A rare case of bilateral isolated internal iliac artery aneurysms excluded with VBX covered stents.

OBJECTIVE: Isolated aneurysms of the internal iliac arteries (IIIAA) are a rare variant of aorto-iliac aneurysms, representing only 0.3-0.5% of intra-abdominal aneurysms. Bilateral isolated hypogastric artery aneurysms are even more rare. The rarity of IIIAA has determined the absence of a high level of evidence about its treatment. METHOD: We present a case of bilateral isolated internal iliac artery aneurysms treated in two stages by positioning GORE VIABAHN VBX Balloon Expandable Endoprosthesis large, chosen for the possibility to adapt it to the anatomical diameter variations between the hypogastric artery and the posterior trunk, which was the distal landing zone chosen in both sides. CONCLUSION AND RESULTS: Total patency was detected 1 year after surgery in both sides. No buttock claudication, erectile dysfunction and/or signs of bowel ischaemia were referred. Preserving the hypogastric flow is an important goal in isolated hypogastric arteries aneurysms' treatment and covered stenting surely represents a valid therapeutical choice.

Below-the-Ankle Orbital Atherectomy in Chronic Limb-Threatening Ischemia Patients as a Bailout Strategy for Limb Salvage: Early Clinical Experience.

PURPOSE: To evaluate the feasibility and early outcomes of below the ankle orbital atherectomy in chronic limb-threatening ischemia in patients with calcified foot arteries. METHODS: 12 patients (mean age 69.4 ± 14.7; range 57 to 85 years) who were affected by diabetes underwent orbital atherectomy below the knee and ankle arterial segments. Technical success was defined as orbital atherectomy passage and debulked the calcified lesion, delivery of adjunctive therapy, and < 30% residual stenosis at final angiogram. The procedural outcome included complications, amputation-free survival, and freedom from clinically-driven target lesion revascularization at 30-days and 6-months of follow-up. RESULTS: Orbital atherectomy was performed in 3 cases in Anterior tibial (AT) and dorsalis pedis (Ped) arteries + Posterior tibial (PT) and Lateral Plantar (Lat Plan), 5 cases in PT and Lat Plan arteries, 1 case of PT and Medial Plantar, 1 case of Peroneal and Plan Lat, and 2 cases of AT and Ped. After atherectomy, we used a drug-coated balloon (DCB) angioplasty. Technical success was achieved in 11 (91.6%) cases. No deaths were registered during the follow-up. The limb salvage rate was 100%, and no major amputations were registered. Amputation-free survival was 50%. Freedom from CD-TLR was 100% at 30 days and 91.7% at 6-months. One patient underwent a TLR at three months. No major cardiovascular events, limb events, or significant procedure-related complications were registered. CONCLUSIONS: CSI orbital atherectomy and DCB angioplasty appear a feasible and promissor treatment options in diabetic CLTI patients.