The Use of Iliac Side Branch Devices in Patients with Aortoiliac Aneurysm.

PURPOSE: The aim of this study was to evaluate the technical feasibility and short-time patency rate of iliac side branch devices based on the authors' institution's experience. MATERIALS AND METHODS: Data of 17 patients (all men) with an aortoiliac aneurysm (median age 72.5 years) who underwent endovascular repair between October 2013 and June 2015 (20 months) at our institution was analyzed retrospectively. Primary endpoint was primary technical success, defined as adequate implantation of the iliac branch device with patency of the hypogastric side branch without the need of further re-interventions within 30 days. Mean follow-up was 8.2 ±â€Š5.4 months. RESULTS: Eighteen iliac side branch devices were implanted with a branch patency of 100 % and a primary technical success rate of 94.4 % (n = 17). Perioperative 30 days mortality was 0 %. The mean diameter of treated abdominal aorta and common iliac artery was 41 ±â€Š14 and 30 ±â€Š8 mm. In one case partial dislocation of the iliac side branch device occurred due to severe kinking of iliac arteries with development of an iliac endoleak type Ib that had to be treated in a second intervention. Three patients (15 %) showed an endoleak type II from the inferior mesenteric artery without the need of re-intervention. After three months one patient suffered from subtotal thrombotic occlusion of the bridging stent that was successfully resolved through intra-arterial fibrinolytic therapy and additional stent graft implantation. CONCLUSION: Summarized, implantation of iliac side branch devices is a feasible technique with favourable short-term results in patients with aortoiliac aneurysm. KEY POINTS: • Implantation of iliac side branch devices is a feasible technique.• Distinguish short-term results of side branch endografting in patients with aortoiliac aneurysm.• Carefully patient selection is necessary to avoid complications and re-interventions. Citation Format: • Maus V, Kurz P, Sommer CM et al. The Use of Iliac Side Branch Devices in Patients with Aortoiliac Aneurysm.. Fortschr Röntgenstr 2016; 188: 746 - 752.

Abdominal aortic aneurysm in Behçet's disease: treatment with endovascular stent graft.

A case of acute rupture of an abdominal aortic aneurysm in a patient with Behçet's disease is reported. The patient was successfully treated by implantation of an endovascular stent graft. The preinterventional diagnostic procedures and the postinterventional follow-up are described and the benefit and risk vs open surgery is discussed.

[MR angiography using Gd-DTPA in staging of abdominal aortic aneurysm: a correlation with DSA and CT]. / MR-Angiographie mit Gd-DTPA zum Staging des abdominellen Aortenaneurysmas: Korrelation mit DSA und CT.

PURPOSE: To evaluate a contrast-enhanced (CE) MRA sequence for staging AAA. METHODS: In 24 patients (male = 20, female = 4, age = 44-81 y) with known AAA the abdominal aorta and its branches including the iliac arteries were imaged, using a 3D GRE-FISP sequence (1.5 T, TR/TE/FA = 25/6/35, slab = 100-140 mm, 32 part., FOV = 440-450 mm, matrix = 256 x 256) during an i.v. infusion of 40 ml of gadopentate dimeglumine. In addition, representative axial single slices (2D breath hold FLASH-sequence. TR/TE/FA = 82/5/30) were acquired following contrast application. MR-results were correlated with i.a. DSA and CT studies. RESULTS: With CE-MRA, AAA (n = 24) and iliac aneurysms (n = 17) could be evaluated in all cases (sens. = 100%, spec. = 100%) including luminal patency and mural thrombus. 50/54 renal arteries could be identified, 4/6 accessory renal arteries (sens. = 66.6%, spec. = 100%), 8/9 renal artery stenoses > 50% (sens. = 88.8%, spec. = 89.3%), 1/1 renal artery occlusion and 7/8 iliac artery stenoses > 50% (sens. = 87.5%, spec. = 97.5%) were depicted correctly. Proximal portion of sup. mes. art. could be detected and evaluated in 21/24 cases. Quantitative determination of therapeutically relevant vascular parameters using MRA was comparable to DSA and CT. CONCLUSION: CE-MRA is a useful method for staging of AAA and may become the method of choice when ultrafast MR techniques are used.

[Percutaneously implanted permanent vena cava filter: follow-up of 117 consecutive patients]. / Perkutan implantierte permanente Vena-cava-Filter: Verlaufsbeobachtungen bei 117 konsekutiven Patienten.

PURPOSE: Retrospective review of indication, insertion technique and problems, complications and effectiveness of 5 different filter designs implanted during a period of 5 years. MATERIALS, PATIENTS AND METHODS: We inserted one Filcard-filter, 4 Antheor DC 3 perm.-filters, 17 Trigon/Cardial-filters, 28 Titan-Greenfield-filters (modified hook) and 65 LGM 30 D/U Vena Tech-filters via a femoral (n = 111) or a jugular (n = 4) approach in 115 of 117 patients. Indication was acute deep thrombosis of the iliac or femoral vein with and without pulmonary embolism (PE) in patients with contraindication to, or unsuccessful, anticoagulation therapy or lysis. Follow-up was possible in 92 patients. RESULTS: In two of 117 patients the filter could not be implanted due to dissection of the left iliac vein. In the other 115 patients we achieved an orthograde position of the filter in 78%, 22% of the filters tilted more than 15 zero and 25% had been opened incompletely. We noticed late filter dislocation in 4 cases, deep vein thrombosis of the access vein in two cases, one haematoma of the insertion site, three asymptomatic perforations of filter struts through the caval wall, 14 filter induced thromboses of the vena cava (15.2%) and 13 recurrent PE (14.1%), fatal in 5 cases (5.4%). CONCLUSION: The implantation of vena caval filters as a prophylaxis of PE is easy and of low risk. Because of the relatively high rate of recurrent PE (14.1%) in our series after implantation, the effectiveness must be judged critically.

[Rational diagnosis of traumatic aortic rupture]. / Rationelle Diagnostik der traumatischen Aortenruptur.

The traumatic aortic rupture has an extremely high spontaneous mortality rate. Important for surviving the trauma is a fast and efficient diagnostic procedure. The suspected diagnosis results from relatively typical criteria in the chest radiograph, especially the continuous widening of the mediastinum. The diagnostic procedure of 26 patients with polytrauma, abnormal chest radiograph and further examinations (intra-arterial digital subtraction angiography [i.a.DSA]: n = 10, contrast-enhanced CT: n = 19, CT and DSA: n = 5) was reviewed. Six patients had an aortic rupture. In 4 patients the diagnosis was confirmed by angiography, in 2 patients by surgery. The specificity was 100% for DSA and 40% for CT. To ensure the suspected diagnosis of a traumatic aortic rupture we therefore primarily recommend angiography. Whenever CT is performed in case of head injury, a CT of the thorax can be added in order to exclude mediastinal bleeding and to reduce the need for angiography.