Name of the Procedure:

Endovascular repair of iliac artery (e.g., aneurysm, pseudoaneurysm, arteriovenous malformation, trauma) using ilio-iliac tube endoprosthesis

Summary

Endovascular repair of the iliac artery involves using a minimally invasive technique to place an ilio-iliac tube endoprosthesis (a type of stent graft) to treat conditions such as aneurysms, pseudoaneurysms, arteriovenous malformations, or trauma of the iliac artery. The procedure is performed through small incisions, typically in the groin, through which the stent graft is guided into place.

Purpose

This procedure addresses issues related to the iliac artery, such as aneurysms (ballooning of the artery wall), pseudoaneurysms (false aneurysms), arteriovenous malformations (abnormal connections between arteries and veins), and trauma. The goal is to reinforce the artery wall, restore normal blood flow, and prevent rupture or other complications.

Indications

• Symptomatic or large iliac artery aneurysms
• Pseudoaneurysms of the iliac artery
• Arteriovenous malformations involving the iliac artery
• Trauma to the iliac artery
• Patients with suitable anatomy for endovascular repair

Preparation

• Fasting for at least 6-8 hours before the procedure
• Medication adjustments as advised by the physician
• Pre-procedure imaging tests such as CT angiography to assess the anatomy
• Blood tests to check kidney function and coagulation status

Procedure Description

1. The patient is positioned on the operating table and sedated or given general anesthesia.
2. Small incisions are made in the groin area to access the femoral arteries.
3. A guidewire is inserted through the femoral artery and advanced to the iliac artery under fluoroscopic guidance.
4. A catheter is then threaded over the guidewire, and the stent graft (ilio-iliac tube endoprosthesis) is deployed at the site of the arterial lesion.
5. The stent graft expands to fit the artery, reinforcing the vessel wall.
6. The catheters and guidewires are removed, and incisions are closed.

Duration

The procedure typically takes 1-3 hours, depending on the complexity of the case.

Setting

The procedure is performed in a hospital setting, specifically in an interventional radiology suite or operating room equipped for endovascular surgery.

Personnel

• Vascular surgeons or interventional radiologists
• Anesthesiologists
• Surgical nurses and technicians
• Radiologic technologists

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Blood vessel damage or dissection
• Stent graft migration or endoleak (leakage around the graft)
• Allergic reaction to contrast dye
• Kidney dysfunction due to contrast agents

Benefits

• Minimally invasive with shorter recovery time compared to open surgery
• Reduced risk of complications and blood loss
• Restoration of normal blood flow and prevention of arterial rupture

Recovery

• Close monitoring in the recovery area for a few hours
• Pain management with prescribed medications
• Avoid heavy lifting and strenuous activities for 1-2 weeks
• Follow-up imaging studies to ensure proper placement and function of the stent graft
• Regular follow-up appointments to monitor arterial health

Alternatives

• Open surgical repair of the iliac artery, which involves a larger incision and longer recovery time
• Conservative management with medications and lifestyle changes (for small, asymptomatic aneurysms)
• Coil embolization or other endovascular techniques for specific conditions

Patient Experience

• The patient may feel some discomfort or pressure during the catheter insertion but should not feel pain due to anesthesia.
• Post-procedure, patients may experience some soreness at the incision sites.
• Pain management will be provided, and most patients can resume normal activities within a week to 10 days.