title: Outcome after concomitant unilateral embolization of the internal iliac artery and contralateral external-to-internal iliac artery bypass grafting during endovascular aneurysm repair.
abstract: OBJECTIVE
  Despite improvement of devices, endovascular aneurysm repair (EVAR) is still challenging in cases with associated aneurysmal involvement of the iliac arteries. This study examined the safety and efficacy of EVAR with concomitant unilateral embolization of the internal iliac artery (IIA) and contralateral external-to-internal iliac artery bypass grafting, with bilateral endograft limbs extended into the external iliac arteries (EIAs).
  
  
  METHODS
  The study included 22 consecutive patients (mean age, 74 years) who underwent elective endovascular repair of aortoiliac or iliac aneurysms, with concomitant coil embolization of the unilateral IIA and contralateral EIA-to-IIA bypass in the same operative setting. Five patients had a unilateral IIA aneurysm, and eight had bilateral IIA aneurysms. EIA-to-IIA bypass grafting was performed through the retroperitoneal approach. The perioperative and midterm outcome of the procedure was assessed.
  
  
  RESULTS
  The procedure was successfully performed in all cases. Eleven patients underwent IIA embolization at the main trunk, and the other 11 cases required IIA occlusion at distal branches. There was no perioperative death or severe complication. The mean follow-up period was 15.7 ± 7.8 months, ranging from 2 to 32 months. The bypass remained patent in all cases, and there was no occurrence of graft-related complication. Enlargement of aneurysms or development of type I endoleak was not observed. Persistent mild buttock claudication occurred in two patients (9%) ipsilaterally to the occluded IIA; one patient after IIA occlusion at the main trunk and the other at distal branches. No other pelvic ischemic manifestation was observed.
  
  
  CONCLUSIONS
  EVAR with simultaneous unilateral IIA embolization and contralateral EIA-to-IIA bypass grafting is feasible, with a relatively low risk of complications. It can be a useful treatment option in cases with complex aortoiliac aneurysms, including those with bilateral IIA aneurysms.
authors.affiliation: Department of Cardiovascular Surgery, Morinomiya Hospital, Osaka, Japan. hosaka-a@umin.ac.jp
authors.forename: Akihiro
authors.initials: A
authors.lastname: Hosaka
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kato
authors.forename: Ippei
authors.initials: I
authors.lastname: Kato
authors.forename: Shingo
authors.initials: S
authors.lastname: Isshiki
authors.forename: Nobukazu
authors.initials: N
authors.lastname: Okubo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D002081:Buttocks / Q000098:blood supply; D004621:Embolization, Therapeutic / Q000009:adverse effects; D057510:Endovascular Procedures / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D017543:Iliac Aneurysm / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D007383:Intermittent Claudication / Q000209:etiology; D007511:Ischemia / Q000209:etiology; D007564:Japan; D018810:Magnetic Resonance Angiography; D008297:Male; D010388:Pelvis / Q000098:blood supply; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex