Modifying the “Eye of the Tiger” Technique: Preserving Gluteal Artery Perfusion in the Treatment of an Aneurysm of the Hypogastric Artery

Abstract

Purpose:

In endovascular aneurysm repair, parallel stent graft deployment is sometimes utilized to preserve the distal branch perfusion. However, there will be some gutter space around 2 stent grafts, which may cause endoleak. The “eye of the tiger” technique was invented to minimize this leak when deploying a small side-branch stent graft in conjunction with a large aortic endograft. The purpose of this case report is to describe our modified technique for 2 small endografts deployed in double D-shape in order to prevent gutter leak, which we applied in endovascular treatment for a hypogastric artery aneurysm.

Case Report:

A 79-year-old male patient presented with a right hypogastric artery aneurysm measuring 44 mm. The patient refused the open surgical repair option and hoped for an endovascular treatment. Therefore, endovascular treatment to exclude the hypogastric artery aneurysm as well as preserve the gluteal arteries was planned. An Internal Iliac Component (IIC)(W. L. Gore & Associates, Flagstaff, AZ, USA) was utilized for the proximal sealing and 2 Viabahn stent grafts (W. L. Gore & Associates) were deployed in the superior and inferior gluteal arteries for distal sealing. Then, 2 VBX stent grafts (W. L. Gore & Associates) were added in the IIC as bridging stents to connect the IIC and both Viabahn stent grafts. Next, over-dilatation of VBX stent grafts was performed alternately with an 8 mm balloon catheter and subsequent kissing balloon dilation with 5 mm balloon catheters, which allowed the VBX stents to be set in double D-shape. A follow-up CT scan performed 1 week after the procedure revealed no endoleak and a favorable shape to the VBX stent grafts.

Conclusion:

The modified method of dilating the VBX stent grafts allowed the double D-shape deployment, minimizing the risk of gutter leak and preserving distal branch perfusion.

Keywords

endovascular treatment balloon expandable stent double D-shape

Get full access to this article

View all access options for this article.

References

Minion

. Molded parallel endografts for branch vessel preservation during endovascular aneurysm repair in challenging anatomy. Int J Angiol. 2012;21(2):81–84.

Almerey

Oldenburg

. Preservation of internal iliac arteries during endovascular aneurysm repair using “eye of the tiger” technique. J Vasc Surg Cases Innov Tech. 2017;3(4):257–260.

Kliewer

Plimon

Taher

, et al. Endovascular treatment of hypogastric artery aneurysms. J Vasc Surg. 2019;70(4):1107–1114.

Skripochnik

Spentzouris

Loh

. Parallel stent graft technique for hypogastric aneurysm repair with flow preservation of distal pelvic circulation. Vasc Endovascular Surg. 2019;53(4):355–358.

Kasirajan

. Branched grafts for thoracoabdominal aneurysms: off-label use of FDA-approved devices. J Endovasc Ther. 2011;18(4):471–476.

Franklin

Silveira

Timi

Lee

Galego Gdo

Bortoluzzi

. Tomographic measurement of gutters and analysis of the conformability of stent grafts in the octopus technique for endovascular thoracoabdominal aneurysm repair. Ann Vasc Surg. 2016;33:202–209.

Xiong

Liu

Wang

Guo

. Use of the octopus endograft technique to reconstruct renovisceral arteries arising from the false lumen of a rapidly expanding type B aortic dissection after endovascular repair. J Endovasc Ther. 2017;24(1):107–111.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

1.04 MB

0.68 MB