ILIAC BRANCH DEVICES TO PRESERVE INTERNAL ILIAC ARTERY IN ANEURISMATIC DISEASE

  • A. Quintas Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, CHLC
  • J. Albuquerque e Castro Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, CHLC
  • J. Aragão Morais Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, CHLC
  • F. Bastos Gonçalves Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, CHLC
  • L. Vasconcelos Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, CHLC
  • G. Alves Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, CHLC
  • R. Ferreira Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, CHLC
  • R. Abreu Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, CHLC
  • N. Camanho Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, CHLC
  • J. Catarino Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, CHLC
  • M. E. Ferreira Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, CHLC
  • L. Mota Capitão Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, CHLC

Abstract

Introdution: Aneurismal disease of the iliac arteries is present in 11 to 43% of abdominal aortic aneurysms. Iliac branched devices (IBDs) enable the preservation of internal iliac arteries minimizing the risk for complications related to its intentional occlusion.

Methods: Retrospective analysis of a consecutive series of patients selected for the endovascular repair of aneurysmatic disease using IBDs in a terciary institution, from September 2010 to April 2016.

Results: 40 patients were treated with IBDs (mean age 73 ± 8 years; 40 males). The aneurysmatic disease treated was:  50% unilateral aorto-iliac (n=20); 35% bilateral aorto-iliac (n=14); 8% isolated unilateral iliac aneurysms (n=3); and 8% bilateral isolated iliac aneuryms (n=3). In 25% of the cases had aneurysmatic degeneration of the internal iliac artery (n=10). The deployed devices were: 39 Zenith Iliac Branch Device Cook® and 1 Excluder Gore®Iliac Branch Endoprothesis. In 90% concomitant EVAR was performed (n=36), with one case of EVAR+TEVAR and bilateral IBD and intentional occlusion of the contralateral internal iliac artery was necessary in 10 patients.

The technical sucess rate was 95% (38/40) and 5 unplanned additional procedures were done.

The 30 day mortality rate was 7,5% (n=3; mesenteric ischemia (n=1), pelvic ischemia (n=1), cardiac (n=1)). In the 30 day procedure complication rate there were three external iliac limb occlusions and one internal iliac branch occlusion. Four early re-interventions were necessary.

At admission 25% of the patients presented with an creatinine >1,5mg/dL, but there was no statistic difference between the pre-operative and post-operative creatinine levels (p=0,869).

The mean follow-up time was 14±17 months, during which there were: 1 external iliac limb thrombosis, 1 internal iliac branch thrombosis and 3 type II endoleaks. There were no modular disconnections or late aneurysmatic ruptures.

Conclusion: Internal iliac artery preservation and prevention of its occlusion complications is achievable with IBDs with high technical sucess. The results show the applicability of the technique that is a valid, effective and secure approach to treat aorto-iliac aneuryms.

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Published
2017-06-03
Section
Original Article

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