Expansion of an iliac aneurysm after treatment with multilayer stent: an unusual case.

A 62 year old man, suffering from arterial hypertension and no other significant comorbidities come to our attention for the presence of an asymptomatic 29 mm left common iliac artery (CIA) aneurysm and bladder cancer. Given the young age of the patient, we opted for endovascular treatment that would allow to maintain the patency of the hypogastric artery. In June 2011, the patient underwent an endovascular exclusion of the left iliac artery aneurysm corrected by multilayer stent placement (Cardiatis 16x120mm) and post-dilatation with 14x40 mm balloon (Medtronic Reliant). At the 3 months follow-up, a CT-angio was made, showing a Type I endoleak with complete perfusion of the aneurismal sac. We analysed the CT-Angio using OsiriX and at the 3D reconstruction a poor adhesion of the stent to the proximal neck was detected. We decided to intervene by implanting two balloon-expendable covered stents (Atrium Adventa; 16x40 mm) The aneurysm sac remained stable for 9 months but at 12 months follow-up the aneurysm presented a diameter of 39mm. Due to the increase of the aneurysm sac, we decided to implant a stent-graft 16-10x95+10-10x80 mm (Medtronic Endurant) with complete exclusion of the aneurysm and internal iliac artery occlusion. At one month follow-up the patient is completed asymptomatic with no endoleak at the Duplex scan and at the CT-Angio.

Tips and tricks to avoid periprocedural neurological complications in carotid artery stenting.

Execution of carotid artery stenting (CAS) requires not only excellent manual dexterity, and a high level of competence, but also in-depth knowledge of the carotid pathology, of the materials available on the market and of the different techniques to apply in given situations. Actually each individual moment of the procedure can be determining for the final result. This review describes each individual step of CAS, including arterial access, carotid engagement, pre-dilatation, the characteristics and use of cerebral protection devices, stent selection and deployment, and post-dilatation. Technical notes and some suggestions are provided on how to minimize the event of periprocedural neurological complications.

Endovascular approach to Leriche syndrome.

The chronic obstruction of the aortic bifurcation and iliac axis was definide by the French surgeon Rene Leriche, whose name it bears today. The advancing age of the population move the definition from a syndrome, as reported from Leriche, to complex aortoiliac vascular lesions current multidisciplinary guidelines recommend to treat extensive aortoiliac occlusive disease by surgical revascularization. Surgery provides good long-term patency, but at the cost of substantial perioperative morbidity. Development of new technologies and techniques has led to increased use of endovascular therapy for extensive aortoiliac disease. This review article summarized current multidisciplinary guidelines indication in endovascular treatment of extensive aorto-iliac disease and the various worldwide single centre experience published on endovascular treatment of Leriche Syndrome.