Treatment of Abdominal Aortic Aneurysms with Accompanied Iliac Artery Aneurysms Using New Sack Sealing Device
Acta Chirurgica Latviensis
Introduction. 20-30% of abdominal aortic aneurysms (AAA) occur simultaneously with unilateral or bilateral common iliac artery aneurysms (CIAA). Endovascular aneurysm repair (EVAR) is known to be an effective AAA treatment method used by many centres in over 80% of cases. Presence of AAA accompanied by CIAA significantly increases the complexity of EVAR with currently available endografts, internal iliac artery (IIA) often requiring coil embolisation resulting in serious post-procedural
... -procedural complications such as ischaemia of pelvic organs, gluteal claudication and erectile dysfunction. Aim of the study. Demonstrate successful endovascular AAA and CIAA treatment with new generation sac-sealing endograft device. Materials and methods. From 2008 Pauls Stradins Clinical University Hospital is participating in the prospective clinical trial assessing the efficacy and stability of the new generation sac-sealing endograft device (Nellix®, Endologix, USA). Until now this trial had 40 enrolled patients with suitable for endovascular treatment aneurysmal morphology. The treatment group has included 16 patients with AAA extending to either one or both common iliac arteries (CIA). The control group consisted of 24 patients with isolated AAA. AAA diameter was 5.6±0.76 cm (min - 4.3, max - 6.98) and 5.16± 0.91 cm (min-3.78, max-7.24) in the treatment and control groups respectively. Seven patients had unilateral and nine patients had bilateral CIAA. The diameter of CIAA was 2.61±0.57 cm (min - 2.04, max - 4.44). Post-procedural follow-up was done at one, six and twelve months and on annual basis thereafter. During follow-up the general health condition of the patients was assessed as well as computer tomography angiography (CTA) and duplex ultrasonography (DUS) imaging was performed in order to examine the status of the aneurysm, endograft condition and patency of IIA. Statistical analysis of data was performed using v19.0 SPSS software (IBM). Results. All patients successfully treated with new generation sac-sealing endograft excluding AAA and CIAA from blood circulation. Average follow-up period was 18 months. Upon follow-up in both groups endograft was stable and fixated in aneurysms with no endoleaks detected. In the treatment group all treated IIAs had remained patent with no pelvic organs ischaemia or gluteal claudication symptoms. Conclusion. New generation sac-sealing endograft is effective and simple in employment for the treatment of concomitant AAA and CIAA allowing the treatment of aneurysms with complex morphology and preserving the blood flow to internal iliac arteries. Further studies are required for long-term assessment of this endograft efficacy.