European Journal of Vascular & Endovascular Surgery
Volume 40, Issue 5 , Pages 679-680, November 2010

Comments regarding ‘A New Endovascular Approach to Exclude Isolated Bilateral Common Iliac Artery Aneurysms’. Eur J Vasc Endovasc Surg Extra 2010;19(6) e55–7

Royal Lancaster Infirmary, UK

published online 26 August 2010.

Article Outline

 

Dear Editor,

I read with interest the innovative technique described by Frigatti et al.1 Therein, a bilateral iliac aneurysm is excluded endoluminally and the ‘chimney’ technique is utilized to preserve the flow into one internal iliac artery (IIA) whilst the other was intentionally occluded. In cases such as these it is useful to reconsider the sequelae of unilateral and bilateral iliac occlusion. Contrary to popular perception, intentional unilateral IIA occlusion appears to carry a similar risk of symptoms as bilateral, ranging from 9 to 45%.2 Neither statistically significant difference in incidence of pelvic ischaemia nor sexual dysfunction has been shown between unilateral and bilateral IIA occlusions.2 Accordingly efforts to preserve bilateral IIA perfusion are justifiable, particularly in younger and active patients.

The use of iliac branch devices (IBD) for such cases should not be discounted, and their successful use to perfuse both IIAs has been described.3 For these devices it is recommended that the target common iliac artery should have a length of at least 50 mm and a minimal diameter of 20 mm adjacent to the side branch. In addition to these considerations, a wide aortic bifurcation, a minimal IIA tortuosity and a long IIA landing zone are favorable anatomic factors. Within these constraints, a recent review has found that contemporary IBD procedures may be performed with high technical success rates and are associated with encouraging mid-term patency of IIA in selected patients. Only 24 out of a collated total of 196 patients occluded the IIA stent, of whom only half became symptomatic.4 In experienced centres, deployment of an IBD does not add a significant additional operating time and issues such as kinking or thrombotic occlusion can be dealt with endovascular means. Though ‘chimney’ stents are a valuable addition to the vascular specialist repertoire, the medium- and long-term performance of these stents is not yet reported.

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References 

  1. Frigatti P, Lepidi S, Piazza M, Maturi C, Menegolo M, Deriu GP, et al. A new endovascular approach to exclude isolated bilateral common iliac artery aneurysms.. Eur J Vasc Endovasc Surg Extra. 2010;19(6):e55–e57
  2. Ghosh J, Murray D, Paravastu S, Farquharson F, Walker MG, Serracino-Inglott F. Contemporary management of aorto-iliac aneurysms in the endovascular era. Eur J Vasc Endovasc Surg. 2009;37(2):182–188
  3. Paravastu SC, Farquharson FG, Serracino-Inglott F. Endovascular repair of aorto-bi-iliac aneurysm. Vasc Endovascular Surg. 2010;44(1):50–51
  4. Karthikesalingam A, Hinchliffe R, Holt PJE, Boyle JR, Loftus IM, Thompson MM. Endovascular aneurysm repair with preservation of the internal iliac artery using the iliac branch graft device. Eur J Vasc Endovasc Surg. 2010;39:285–294

PII: S1078-5884(10)00460-0

doi:10.1016/j.ejvs.2010.07.027

Refers to article:

  • A New Endovascular Approach to Exclude Isolated Bilateral Common Iliac Artery Aneurysms , 26 April 2010

    P. Frigatti, S. Lepidi, M. Piazza, C. Maturi, M. Menegolo, G.P. Deriu, F. Grego
    EJVES Extra June 2010 (Vol. 19, Issue 6, Pages e55-e57)

European Journal of Vascular & Endovascular Surgery
Volume 40, Issue 5 , Pages 679-680, November 2010

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