Torrealba Jose, Grandi Alessandro, Nana Petroula, Panuccio Giuseppe, Rohlffs Fiona, Kölbel Tilo
German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Hospital Hamburg Eppendorf, Hamburg, Germany.
J Endovasc Ther. 2025 Oct;32(5):1457-1465. doi: 10.1177/15266028231208657. Epub 2023 Oct 30.
To report on the outcomes of patients undergoing an iliac branch device implantation after previous open or endovascular aorto-biliac repair, using exclusively femoral access for catheterization and delivery of the covering stent to the hypogastric artery.
Single-center retrospective study in which all patients in whom an iliac branch device was implanted after previous open or endovascular aorto-biliac repair were identified. Patients in whom the hypogastric artery catheterization and delivery of the bridging cover stent were achieved via exclusive femoral access were included. Different techniques were used based on surgeon preference. Technical success and access-related complications, as well as iliac branch device endoleak or occlusions during follow-up, were evaluated.
From 2015 to 2021, 28 patients with a prior open or endovascular aorto-biliac repair underwent 34 iliac branch device implantations. Most (71%) had juxtarenal or thoracoabdominal aortic aneurysms, 82% had common iliac artery aneurysms, and 25% had hypogastric artery aneurysms. Bilateral iliac branch device implantations were performed in 21% of the patients, and in 26% of cases, landing in the superior gluteal artery was obtained. An "up-and-over" technique from the contralateral groin was used in 65% of the cases, and a steerable sheath in 35%. Technical success was 94%, with no complications related to access or technique to catheterize and deliver the stents in the hypogastric artery. The cohort had 20% of major complications, with 3 perioperative deaths. Kaplan-Meier estimated an iliac branch device freedom from occlusion and endoleak was 92% and 83% at 2 years.
The implantation of an iliac branch device over previous aortic or open endografts involving the aortic bifurcation is feasible and safe. We suggest using a femoral approach as the primary access of choice.Clinical ImpactIn this study we present 28 patients with previous aortoiliac grafts in which iliac branch devices were performed as a subsequent step.We demonstrated the feasibility of the technique despite the difficulty of crossing a neobifurcation, with a steep angle, without complications associated with the technique. Based on our experience, we recommend transfemoral access as the first option for bypassing the hypogastric artery stent, preserving upper extremity access and its possible complications.
报告在先前接受开放性或血管腔内主动脉-髂动脉修复术后接受髂支装置植入的患者的治疗结果，采用单纯股动脉入路进行插管并将覆膜支架输送至髂内动脉。
一项单中心回顾性研究，纳入所有在先前接受开放性或血管腔内主动脉-髂动脉修复术后植入髂支装置的患者。纳入通过单纯股动脉入路成功进行髂内动脉插管并输送桥接覆膜支架的患者。根据外科医生的偏好采用不同技术。评估技术成功率、与入路相关的并发症以及随访期间髂支装置的内漏或闭塞情况。
2015年至2021年，28例先前接受过开放性或血管腔内主动脉-髂动脉修复术的患者接受了34次髂支装置植入。大多数患者（71%）患有近肾型或胸腹主动脉瘤，82%患有髂总动脉瘤，25%患有髂内动脉瘤。21%的患者进行了双侧髂支装置植入，26%的病例支架锚定在上臀动脉。65%的病例采用对侧腹股沟“上翻”技术，35%的病例采用可弯曲鞘管技术。技术成功率为94%，在髂内动脉插管和输送支架过程中未出现与入路或技术相关的并发症。该队列有20%的严重并发症，3例围手术期死亡。Kaplan-Meier法估计，髂支装置在2年时无闭塞和内漏的发生率分别为92%和83%。
在先前涉及主动脉分叉的主动脉或开放性人工血管移植物上植入髂支装置是可行且安全的。我们建议将股动脉入路作为首选的主要入路。临床意义在本研究中，我们报告了28例先前接受过主动脉-髂动脉人工血管移植术的患者，随后进行了髂支装置植入。尽管跨越新的分叉角度陡峭存在困难，但我们证明了该技术的可行性，且未出现与该技术相关的并发症。根据我们的经验，我们推荐经股动脉入路作为绕过髂内动脉支架的首选方法，以保留上肢入路及其可能的并发症。
