Silvan Jungi, Dimitrios D Papazoglou, Hon-Lai Chan, Jürg Schmidli, Vladimir Makaloski
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The internal iliac artery was cannulated and bridged with a covered stent. Technical success rate was 100%. After a median follow-up period of 10 months, there was 1 type II endoleak and no migrations, stent fractures, or loss of device integrity. One iliac limb occlusion occurred after 7 months, which needed a secondary endovascular intervention, restoring patency.</p><p><strong>Conclusion: </strong>Surgeon-modified fenestrated iliac stent graft is feasible and might be used as an alternative in patients with a complex iliac anatomy not suitable to commercially available IBDs. Long-term follow-up is needed to evaluate stent graft patency and potential complications.Clinical ImpactSurgeon modified fenetrated iliac stent grafts might be a promising alternative to iliac branch devices, extending endovascular solutions to a broader patient population with complex aorto-iliac anatomies preserving antegrade internal iliac artery perfusion. It is possible to treat small iliac bifurcations and large angulations of the iliac bifurcation safely and there is no need for a contralateral or upper-extremity access.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"342-349"},"PeriodicalIF":1.7000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Novel Surgeon-Modified Fenestrated Iliac Stent Graft.\",\"authors\":\"Silvan Jungi, Dimitrios D Papazoglou, Hon-Lai Chan, Jürg Schmidli, Vladimir Makaloski\",\"doi\":\"10.1177/15266028231173311\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>We describe the feasibility and early results of a novel endovascular approach with a surgeon-modified fenestrated iliac stent graft to preserve pelvic perfusion in patients with iliac aneurysms not suitable for iliac branch devices (IBDs).</p><p><strong>Technique: </strong>Seven high-risk patients, median age 76 years (range 63-83), with a complex aortoiliac anatomy with contraindications for commercially available IBDs were treated with a novel surgeon-modified fenestrated iliac stent graft between August 2020 and November 2021. The modified device was built using an iliac limb stent graft (Endurant II Stent Graft; Medtronic), which was partially deployed, surgically fenestrated with a scalpel, reinforced, re-sheathed, and inserted via femoral access. The internal iliac artery was cannulated and bridged with a covered stent. Technical success rate was 100%. After a median follow-up period of 10 months, there was 1 type II endoleak and no migrations, stent fractures, or loss of device integrity. One iliac limb occlusion occurred after 7 months, which needed a secondary endovascular intervention, restoring patency.</p><p><strong>Conclusion: </strong>Surgeon-modified fenestrated iliac stent graft is feasible and might be used as an alternative in patients with a complex iliac anatomy not suitable to commercially available IBDs. Long-term follow-up is needed to evaluate stent graft patency and potential complications.Clinical ImpactSurgeon modified fenetrated iliac stent grafts might be a promising alternative to iliac branch devices, extending endovascular solutions to a broader patient population with complex aorto-iliac anatomies preserving antegrade internal iliac artery perfusion. 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引用次数: 0
摘要
目的:我们描述了一种新的血管内入路的可行性和早期结果,即外科改良的开窗髂支架移植,以保持不适合髂分支装置(ibd)的髂动脉瘤患者盆腔灌注。技术:在2020年8月至2021年11月期间,7名高危患者,中位年龄76岁(63-83岁),具有复杂的主动脉-髂解剖结构,并有市售ibd的禁忌症,接受了一种新型手术改良的开窗髂支架移植。该改良装置采用髂肢体支架(Endurant II stent graft;美敦力(Medtronic)),部分部署,手术开窗,用手术刀,加强,重新鞘,并通过股骨通道插入。髂内动脉插管,用覆盖支架桥接。技术成功率100%。中位随访10个月后,有1例II型内漏,无移位、支架骨折或器械完整性丧失。7个月后发生1例髂肢体闭塞,需要二次血管内介入,恢复通畅。结论:外科改良的开窗髂骨支架移植是可行的,可以作为一种替代方案,用于髂解剖结构复杂,不适合市售ibd的患者。需要长期随访来评估支架通畅和潜在的并发症。临床影响:外科医生改良的有孔髂支架移植可能是髂分支装置的一个有希望的替代方案,将血管内解决方案扩展到更广泛的患者群体,这些患者具有复杂的主动脉-髂解剖结构,保留了顺行髂内动脉灌注。可以安全地治疗小的髂分叉和大角度的髂分叉,不需要对侧或上肢通路。
Purpose: We describe the feasibility and early results of a novel endovascular approach with a surgeon-modified fenestrated iliac stent graft to preserve pelvic perfusion in patients with iliac aneurysms not suitable for iliac branch devices (IBDs).
Technique: Seven high-risk patients, median age 76 years (range 63-83), with a complex aortoiliac anatomy with contraindications for commercially available IBDs were treated with a novel surgeon-modified fenestrated iliac stent graft between August 2020 and November 2021. The modified device was built using an iliac limb stent graft (Endurant II Stent Graft; Medtronic), which was partially deployed, surgically fenestrated with a scalpel, reinforced, re-sheathed, and inserted via femoral access. The internal iliac artery was cannulated and bridged with a covered stent. Technical success rate was 100%. After a median follow-up period of 10 months, there was 1 type II endoleak and no migrations, stent fractures, or loss of device integrity. One iliac limb occlusion occurred after 7 months, which needed a secondary endovascular intervention, restoring patency.
Conclusion: Surgeon-modified fenestrated iliac stent graft is feasible and might be used as an alternative in patients with a complex iliac anatomy not suitable to commercially available IBDs. Long-term follow-up is needed to evaluate stent graft patency and potential complications.Clinical ImpactSurgeon modified fenetrated iliac stent grafts might be a promising alternative to iliac branch devices, extending endovascular solutions to a broader patient population with complex aorto-iliac anatomies preserving antegrade internal iliac artery perfusion. It is possible to treat small iliac bifurcations and large angulations of the iliac bifurcation safely and there is no need for a contralateral or upper-extremity access.
期刊介绍:
The Journal of Endovascular Therapy (formerly the Journal of Endovascular Surgery) was established in 1994 as a forum for all physicians, scientists, and allied healthcare professionals who are engaged or interested in peripheral endovascular techniques and technology. An official publication of the International Society of Endovascular Specialists (ISEVS), the Journal of Endovascular Therapy publishes peer-reviewed articles of interest to clinicians and researchers in the field of peripheral endovascular interventions.