IBD/IBE VS. HYPOGASTRIC ARTERY EMBOLIZATION — HOW TO CHOOSE AND WHAT’S THE OUTCOME?
Introduction: There is no standard anatomic or clinical criteria guiding treatment modalities of iliac aneurysms. The main endovascular options are hypogastric artery endovascular exclusion or hypogastric preservation with iliac branch devices (IBD) or iliac branch endoprosthesis (IBE). However, outcomes of each technique are not clear yet.
Methods: An observational retrospective study was designed. Patients who underwent EVAR + IBD/IBE (Group 1) or EVAR + hypogastric artery embolization (Group 2) on a tertiary hospital, from January 2016 to April 2019, were included. Data were collected from medical records. Primary endpoint was procedure-related complications (intra-operative complications; type 1 and 3 endoleaks; EVAR limb occlusions; pelvic, intestinal and spinal cord ischemia; gluteal claudication; procedure-related mortality). Secondary endpoints were hospitalization duration, type 2 endoleaks, freedom from reintervention and global survival.
Results: 30 patients were included. 19 underwent elective IBD/IBE due to asymptomatic aneurysm; 11 underwent hypogastric artery embolization, 5 of them in emergency. Mean age was lower in Group 1 (69,79 ±8,30 years vs. 75,73±6,15 years in Group 2; p=0,049). Technical success was 100%. There was no significant difference in procedure-related complications (Group 1: 21%; Group 2: 36%; p=0,417); we found similar rates of mortality and EVAR limb occlusions. The difference in incidence of gluteal claudication was non-significant (30% in Group 2 vs. 7% in Group 1; p=0,267). Freedom from reintervention was similar in both groups (Group 1: 84%, Group 2: 83%; p=0,827). Global survival at two years was similar (Group 1: 89,5±0,7%; Group 2: 87,5±1,2%; p=0,935).
Conclusion: Both procedures are safe and effective and, nowadays, its individualized selection is mostly determined by procedure cost and urgency.
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