title: Endovascular preservation of pelvic circulation with external iliac-to-internal iliac artery "cross-stenting" in patients with aorto-iliac aneurysms: a case report and literature review.
abstract: Endovascular success depends heavily upon anatomical suitability for secure graft placement. Common iliac artery (CIA) aneurysms frequently extend close to the iliac bifurcation, requiring distal fixation in the external iliac artery (EIA), in turn excluding the internal iliac artery (IIA). The preservation of circulation to at least one IIA artery is highly recommended. We report an endovascular technique for complete preservation of the hypogastric arteries of an aorto-iliac aneurysm extending into the iliac bifurcation and hypogastric artery. A left CIA aneurysm involving the iliac bifurcation was excluded with a covered Fluency stent-graft (Bard Inc., New Jersey, USA) deployed from the EIA into the IIA followed by the internal deployment of a Luminex uncovered stent (Bard Inc.) extended into one branch of the hypograstric artery. IVUS evaluation was essential in determining precise aneurysm and sealing zone measurements. Complete preservation of hypogastric circulation was achieved. The placement of the uncovered stent effectively extended the sealing zones without covering either of the hypogastric distal branches and concurrently corrected the Fluency stent kinking due to severe arterial tortuosity. In CIA aneurysms involving the IIA, an uncovered stent can extend the sealing zones, whilst maintaining complete preservation of pelvic circulation and offers support to the covered stent-graft. IVUS seems necessary for precise neck evaluation.
authors.affiliation: Department of Vascular Surgery, University of Modena and Reggio Emilia, Nuovo Ospedale St. Agostino-Estense Baggiovara, Modena, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Silingardi
authors.forename: S
authors.initials: S
authors.lastname: Tasselli
authors.forename: S
authors.initials: S
authors.lastname: Gennai
authors.forename: G
authors.initials: G
authors.lastname: Saitta
authors.forename: G
authors.initials: G
authors.lastname: Coppi
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D017543:Iliac Aneurysm / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D010388:Pelvis / Q000098:blood supply*; D011474:Prosthesis Design; D012039:Regional Blood Flow; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional