Internal iliac artery revascularization as an adjunct to endovascular repair of XXXX .

@entity1 @entity323 @entity63 @entity1070 @entity439 @entity613 @entity583 @entity1029 @entity1028
PURPOSE: Endovascular repair of @entity439 may be limited by extension of the @entity439 to the iliac bifurcation, necessitating endpoint implantation in the external iliac artery. In such cases the circulation to the internal iliac artery is interrupted. Bilateral internal iliac artery occlusion during endovascular repair may be associated with significant morbidity, including @entity613 , @entity323 , and @entity63 of the sigmoid colon and perineum. We have employed internal iliac artery revascularization (IIR) to allow endograft implantation in the external iliac artery while preserving flow to the internal iliac artery in @entity1 with @entity439 involving the iliac bifurcation bilaterally. METHODS: A total of 11 IIR procedures were performed in 10 @entity1 undergoing @entity1028 ( @entity1028 ) repair (9 @entity1 , 1 @entity1 ; mean age, 74 years). IIR was accomplished via a retroinguinal incision in 9 cases and a retroperitoneal incision in 2 cases. Six-mm polyester grafts were used for external-to-internal iliac artery bypass in 10 cases and internal iliac artery transposition onto the external iliac artery was used in one case. @entity1028 repair was performed using a modular bifurcated device (Talent-LPS, Medtronics, Minneapolis, Minn) after IIR. Bypass graft patency was determined immediately after the surgery, at 1 month, and every 3 months thereafter, using duplex ultrasound scanning and computed-tomography angiography. Mean @entity439 diameters were as follows: @entity1028 , 6.4 +/- 0.7 cm; ipsilateral common iliac, 3.7 +/- 1.0 cm; contralateral common iliac, 3.9 +/- 0.8 cm. RESULTS: Successful IIR and @entity1028 repair were accomplished in all cases. No proximal, distal, or graft junction @entity1070 occurred. Two @entity1 demonstrated retrograde @entity439 originating from the lumbar arteries. One thrombosed spontaneously within 3 months. One perioperative @entity583 occurred. Reduction in @entity439 size was documented in 5 aortic, 5 ipsilateral iliac, and 3 contralateral @entity1029 . @entity613 , @entity323 , @entity63 , and mortality did not occur. All IIRs have remained patent during a follow-up period of 4 to 15 months (mean, 10.1 months). CONCLUSIONS: IIR may be used with good short-term to intermediate-term patency to prevent @entity63 in @entity1 whose @entity439 anatomy requires extension of the endograft into the external iliac artery. This may allow @entity1028 repair to be performed in @entity1 who might otherwise be at risk for developing complications associated with bilateral internal iliac artery occlusion.
