The JOTEC iliac branch device for exclusion of hypogastric artery aneurysms: ABRAHAM study
AbstractObjectiveHypogastric artery aneurysms (HAAs) are rare but life-threatening in cases of rupture. Open or endovascular techniques traditionally aimed at occluding the hypogastric artery (HA) have considerable risk of pelvic ischemia. Iliac branch devices (IBDs) are indicated for aortoiliac ane...
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| Veröffentlicht in: | Journal of vascular surgery 2019-09, Vol.70 (3), p.748-755 |
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| creator | Dueppers, Philip, MD Duran, Mansur, MD Floros, Nikolaos, MD Schelzig, Hubert, MD Wagenhäuser, Markus U., MD Oberhuber, Alexander, MD |
| description | AbstractObjectiveHypogastric artery aneurysms (HAAs) are rare but life-threatening in cases of rupture. Open or endovascular techniques traditionally aimed at occluding the hypogastric artery (HA) have considerable risk of pelvic ischemia. Iliac branch devices (IBDs) are indicated for aortoiliac aneurysms; however, they have also been used lately for HAAs. Currently, there are no reports about patient outcomes focusing on HAA therapy using IBDs. We retrospectively analyzed early and midterm outcomes using IBDs for HAAs. MethodsPatients who received IBDs for HAAs at our department from January 1, 2012, through March 1, 2018, were included. Exclusion criteria were as follows: no HA involvement, emergency procedures, and HA stent grafting without IBD. Perioperative and follow-up data were collected from medical records. ResultsThere were 18 IBDs (only IBD, n = 4; IBD + endovascular aneurysm repair [EVAR], n = 7; IBD ± EVAR + side branch occlusion, n = 7) implanted into 14 male patients (76 ± 4 [70-83] years). There were no intraoperative complications, and the technical success rate was 100%. After 19 ± 11 (2-39) months of follow-up, two hybrid (external iliac artery occlusion, n = 1; EVAR graft kinking, n = 1) and four endovascular reinterventions due to two type IB (side branch coiling + stent graft extension) and two type IIIB (stent grafting) endoleaks were required. One IBD-related type II endoleak revealed constant aneurysm diameters during follow-up. One small type IB endoleak was self-limited. Estimated freedom from reintervention was 31% ± 23% at 2.7 years. The clinical success and patency rate was 100%. The IBD-related mortality was 0%. ConclusionsThe IBD for HAA shows good early and midterm results. Adequate sealing of HA landing zones and side branch occlusion are technically challenging but crucial to prevent type IB and type II endoleaks. |
| doi_str_mv | 10.1016/j.jvs.2018.10.124 |
| format | Article |
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Open or endovascular techniques traditionally aimed at occluding the hypogastric artery (HA) have considerable risk of pelvic ischemia. Iliac branch devices (IBDs) are indicated for aortoiliac aneurysms; however, they have also been used lately for HAAs. Currently, there are no reports about patient outcomes focusing on HAA therapy using IBDs. We retrospectively analyzed early and midterm outcomes using IBDs for HAAs. MethodsPatients who received IBDs for HAAs at our department from January 1, 2012, through March 1, 2018, were included. Exclusion criteria were as follows: no HA involvement, emergency procedures, and HA stent grafting without IBD. Perioperative and follow-up data were collected from medical records. ResultsThere were 18 IBDs (only IBD, n = 4; IBD + endovascular aneurysm repair [EVAR], n = 7; IBD ± EVAR + side branch occlusion, n = 7) implanted into 14 male patients (76 ± 4 [70-83] years). There were no intraoperative complications, and the technical success rate was 100%. After 19 ± 11 (2-39) months of follow-up, two hybrid (external iliac artery occlusion, n = 1; EVAR graft kinking, n = 1) and four endovascular reinterventions due to two type IB (side branch coiling + stent graft extension) and two type IIIB (stent grafting) endoleaks were required. One IBD-related type II endoleak revealed constant aneurysm diameters during follow-up. One small type IB endoleak was self-limited. Estimated freedom from reintervention was 31% ± 23% at 2.7 years. The clinical success and patency rate was 100%. The IBD-related mortality was 0%. ConclusionsThe IBD for HAA shows good early and midterm results. Adequate sealing of HA landing zones and side branch occlusion are technically challenging but crucial to prevent type IB and type II endoleaks.