SINGLE CENTER REAL-WORLD ANALYSIS OF THE USE OF ILIAC BRANCHED DEVICES FOR AORTO- ILIAC ANEURYSM REPAIR

Authors

  • Marta Romão Rodrigues Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Portugal
  • Ryan Melo Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Portugal
  • Pedro Garrido Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Portugal
  • Luís Silvestre Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Portugal
  • Ruy Fernandes e Fernandes Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Portugal
  • Carlos Martins Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Portugal
  • Luís Mendes Pedro Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Portugal

DOI:

https://doi.org/10.48750/acv.444

Keywords:

Iliac-Branch-Device, Aorto-iliac aneurysm, Iliac aneurysm, Cohort, Iliac artery preservation, EVAR, IBD

Abstract

Introduction: Endovascular repair of aortic aneurysms is widely established. However, aorto-iliac aneurysms pose a challenge, specifically regarding distal sealing. A frequent approach is extending the iliac limb to the external iliac artery (EIA) with occlusion of the internal iliac artery (IIA), often with varying degree of pelvic ischemia causing significant morbidity. Iliac branched devices (IBD) allow for the creation of distal landing zones in the EIA and IIA, maintaining pelvic perfusion. We performed a descriptive analysis and outcome evaluation of IBD use in a single center patient cohort.

Methods: An observational, descriptive, retrospective cohort analysis of all consecutive patients intended to treat with IBDs from Jan-2008 to Dec-2020 was performed. Technical success was defined as correct implantation of the IBD with confirmed patency of both EIA and IIA. We included all patients where at least one IBD was deployed, irrespective of additional procedures.
Statistical analysis was performed using STATA 16, for Mac.

Results: Of the initial 54 patients, 53 were included, (technical success 98,1%). Fifty-two were men (98.2%), mean age 73.5 years (SD 8.1). Mean aortic diameter was 56.4mm (SD 13.4), mean CIA aneurysm diameter 37.0mm (SD 12.7).
A total of 60 IBD’s were performed (CookÆ Medical’s ZBIS device), of which 5 as part of complex aortic treatment with fenestrated endografts, 32 EVAR with unilateral IBD, 7 EVAR with bilateral IBD, 6 EVAR with unilateral IBD and contra- lateral extension to the EIA with embolization of the IIA and 3 isolated IBD (for type 1B endoleaks following EVAR or isolated iliac aneurysm).
Peri-operative complications included acute kidney injury (AKI) (11,3% - 5/44), paraparesis and intestinal ischemia (1,9% each), one embolic intra-operatory stroke (1,9%) and one acute myocardial infarction (MI) (1,9%). Median follow-up was 9 months (IQR:16, 1-80months), during which 4,9% (2/42) developed type IB endoleaks, 4,9% (2/42) iliac aneurysm enlargement, 2,4% (1/42) limb kinking, 4,9% (2/42) limb occlusion, with a 7,14% (3/42) re-intervention rate. We found no association between limb patency and single, dual-antiplatelet treatment or anti-coagulation (p=0,6). There was no significative difference in AKI incidence between bilateral or unilateral IBD (irrespective of contra-lateral procedure). No in-hospital mortality was registered. There was one case of in-hospital death post-MI (1,9%), overall mortality 17% (9/53).

Conclusion: In this cohort we found that the most common complication is AKI, apparently not directly related to the technique itself. Follow-up complications were few and mainly associated to loss of distal seal or limb occlusion, but implying a considerable re-intervention rate.

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References

1. Simonte G, Parlani G. Alternative solution for bilateral common iliac aneurysm in a patient with left external iliac artery occlusion. Eur J Vasc Endovasc Surg 2015;50(6):697.

2. Rayt HS, Bown MJ, Lambert KV, Fishwick NG, McCarthy MJ, London NJ, et al. Buttock claudication and erectile dysfunction after internal iliac artery embolization in patients prior to endovascular aortic aneurysm repair. Cardiovasc Intervent Radiol 2008;31:728e34.

3. Pavlidis D, Hormann M, Libicher M, Gawenda M, Brunkwall J. Buttock claudication after interventional occlusion of the hypogastric arteryda mid-term follow-up. Vasc Endovasc Surg 2012;46:236e41.
4. Serracino-Inglott F, Bray AE, Myers P. Endovascular abdominal aortic aneurysm repair in patients with common iliac artery aneurysmseInitial experience with the Zenith bifurcated iliac side branch device. J Vasc Surg 2007;46:211e7

5. Bosanquet_DC, Wilcox_C, Whitehurst_L, Cox_A, Williams_IM, Twine_CP, et al. Systematic review and meta-analysis of the eJect of internal iliac artery exclusion for patients undergoing EVAR. European Journal of Vascular and Endovascular Surgery
2017;53(4):534-48.
6. Verzini_F, Parlani_G, Romano_L, De Rango_P, Panuccio_G, Cao_P. Endovascular treatment of iliac aneurysm: concurrent comparison of side branch endograH versus hypogastric exclusion. Journal of Vascular Surgery 2009;49(5):1154-61.
7. McLafferty RB. Adverse consequences of internal iliac artery occlusion during endovascular repair of abdominal aortic aneurysms. J Vasc Surg 2000;32:676-83.
8. Gray D, Shahverdyan R, Jakobs C, Brunkwall J, Gawenda M. Endovascular Aneurysm Repair of Aortoiliac Aneurysms with an Iliac Side-branched Stent graft: Studying the Morphological Applicability of the Cook Device. Eur J Vasc Endovasc Surg. Março de 2015;49(3):283–8
9. Wong S, Greenberg RK, Brown CR, Mastracci TM, Bena J, Eagleton MJ. Endovascular repair of aortoiliac aneurysmal disease with the helical iliac bifurcation device and the bifurcated-bifurcated iliac bifurcation device. J Vasc Surg 2013;58:861-9
10. Loth AG, Rouhani G, Gafoor SA, Sievert H, Stelter WJ. Treatment of iliac artery bifurcation aneurysms with the secondgeneration straight iliac bifurcated device. J Vasc Surg 2015;62(5):1168e75.
11. Parlani G, Verzini F, de Rango P, Brambilla D, Coscarella C, Ferrer C, et al. Long-term results of iliac aneurysm repair with iliac branched endograft: a 5-year experience on 100 consecutive cases. Eur J Vasc Endovasc Surg 2012;43:287-92
12. Sousa_LHDG, Baptista-Silva_JCC, Vasconcelos_V, Flumignan_RLG, Nakano_LCU. Internal iliac artery revascularisation versus internal iliac artery occlusion for endovascular treatment of aorto-iliac aneurysms. Cochrane Database of Systematic Reviews 2020, Issue 7. Art. No.: CD013168. DOI: 10.1002/14651858.CD013168.pub2

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Published

2021-12-24

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Original Article