Endovascular repair of aortoiliac aneurysmal disease with the helical iliac bifurcation device and the bifurcated-bifurcated iliac bifurcation device

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Presentation transcript:

Endovascular repair of aortoiliac aneurysmal disease with the helical iliac bifurcation device and the bifurcated-bifurcated iliac bifurcation device Shen Wong, MD, Roy K. Greenberg, MD, Chase R. Brown, BS, Tara M. Mastracci, MD, James Bena, MS, Matthew J. Eagleton, MD Journal of Vascular Surgery Volume 58, Issue 4, Pages 861-869 (October 2013) DOI: 10.1016/j.jvs.2013.02.033 Copyright © 2013 Terms and Conditions

Fig 1 A, This figure demonstrates the differences between the three devices. The helical iliac branch device (H-IBD) is about 5 cm long and, thus, extends 1 cm into the aortic portion on an abdominal aortic aneurysm if the common iliac artery (CIA) is slightly longer than 4 cm, placing two modular joints within a potentially large volume. If the CIA is shorter, then the device is even higher potentially compromising durability more and making the procedure much more challenging. The bifurcated-bifurcated IBD (BB-IBD) is designed for shorter CIAs, by allowing for the treatment of aneurysms involving CIAs as short as 2 to 2.5 cm without difficulty. Longer CIA aneurysms can also be treated, but the mating device to reach the internal iliac artery (IIA) landing zone must then be longer as well. Once the BB-IBD was developed, the need to treat CIAs that were shorter than 5.5 to 6 cm was obliviated, so the H-IBD2 was developed by lengthening the overlap with the aortic component to add more security to the joint. B, These images represent the actual devices. The straight IBD (S-IBD) is depicted first; note the minimal (10-15 mm) overlap zone in contrast to the H-IBD where the wrap of the branch around the device extends the overlap zone to 27 mm. The H-IBD2 has the extended overlap zone with the mating component increasing it from 22 mm in the H-IBD1 to 31 mm in the H-IBD2. The BB-IBD is designed to mate with a 24-mm-diameter tubular graft in the distal aorta. This is identical to the distal components used in fenestrated and branched grafts, making this an ideal distal component for such cases, replacing the distal bifurcated component that would have to be combined with an IBD to achieve treatment of a CIA or IIA aneurysm. Journal of Vascular Surgery 2013 58, 861-869DOI: (10.1016/j.jvs.2013.02.033) Copyright © 2013 Terms and Conditions

Fig 2 This image superimposes a completed iliac branch device (IBD) with the underlying angiogram depicting the relationship between the natural lay of the mating Fluency stent graft with the intended treatment anatomy. Journal of Vascular Surgery 2013 58, 861-869DOI: (10.1016/j.jvs.2013.02.033) Copyright © 2013 Terms and Conditions

Fig 3 This Kaplan-Meier curve estimates the survival for all of the patients in the trial. Through 7 years, the standard error was under 10%. Journal of Vascular Surgery 2013 58, 861-869DOI: (10.1016/j.jvs.2013.02.033) Copyright © 2013 Terms and Conditions

Fig 4 Branch patency for the entire cohort is demonstrated by the Kaplan-Meier curve in the figure. Standard error was <10% throughout. Journal of Vascular Surgery 2013 58, 861-869DOI: (10.1016/j.jvs.2013.02.033) Copyright © 2013 Terms and Conditions

Fig 5 Intraoperative pictures. a, Tight ostial lesion (A) and stent graft in situ (B). b, Internal iliac artery (IIA) aneurysm (A), coiling of anterior divisional branch (B), and placement of mating stent into the posterior divisional branch (C). c, Completed repair: infrarenal device (A) and fenestrated proximal device (B). Journal of Vascular Surgery 2013 58, 861-869DOI: (10.1016/j.jvs.2013.02.033) Copyright © 2013 Terms and Conditions