Iliac branched device (IBD)
for internal iliac aneurysm
- is it really worthwhile? M. Austermann
Department of Vascular Surgery
St. Franziskus Hospital Münster
University Hospital Münster
Head: Univ.- Prof. Dr. G. Torsello
home page: www.gefaesschirurgie-muenster.de
IBD for internal iliac aneurysm
Is it worthwhile?
Yes!
Embolization of the
Internal iliac artery
18 studies
634 patients
Rayt HS, Bown MJ, Lambert KV et al. Buttock claudication and erectile dysfunction after internal iliac artery embolization in
patients prior to endovascular aortic aneurysm repair. Cardiovasc Intervent Radiol 2008;31:728-34
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IBD for internal iliac aneurysm
Iliac branched device (IBD)
ZBIS - COOK®
First series:
Malina et al, 2006 (10 pts)
J Endovasc Ther 2006 Aug; 13 (4):496-500
First systematic
review:
Karthikesalignam et al 2010 (196 pts)
Eur J Vasc Endovasc Surg 2010 Mar; 39 (3) 285-94
45 / 61 mm
41 / 58 mm
10 / 12 mm
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IBD for internal iliac aneurysm
Common iliac aneurysm (IFU):
>45 mm
>20 mm
15 – 20 mm
< 10 - 12 mm
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IBD for internal iliac aneurysm
Open repair of iliac aneurysm:
Challenging because of
deep pelvic location especially in
obesed patients and after previous
abdominal surgery
Risk for deep venous or ureter
injuries or dysfuction of the
sympathic plexus.
Richardson 1988
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IBD – Münster experience
4/2005 – 12/2014
176 pt were treated with 210 IBD`s:
45
40
35
30
25
45
20
35
15
10
5
0
24
17
15
4
13
17
6
2005 2006 2007 2008 2009 2010 2011 2012 2013
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Procedure time (min), median (IQR)
138.5 (110.8-179.3)
Contrast (ml), median (IQR)
130 (105-165)
IBD
–
Münster
experience
Fluoroscopy time (min), median (IQR) 42.3 (33.4-56.5)
Table notes
Table I I . Perioperative results (30 days)
n=176
Mortality
Reintervention
Acute renal failure
Myocardial infarction
Graft thrombosis
Pneumonia
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1 (0.6)
11 6.3)
3 (1.7)
3 (1.7)
4 (2.3)
4 (2.3)
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IBD – Münster experience
Table I I I . Follow-up results (Median FU 20,1 month (IQR 4,2 -49,6)
n=176
Mortality
Reintervention
Type I endoleak
Type III endoleak
Migration
Occlusion
Conversion
Buttock claudicatio
Erectile dyfunction
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40
11
2
5
14
2
6
1
(13.6)
(22.7)
(6.3)
(1.1)
(3.0)
(8.2)
(1.1)
(3.4)
(0.6)
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IBD – Münster experience
Patency rate hypogastric branch (6/2014):
Pt at
Risk
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176
102
78
62
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IBD for internal iliac aneurysm
Morphological score from
IFU and IBD publications till 2010
J Endovasc Ther 2010 Apr; 17(2):163-71
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IBD for internal iliac aneurysm
Throwback:
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Dislocation of the bridging device
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IBD for internal iliac aneurysm
Throwback:
Dislocation of the bridging device
27.06.2014
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IBD for internal iliac aneurysm
Throwback:
Dislocation of the bridging device
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IBD for internal iliac aneurysm
Austermann et al. JVS 2013
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IBD for internal iliac aneurysm
Big aneurysms CIA (7 cm) and IIA (4 cm) on both sides
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IBD for internal iliac aneurysm
Big aneurysms CIA (7 cm) and IIA (4 cm) on both sides
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IBD for internal iliac aneurysm
Big aneurysms CIA (7 cm) and IIA (4 cm) on both sides
27.06.2014
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IBD for internal iliac aneurysm
Big aneurysms CIA (7 cm) and IIA (4 cm) on both sides
27.06.2014
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18
IBD for internal iliac aneurysm
Juxtarenal aorto-bi-iliac aneurysm with involvement of both IIAs
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IBD for internal iliac aneurysm
Juxtarenal aorto-bi-iliac aneurysm with involvement of both IIAs
27.06.2014
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20
IBD for internal iliac aneurysm
Juxtarenal aorto-bi-iliac aneurysm with involvement of both IIAs
27.06.2014
[email protected]
21
IBD for internal iliac aneurysm
Juxtarenal aorto-bi-iliac aneurysm with involvement of both IIAs
27.06.2014
[email protected]
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IBD for internal iliac aneurysm
Münster technique:
4/2011 – 12/2013
28 internal iliac aneurysms 23 patients were treated by the
following technique:
BECS (Advanta) und SECS (Viabahn)
+ Endolining mit SE-BMS (Smart, Zilver, Complete)
Results:
Two IIA-branch-occlusions (Patency 93%).
No Type 1/3 endoleak.
No perioperative mortality. (30 d)
Buttock claudication: 1 (4%)
Late mortality: 1 (not aneurysm related)
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IBD for internal iliac aneurysm
Conclusion:
It is worthwhile to preserve the flow to the hypogastric artery
also aneurysms with involvement of the IIA, to avoid buttock
claudication and erectile dysfunction.
This can be savely done by the iliac branched device in
combination with BECS and SECS.
Important:
Stable position inside the aneurysm (BECS)
Flexibility at the level of the sealingzone
(SECS)
Endolining to create a smooth transition of the
the stents.
Enough overlap of the stents to avoid dislocation
of the stents.
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IBD for internal iliac aneurysm
Thank you for your attention !
e-mail: [email protected]
home page: www.gefaesschirurgie-muenster.de
Universitätsklinik Münster
27.06.2014
St. Franziskus Hospital Münster
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