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2018.10.124</identifier><identifier>PMID: 30850288</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Aneurysm - diagnostic imaging ; Aneurysm - physiopathology ; Aneurysm - surgery ; Aneurysm endoleak ; Arteries - diagnostic imaging ; Arteries - physiopathology ; Arteries - surgery ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation - adverse effects ; Blood Vessel Prosthesis Implantation - instrumentation ; Endoleak - etiology ; Endoleak - therapy ; Endovascular procedures ; Endovascular Procedures - adverse effects ; Endovascular Procedures - instrumentation ; Female ; Graft Occlusion, Vascular - etiology ; Graft Occlusion, Vascular - therapy ; Humans ; Iliac aneurysm ; Iliac artery ; Male ; Pelvis - blood supply ; Progression-Free Survival ; Prosthesis Design ; Retrospective Studies ; Risk Factors ; Surgery ; Time Factors ; Vascular Patency</subject><ispartof>Journal of vascular surgery, 2019-09, Vol.70 (3), p.748-755</ispartof><rights>Society for Vascular Surgery</rights><rights>2019 Society for Vascular Surgery</rights><rights>Copyright © 2019 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c451t-3e419c7901aa3fa3135c651f414ef7252a0ac370f52ac374d691bd849b427a7b3</citedby><cites>FETCH-LOGICAL-c451t-3e419c7901aa3fa3135c651f414ef7252a0ac370f52ac374d691bd849b427a7b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0741521419300631$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30850288$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dueppers, Philip, MD</creatorcontrib><creatorcontrib>Duran, Mansur, MD</creatorcontrib><creatorcontrib>Floros, Nikolaos, MD</creatorcontrib><creatorcontrib>Schelzig, Hubert, MD</creatorcontrib><creatorcontrib>Wagenhäuser, Markus U., MD</creatorcontrib><creatorcontrib>Oberhuber, Alexander, MD</creatorcontrib><title>The JOTEC iliac branch device for exclusion of hypogastric artery aneurysms: ABRAHAM study</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>AbstractObjectiveHypogastric artery aneurysms (HAAs) are rare but life-threatening in cases of rupture. Open or endovascular techniques traditionally aimed at occluding the hypogastric artery (HA) have considerable risk of pelvic ischemia. Iliac branch devices (IBDs) are indicated for aortoiliac aneurysms; however, they have also been used lately for HAAs. Currently, there are no reports about patient outcomes focusing on HAA therapy using IBDs. We retrospectively analyzed early and midterm outcomes using IBDs for HAAs. MethodsPatients who received IBDs for HAAs at our department from January 1, 2012, through March 1, 2018, were included. Exclusion criteria were as follows: no HA involvement, emergency procedures, and HA stent grafting without IBD. Perioperative and follow-up data were collected from medical records. ResultsThere were 18 IBDs (only IBD, n = 4; IBD + endovascular aneurysm repair [EVAR], n = 7; IBD ± EVAR + side branch occlusion, n = 7) implanted into 14 male patients (76 ± 4 [70-83] years). There were no intraoperative complications, and the technical success rate was 100%. After 19 ± 11 (2-39) months of follow-up, two hybrid (external iliac artery occlusion, n = 1; EVAR graft kinking, n = 1) and four endovascular reinterventions due to two type IB (side branch coiling + stent graft extension) and two type IIIB (stent grafting) endoleaks were required. One IBD-related type II endoleak revealed constant aneurysm diameters during follow-up. One small type IB endoleak was self-limited. Estimated freedom from reintervention was 31% ± 23% at 2.7 years. The clinical success and patency rate was 100%. The IBD-related mortality was 0%. ConclusionsThe IBD for HAA shows good early and midterm results. Adequate sealing of HA landing zones and side branch occlusion are technically challenging but crucial to prevent type IB and type II endoleaks.