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Purpose To assess the safety, feasibility, and effectiveness of coil embolization of the proximal internal iliac artery (IIA) before stent-graft extension in patients previously treated by endovascular aortic repair (EVAR). Materials and Methods Over a period of 9 years, 16 ipsilateral, proximal IIA coil embolization procedures were performed before stent-graft extension in 13 patients previously treated by a modular aortic stent graft. Indication for coil embolization and concomitant stent-graft extension were secondary (ie, late) distal type I endoleak ( n = 9) and late onset of an isolated common iliac artery aneurysm ( n = 7) as a result of increasing dilation of a common iliac artery during follow-up after EVAR; mean common iliac artery diameter before coil embolization was 26.1 mm (range, 15–35 mm). Clinical and radiologic follow-up (mean, 39 months; range, 6–102 months) was done in accordance with an established registry. Results All procedures were successful except for one performed with 0.035-inch coils. Clinically, buttock claudication was noted in five of 13 patients (38%). No type II endoleak occurred through the coil-embolized internal iliac arteries. The mean common iliac artery diameter at 6-month follow-up was 23.0 mm (range, 14–30 mm; P = .0005). Conclusions Ipsilateral coil or microcoil embolization of the proximal IIA before stent-graft extension in patients previously treated by an aortic stent graft seems to be safe and feasible, with favorable outcomes after a mean follow-up of 39 months.

Purpose To assess the incidence and clinical significance of thrombotic, nonocclusive mural deposits in abdominal aortic stent-grafts incidentally found on follow-up computed tomography scans after endovascular aneurysm repair (EVAR). Materials and Methods Between 1998 and 2007, 288 patients underwent EVAR of an infrarenal aortic aneurysm. In the majority of cases, a Zenith stent-graft ( n = 187) or Excluder stent-graft ( n = 71) was implanted. Clinical and radiologic follow-up was performed prospectively according to the EUROSTAR registry, with mean follow-up periods of 4.69 and 5.05 years, respectively, for the Excluder and Zenith groups. Results Thrombotic deposits were found in 17% and 33% of patients in the Excluder and Zenith groups, respectively, which represents a significant difference ( P = .038). Clinically, no distal atheroembolic events were noted during follow-up, and there was no significant difference in survival between patients with and without thrombotic deposits ( P = .80). Conclusions Incidentally found thrombotic deposits in abdominal aortic endografts are common and device-specific, with a lower incidence in the Excluder group versus the Zenith group. These thrombotic deposits are clinically silent, do not require additional treatment at short-term and midterm follow-up, and do not affect the overall survival of the treated patients.

Purpose To assess the time period of onset, etiology, and outcomes of limb occlusion after endovascular repair of abdominal aortic aneurysms with supported endografts. Materials and Methods From 1998 to 2007, 288 patients underwent endovascular aneurysm repair (EVAR) to exclude an infrarenal aortic aneurysm. In the majority of patients, a Zenith stent-graft ( n = 187) or Excluder stent-graft ( n = 71) was implanted. Nine patients presented with limb occlusion during follow-up. All occluded stent-grafts were modular ( n = 8) or aortomonoiliac ( n = 1) Zenith endoprostheses. One additional patient who was previously treated with a Zenith aortomonoiliac stent-graft was referred to our institution for further treatment of stent-graft thrombosis. Results The initial clinical presentations were acute ischemia ( n = 5), buttock claudication ( n = 3), and incidental findings on follow-up imaging ( n = 2). Occlusion occurred within the first month after EVAR ( n = 5), between the first and second month after EVAR ( n = 2), 10 months after EVAR ( n = 1), and 4–5 years after EVAR ( n = 2). Underlying causes of occlusion were kinking of the stent-graft ( n = 5), small-diameter endograft limb with extension to the external iliac artery ( n = 3), and migration and dislocation of an endograft limb ( n = 2). Treatment consisted of catheter-directed thrombolysis and stent placement ( n = 3), surgical thrombectomy or bypass operation ( n = 5), and expectant management ( n = 2). Outcome of all revascularization procedures showed immediate clinical success in all patients and no late recurrent limb ischemia at a mean follow-up of 38.9 months. Conclusions Limb occlusion of aortic stent-grafts mostly occurs shortly after EVAR and can be related to underlying kinking of the metallic skeleton, extension of the stent-graft into the external iliac artery, or migration and dislocation of an endograft limb. Satisfactory and durable clinical outcomes can be obtained after appropriate revascularization.