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CardioVascular and Interventional Radiology
Published in: CardioVascular and Interventional Radiology 5/2012

01-10-2012 | Technical Note

Single-Center Experience and 1-Year Follow-up Results of “Sandwich Technique” in the Management of Common Iliac Artery Aneurysms During EVAR

Authors: Carmelo Ricci, Claudio Ceccherini, Marco Cini, Francesco Vigni, Sara Leonini, Giulio Tommasino, Luigi Muzzi, Enrico Tucci, Antonio Benvenuti, Eugenio Neri

Published in: CardioVascular and Interventional Radiology | Issue 5/2012

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Abstract

Purpose

Abdominal aortic aneurysm (AAA) accompanied by common iliac artery (CIA) aneurysms requires a more demanding procedure owing to the difficulties in obtaining an adequate distal landing zone for the stent-graft limb(s), a potential site of endoleak. The “sandwich technique” is a procedure to increase EVAR feasibility in the setting of adverse or challenging CIA anatomy. Its main advantages include no restrictions in terms of CIA diameter or length or internal iliac artery (IIA) diameter, no need to wait for a specific stent-graft. Our purpose is to describe our single-center experience and one year follow-up results of this new procedure.

Materials and Methods

From April 2009 to June 2010, the sandwich technique was performed in our institution in 7 patients treated for AAA and unilateral CIA aneurysms (n. 5) or bilateral CIA aneurysms (n. 2). Inclusion criteria were the presence of unilateral or bilateral CIA aneurysm (independently from its diameter), IIA artery measuring up to 9 mm in its maximum diameter, not dilatation of IIA and EIA.

Results

The mean follow-up length was 15 months (range: 14–20 months). All stent-implanted iliac branches remained patent on 1 year follow-up and IIA flow was preserved. None of the patients had symptoms of pelvic ischemia. CT scan follow-up showed aneurysm shrinkage in five patients, without any sign of endoleaks in all cases.

Conclusions

In selected cases, the “sandwich technique” showed good outcomes confirming to be a safe and easy to perform way to overcome anatomical constraints and expanding the limits of EVAR.
Literature
1.
2.
Karch LA, Hodgson KJ, Mattos MA et al (2000) Adverse consequences of internal iliac artery occlusion during endovascular repair of abdominal aortic aneurysms. J Vasc Surg 32:676–683PubMedCrossRef
3.
Yano OJ, Morrissey N, Eisen L et al (2001) Intentional internal iliac artery occlusion to facilitate endovascular repair of aortoiliac aneurysms. J Vasc Surg 34:204–211PubMedCrossRef
4.
Parodi JC, Ferreira M (1999) Relocation of the iliac artery bifurcation to facilitate endoluminal treatment of abdominal aortic aneurysms. J Endovasc Surg 6:342–347PubMedCrossRef
5.
Faries PL, Morrissey N, Burks JA et al (2001) Internal iliac artery revascularization as an adjunct to endovascular repair of aortoiliac aneurysms. J Vasc Surg 34:892–899PubMedCrossRef
6.
Mertens RA, Bergoeing MP, Marine LA et al (2010) Antegrade hypogastric revascularization during endovascular aortoiliac aneurysm repair: an alternative to bilateral embolization. Ann Vasc Surg 24(255):e9–e12PubMed
7.
Bergamini RM, Rachel ES, Kinney EV et al (2002) External iliac artery-to-internal iliac artery endograft: a novel approach to preserve pelvic inflow in aortoiliac stent grafting. J Vasc Surg 35:120–124PubMed
8.
Criado FJ, Wilson EP, Velazquez OC et al (2000) Safety of coil embolization of the internal iliac artery in endovascular grafting of abdominal aortic aneurysms. J Vasc Surg 32:684–688PubMedCrossRef
9.
Gough MJ, MacMahon MJ (1998) A minimally invasive technique allowing ligation of the internal iliac artery during endovascular repair of aortic aneurysms with an aorto-uni-iliac device. Eur J Vasc Endovasc Surg 16:535–536PubMedCrossRef
10.
Karch LA, Hodgson KJ, Mattos MA et al (2001) Management of ectatic, nonaneurysmal iliac arteries during endoluminal aortic aneurysm repair. J Vasc Surg 33:S33–S38PubMedCrossRef
11.
Torsello G, Schonefeld E, Osada N et al (2010) Endovascular treatment of common iliac artery aneurysms using the bell-bottom technique: long-term results. J Endovasc Ther 17:504–509PubMedCrossRef
12.
Greenberg RK, West K, Pfaff K et al (2006) Beyond the aortic bifurcation: branched endovascular grafts for thoracoabdominal and aortoiliac aneurysms. J Vasc Surg 43:879–887PubMedCrossRef
13.
Malina M, Dirven M, Sonesson B et al (2006) Feasibility of a branched stent-graft in common iliac artery aneurysms. J Endovasc Ther 13:496–500PubMedCrossRef
14.
Verzini F, Parlani G, Romano L et al (2009) Endovascular treatment of iliac aneurysm: concurrent comparison of side branch endograft versus hypogastric exclusion. J Vasc Surg 49:1154–1161PubMedCrossRef
15.
Pua U, Tan K, Rubin BB, Sniderman KW, Rajan DK, Oreopoulos GD, Lindsey TF (2011) Iliac branch graft in the treatment of complex aortoiliac aneurysms: early results from a North American institution. J Vasc Interv Radiol 22(4):542–549PubMedCrossRef
16.
Falkensammer J, Hakaim AG, Oldenburg WA et al (2007) Natural history of the iliac arteries after endovascular abdominal aortic aneurysm repair and suitability of ectatic iliac arteries as a distal sealing zone. J Endovasc Ther 14:619–624PubMedCrossRef
17.
Parodi JC, Parodi FE (2011) Commentary: the sandwich technique to preserve the hypogastric artery during EVAR. J Endovasc Ther 18(1):112–113PubMedCrossRef
Metadata
Title
Single-Center Experience and 1-Year Follow-up Results of “Sandwich Technique” in the Management of Common Iliac Artery Aneurysms During EVAR
Authors
Carmelo Ricci
Claudio Ceccherini
Marco Cini
Francesco Vigni
Sara Leonini
Giulio Tommasino
Luigi Muzzi
Enrico Tucci
Antonio Benvenuti
Eugenio Neri
Publication date
01-10-2012
Publisher
Springer-Verlag
Published in
CardioVascular and Interventional Radiology / Issue 5/2012
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-012-0378-0

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