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aneurysm - diagnostic imaging</subject><subject>Aneurysm - physiopathology</subject><subject>Aneurysm - surgery</subject><subject>Aneurysm endoleak</subject><subject>Arteries - diagnostic imaging</subject><subject>Arteries - physiopathology</subject><subject>Arteries - surgery</subject><subject>Blood Vessel Prosthesis</subject><subject>Blood Vessel Prosthesis Implantation - adverse effects</subject><subject>Blood Vessel Prosthesis Implantation - instrumentation</subject><subject>Endoleak - etiology</subject><subject>Endoleak - therapy</subject><subject>Endovascular procedures</subject><subject>Endovascular Procedures - adverse effects</subject><subject>Endovascular Procedures - instrumentation</subject><subject>Female</subject><subject>Graft Occlusion, Vascular - etiology</subject><subject>Graft Occlusion, Vascular - therapy</subject><subject>Humans</subject><subject>Iliac aneurysm</subject><subject>Iliac artery</subject><subject>Male</subject><subject>Pelvis - blood supply</subject><subject>Progression-Free Survival</subject><subject>Prosthesis Design</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Time Factors</subject><subject>Vascular Patency</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU-P0zAQxS0EYsvCB-CCfOSS4vGfxAEJqVQLC1q0EpQLF8txJtQhTYqdVOTb49CFAwdOMxq99zTzG0KeAlsDg_xFu25Pcc0Z6PUy4vIeWQEriyzXrLxPVqyQkCkO8oI8irFlDEDp4iG5EEwrxrVeka-7PdIPt7urLfWdt45WwfZuT2s8eYe0GQLFn66boh96OjR0Px-HbzaOwTtqw4hhprbHKczxEF_SzZtPm-vNRxrHqZ4fkweN7SI-uauX5Mvbq932Oru5ffd-u7nJnFQwZgIllK4oGVgrGitAKJcraCRIbAquuGXWiYI1qUtV1nkJVa1lWUle2KISl-T5OfcYhh8TxtEcfHTYdWmxYYqGgy6VEqVWSQpnqQtDjAEbcwz-YMNsgJkFqWlNQmoWpL9HXCbPs7v4qTpg_dfxh2ESvDoLMB158hhMdB57h7UP6EZTD_6_8a__cbvO997Z7jvOGNthCn2iZ8BEbpj5vPx0eSmUgrE80foFumSaaA</recordid><startdate>20190901</startdate><enddate>20190901</enddate><creator>Dueppers, Philip, MD</creator><creator>Duran, Mansur, MD</creator><creator>Floros, Nikolaos, MD</creator><creator>Schelzig, Hubert, MD</creator><creator>Wagenhäuser, Markus U., MD</creator><creator>Oberhuber, Alexander, MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20190901</creationdate><title>The JOTEC iliac branch device for exclusion of hypogastric artery aneurysms: ABRAHAM study</title><author>Dueppers, Philip, MD ; Duran, Mansur, MD ; Floros, Nikolaos, MD ; Schelzig, Hubert, MD ; Wagenhäuser, Markus U., MD ; Oberhuber, Alexander, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c451t-3e419c7901aa3fa3135c651f414ef7252a0ac370f52ac374d691bd849b427a7b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aneurysm - diagnostic imaging</topic><topic>Aneurysm - physiopathology</topic><topic>Aneurysm - surgery</topic><topic>Aneurysm endoleak</topic><topic>Arteries - diagnostic imaging</topic><topic>Arteries - physiopathology</topic><topic>Arteries - surgery</topic><topic>Blood Vessel Prosthesis</topic><topic>Blood Vessel Prosthesis Implantation - adverse effects</topic><topic>Blood Vessel Prosthesis Implantation - instrumentation</topic><topic>Endoleak - etiology</topic><topic>Endoleak - therapy</topic><topic>Endovascular procedures</topic><topic>Endovascular Procedures - adverse effects</topic><topic>Endovascular Procedures - instrumentation</topic><topic>Female</topic><topic>Graft Occlusion, Vascular - etiology</topic><topic>Graft Occlusion, Vascular - therapy</topic><topic>Humans</topic><topic>Iliac aneurysm</topic><topic>Iliac artery</topic><topic>Male</topic><topic>Pelvis - blood supply</topic><topic>Progression-Free