Parallel endografts in the treatment of distal aortic and common iliac aneurysms.
OBJECTIVE
Endovascular treatment of distal abdominal aortic aneurysms (D-AAA) and bilateral common iliac artery aneurysms (BCIAA) may present technical challenges for standard EVAR. Parallel iliac leg endografts (ILEs) of standard aortic devices and covered stents have been successfully employed to treat patients with D-AAA and BCIAA. The perioperative and long-term results of this straightforward endovascular technique are presented.


METHODS
Beginning in 2009, patients deemed unfit for open surgery underwent parallel endografts D-AAA and BCIAA exclusion. Avoiding the use of a main body, ILEs are simultaneously delivered from both femoral arteries, landing parallel into the aortic neck (parallel grafts: PG). Distal landing zones including external iliac arteries (EIAs) are reached using appropriate ILEs. A third parallel covered stent graft (Viabahn, Gore) is delivered from a left brachial approach to maintain prograde blood flow to one internal iliac artery (IIA) when needed.


RESULTS
Eighteen patients were successfully treated using parallel endografts, nine for BCIAA and nine for D-AAA. All D-AAA presented an irregular saccular shape, including three penetrating aortic ulcers and two pseudoaneurysms of previous aortic grafts. Prograde flow to one IIA was successfully maintained using a Viabahn graft in five patients with BCIAA. Mean aneurysm size was 50 mm in D-AAA and 43 mm in BCIAA. One patient required a perioperative ILE extension to treat a type Ib endoleak. One patient suffered a minor stroke 24 hours after the procedure. Two type II endoleaks were observed postoperatively. Five patients died of non-aneurysm related causes during follow-up. No new endoleaks, graft displacements or occlusions were observed during follow-up (median: 26 months, range 12-42 months).


CONCLUSIONS
Successful exclusion of D-AAA and BCIAA was achieved in high-risk patients using parallel endografts, allowing antegrade blood flow to one IIA when needed. Commercially available endografts were used in a simple and effective approach, with excellent follow-up results.
Department of Cardiac, Thoracic and Vascular Sciences, Division of Vascular and Endovascular Surgery, University of Padova, Padova, Italy. Electronic address: slepidi@unipd.it.
S
S
Lepidi
Department of Cardiac, Thoracic and Vascular Sciences, Division of Vascular and Endovascular Surgery, University of Padova, Padova, Italy.
M
M
Piazza
Department of Cardiac, Thoracic and Vascular Sciences, Division of Vascular and Endovascular Surgery, University of Padova, Padova, Italy.
P
P
Scrivere
Department of Cardiac, Thoracic and Vascular Sciences, Division of Vascular and Endovascular Surgery, University of Padova, Padova, Italy.
M
M
Menegolo
Department of Cardiac, Thoracic and Vascular Sciences, Division of Vascular and Endovascular Surgery, University of Padova, Padova, Italy.
M
M
Antonello
Department of Cardiac, Thoracic and Vascular Sciences, Division of Vascular and Endovascular Surgery, University of Padova, Padova, Italy.
F
F
Grego
Department of Surgery, Division of Vascular Surgery, City Hospital, Udine, Italy.
P
P
Frigatti
D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000175:diagnosis / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D017543:Iliac Aneurysm / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D011474:Prosthesis Design; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014456:Ulcer / Q000175:diagnosis / Q000601:surgery*
Abdominal aortic aneurysm; Endovascular repair; Iliac aneurysm; Parallel endograft