artery was occluded using steel coils (3â5 mm, William Cook Europe A/S,. Bjaerverskor, Denmark) to prevent an endoleak. Both the common iliac and external ...
ARTICLE IN PRESS M. Da Rocha et al. / Interactive CardioVascular and Thoracic Surgery 8 (2009) 491–493 eComment: Endovascular repair of iliac aneurysms Authors: Karsten Knobloch, Hannover Medical School, Plastic, Hand and Reconstructive Surgery, Hannover, Germany; Omke Teebken, Max Pichlmaier doi:10.1510/icvts.2008.194936A We appreciate reading the case report by Dr Da Rocha and coworkers from Barcelona regarding the endovascular occlusion of a common iliac artery aneurysm after open repair and abdominal aortic aneurysm w1x. Paraanastomotic iliac aneurysms after conventional repair of abdominal aortic aneurysms are associated with significant morbidity and mortality. Conventional open surgical repair of such aneurysms often involves general anesthesia and may necessitate complex vascular reconstruction. The authors stated: ‘As far as we know there is no report of an elective, endovascular correction of a recurrent common iliac artery aneurysm published before’. We had a similar experience regarding the feasibility of endovascular repair of an iliac pseudoaneurysm after conventional abdominal aneurysm repair w2x. A 60-year-old female presented with an asymptomatic 3.1 cm aneurysm of the right iliac artery in the anastomotic area after implantation of an aortic biiliacal prosthesis 25 years before. She had several vascular procedures over the last 30 years including thrombectomy of the superficial femoral artery at both sides, re-thrombectomy with iliac-patch-plasty with Dacron, implantation of the aortic biiliacal prosthesis and reconstruction of the right renal artery due to renal artery stenosis with hypertension. The procedure was performed under local anesthesia via a retrograde right femoral approach using an 11F introduction sheath. The right internal iliac artery was occluded using steel coils (3–5 mm, William Cook Europe A/S,
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Bjaerverskor, Denmark) to prevent an endoleak. Both the common iliac and external iliac arteries were dilated satisfactorily using percutaneous transluminal angioplasty (PTA). A stent graft (Wallgraft姠 Endoprothesis, diameter 10 mm, length 70 mm, Boston Scientific, Boston, MA, USA) was introduced and placed in the common iliac and external iliac artery without complications. Angiography confirmed successful coiling of the internal iliac artery without retrograde filling of the aneurysm as well as complete exclusion of the aneurysm from the circulation. Perioperative antibiotic prophylaxis was achieved with ceftriaxone (Rocephin 2 g intravenously). The patient was discharged from hospital on the second postoperative day without complication. Follow-up CT-scan a month after the intervention confirmed successful exclusion of the iliac aneurysm without an endoleak. Eighteen months after the procedure the patient remains symptom free without any buttock claudication or signs of pelvic or peripheral ischemia assessed with a duplex scan. Thus, endovascular repair appears a feasible option in selected patients. References w1x Da Rocha M, Adriani D, Leon F, Riambau VA. Endovascular occlusion of a common iliac artery aneurysm after open repair of an abdominal aortic aneurysm. Interact CardioVasc Thorac Surg 2009;8:491–493. w2x Knobloch K, Teebken O, Pichlmaier M, Weiss T, Savellano D, Galanski M, Haverich A, Chavan A. Iliac pseudoaneurysm stenting after conventional abdominal aneurysm repair. Eur J Vasc Endovasc Surg Extra 2003;6:91–93.