Survival</topic><topic>Prosthesis Design</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Time Factors</topic><topic>Vascular Patency</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dueppers, Philip, MD</creatorcontrib><creatorcontrib>Duran, Mansur, MD</creatorcontrib><creatorcontrib>Floros, Nikolaos, MD</creatorcontrib><creatorcontrib>Schelzig, Hubert, MD</creatorcontrib><creatorcontrib>Wagenhäuser, Markus U., MD</creatorcontrib><creatorcontrib>Oberhuber, Alexander, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dueppers, Philip, MD</au><au>Duran, Mansur, MD</au><au>Floros, Nikolaos, MD</au><au>Schelzig, Hubert, MD</au><au>Wagenhäuser, Markus U., MD</au><au>Oberhuber, Alexander, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The JOTEC iliac branch device for exclusion of hypogastric artery aneurysms: ABRAHAM study</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2019-09-01</date><risdate>2019</risdate><volume>70</volume><issue>3</issue><spage>748</spage><epage>755</epage><pages>748-755</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><abstract>AbstractObjectiveHypogastric artery aneurysms (HAAs) are rare but life-threatening in cases of rupture. Open or endovascular techniques traditionally aimed at occluding the hypogastric artery (HA) have considerable risk of pelvic ischemia. Iliac branch devices (IBDs) are indicated for aortoiliac aneurysms; however, they have also been used lately for HAAs. Currently, there are no reports about patient outcomes focusing on HAA therapy using IBDs. We retrospectively analyzed early and midterm outcomes using IBDs for HAAs. MethodsPatients who received IBDs for HAAs at our department from January 1, 2012, through March 1, 2018, were included. Exclusion criteria were as follows: no HA involvement, emergency procedures, and HA stent grafting without IBD. Perioperative and follow-up data were collected from medical records. ResultsThere were 18 IBDs (only IBD, n = 4; IBD + endovascular aneurysm repair [EVAR], n = 7; IBD ± EVAR + side branch occlusion, n = 7) implanted into 14 male patients (76 ± 4 [70-83] years). There were no intraoperative complications, and the technical success rate was 100%. After 19 ± 11 (2-39) months of follow-up, two hybrid (external iliac artery occlusion, n = 1; EVAR graft kinking, n = 1) and four endovascular reinterventions due to two type IB (side branch coiling + stent graft extension) and two type IIIB (stent grafting) endoleaks were required. One IBD-related type II endoleak revealed constant aneurysm diameters during follow-up. One small type IB endoleak was self-limited. Estimated freedom from reintervention was 31% ± 23% at 2.7 years. The clinical success and patency rate was 100%. The IBD-related mortality was 0%. ConclusionsThe IBD for HAA shows good early and midterm results. Adequate sealing of HA landing zones and side branch occlusion are technically challenging but crucial to prevent type IB and type II endoleaks.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30850288</pmid><doi>10.1016/j.jvs.2018.10.124</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Aneurysm - diagnostic imaging Aneurysm - physiopathology Aneurysm - surgery Aneurysm endoleak Arteries - diagnostic imaging Arteries - physiopathology Arteries - surgery Blood Vessel Prosthesis Blood Vessel Prosthesis Implantation - adverse effects Blood Vessel Prosthesis Implantation - instrumentation Endoleak - etiology Endoleak - therapy Endovascular procedures Endovascular Procedures - adverse effects Endovascular Procedures - instrumentation Female Graft Occlusion, Vascular - etiology Graft Occlusion, Vascular - therapy Humans Iliac aneurysm Iliac artery Male Pelvis - blood supply Progression-Free Survival Prosthesis Design Retrospective Studies Risk Factors Surgery Time Factors Vascular Patency |
| title | The JOTEC iliac branch device for exclusion of hypogastric artery aneurysms: ABRAHAM study |
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