Embolization of a Previously Excluded Symptomatic Internal Iliac Aneurysm Through the Iliac Vein.

A 69-year-old man was referred urgently for a 58-mm enlarging painful right internal iliac artery (IIA) aneurysm. Since exclusion through proximal IIA coverage and distal IIA branches embolization had been previously performed, aneurysm sac puncture through the iliac vein was decided. The ipsilateral common femoral vein was antegradely punctured, and a 16.5 G Ross modified Colapinto needle from a transjugular intrahepatic access set was used to puncture the sac and fill the aneurysm with coils. Embolization of an IIA aneurysm through the iliac vein may represent an alternative when prior IIA aneurysm exclusion has been performed.

Physician-Modified C3 Excluder Endograft as the Preferred Solution to Treat a Juxtarenal Para-Anastomotic Aneurysm.

Feasibility and early satisfactory results of physician-modified endografts have been reported. Most reports described the use of Cook Dacron aortic endografts (Cook Medical, Inc., Bloomington, IN). However, in some specific anatomic features (short aortic length, narrow aorta), the use of this device may not be appropriate.We here report a case of juxtarenal aortic aneurysm proximal to a former aortobifemoral graft in a high surgical risk patient. Due to a narrow proximal neck and a short aortic length, a physician-modified Gore C3 Excluder device (W. L. Gore & Associates, Inc., Flagstaff, AR) incorporating a fenestration for a large accessory renal artery was implanted. At 6-month follow-up, the aneurysm remains excluded and computed tomography scan demonstrates patent renal vessels.Surgeon-modified Gore C3 Excluder device implantation is feasible. Because of specific device characteristics (short main body, repositioning ability), it represents a valuable alternative in high-risk patients with juxtarenal aneurysms not amenable to other techniques.

Radial access for endovascular ilio-femoral procedures.

Common femoral artery puncture for ilio-femoral angioplasty can be hazardous or cumbersome in specific situations that require upper limb access (presence of a hostile groin, previous femoral surgery, cross-over maneuver in the setting of bifurcated aortic graft or pre-existing iliac kissing stents). The brachial artery is an alternative access site that is burdened with significant local complication rates. As in the coronary setting, feasibility and safety of transradial peripheral angioplasty has been reported in the recent literature. Procedural success rates ranged from 87% to 100%. No major access site bleeding was observed. Procedure and fluoroscopy time were not substantially increased, and decreased along with the learning curve. The majority of reports were limited to iliac lesions treatment, due to the lack of long-shaft and dedicated devices. Our experience showed the feasibility of this technique in iliac lesions but also in superficial femoral and popliteal artery procedures. Radial access can be used in situations where femoral approach is unsuitable and as first-line approach in the setting of ambulatory procedures. Although devices evolve, main limitations remain related to the lack of longer introducer sheaths and the absence of specific rescue devices and drug-eluting balloons. As a conclusion, radial access for endovascular ilio-femoral procedures is currently a promising alternative to femoral and humeral access in selected patients with the possibility of same-day discharge, and could progressively be considered when planning peripheral procedures.