Cerebrovascular accident (stroke) 2 % Thrombotic/embolic 2 % Gastrointestinal (bowel problems) 5 % Impotence 60 % Hematoma/bleeding/coagulopathy 6 %