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Purpose: The use of surgeon-modified fenestrated endograft to treat a bleeding complication in the common iliac artery.

Technique: An Endurant limb graft was modified on back table in theater after planning the fenestration using a semi-automated centerline. The Endurant stent was planned to land flush at the aortic bifurcation.

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Article Synopsis
  • - This article reviews current literature and expert opinions on using iliac branch endoprosthesis (IBE) for treating complex abdominal aortic aneurysms (AAA) that also involve the iliac arteries.
  • - Around 25% of AAA patients have aneurysms that extend into ilac vessels, complicating standard endovascular aortic repair (EVAR) procedures and requiring careful assessment to ensure proper treatment.
  • - The IBE is shown to be an effective and durable treatment option for complex aorto-iliac aneurysms, offering results comparable to open surgery but with lower risks, while also preserving pelvic circulation to avoid potential complications.
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Objective: Knowledge of hostile factors and their influence on long-term seal in the iliac landing zone is limited. Currently endorsed clinical practice guidelines lack structural evidence on how the iliac landing zone should be assessed in the pre-, intra-, and postoperative phases. The goal of this study was to obtain an international, expert-based consensus on the definition of a hostile iliac landing zone, on how to size and plan stent-grafts to optimize sustainable distal seal, and on the postprocedural follow-up protocol.

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Introduction: Endovascular aneurysm repair (EVAR) is a safe and widespread treatment option for abdominal aortic aneurysm (AAA). Unfavourable anatomy, such as hostile neck and aorto-iliac atherosclerosis, can lead to many complications and compromise the long term reliability of the endograft, resulting in a high rate of EVAR failure. Intravascular lithotripsy (IVL) has emerged as an alternative treatment to address severe iliofemoral atherosclerosis, aiding trackability of devices in EVAR.

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Article Synopsis
  • * Researchers analyzed the outcomes of five male patients who underwent surgery for pDAAA between January 2018 and March 2023, finding no 30-day mortality and manageable complications during their follow-ups.
  • * The findings suggest that open surgical repair can be a viable treatment option for pDAAA, allowing for future interventions if needed, although more extensive research is recommended to establish broader treatment guidelines.
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