Results of a double-barrel technique with commercially available devices for hypogastric preservation during aortoilac endovascular abdominal aortic aneurysm.

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Presentation transcript:

Results of a double-barrel technique with commercially available devices for hypogastric preservation during aortoilac endovascular abdominal aortic aneurysm repair Brian G. DeRubertis, MD, William J. Quinones-Baldrich, MD, Joshua I. Greenberg, MD, Juan C. Jimenez, MD, Jason T. Lee, MD Journal of Vascular Surgery Volume 56, Issue 5, Pages 1252-1259 (November 2012) DOI: 10.1016/j.jvs.2012.04.070 Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 1 Hypogastric preservation procedures were attempted for 24 hypogastric arteries in 22 patients, with a technical success rate of 95.7%. Nineteen patients underwent unilateral preservation procedures, while two patients underwent bilateral hypogastric preservation. IIA, Internal iliac artery. Journal of Vascular Surgery 2012 56, 1252-1259DOI: (10.1016/j.jvs.2012.04.070) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 2 Operative technique from contralateral femoral access. A, The bifurcated graft has been implanted, and a Stiff Angled Glidewire (yellow arrows) has been inserted alongside the ipsilateral Lunderquist wire as a femorofemoral wire to facilitate passage of the up-and-over sheath. B, The contra-lateral femoral sheath (closed arrow) is advanced over the femorofemoral wire (yellow arrows) to the origin of the hypogastric artery, then a Rosen wire (open arrows) is used to guide the Viabahn into the hypogastric artery. C, The hypogastric and external iliac limbs are simultaneously deployed within the iliac limb of the bifurcated endograft with the origins of both these stents resting at the origin of the iliac limb of the bifurcated endograft. D, Kissing-balloon angioplasty is performed (arrowheads) to mold the external iliac limb around the hypogastric limb. E, Completion angiography demonstrates exclusion of the common iliac aneurysm and preservation of hypogastric blood flow. Journal of Vascular Surgery 2012 56, 1252-1259DOI: (10.1016/j.jvs.2012.04.070) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 3 Symmetric (A) and asymmetric (B) sizing technique for choosing hypogastric and external iliac limb components. Symmetric sizing generally employed Viabahn covered stents for the hypogastric branch and either Viabahns or Gore iliac extension limbs for the external iliac branch. Asymmetric sizing employed the use of Viabahns for the hypogastric limb and a 16 mm Endologix iliac extension limb for the external iliac branch. C, Axial appearance of bilateral double-barrel hypogastric and external iliac limbs on postoperative computed tomography (CT) imaging (asymmetric sizing technique). Journal of Vascular Surgery 2012 56, 1252-1259DOI: (10.1016/j.jvs.2012.04.070) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 4 Postoperative computed tomography (CT) angiogram with three-dimensional reconstructions demonstrating successful aneurysm repair with preservation of hypogastric perfusion in patients undergoing bilateral (A) and unilateral (B) preservation procedures. Journal of Vascular Surgery 2012 56, 1252-1259DOI: (10.1016/j.jvs.2012.04.070) Copyright © 2012 Society for Vascular Surgery Terms and Conditions