3:27 PM Abstract No. 154 Iliac bifurcated graft: extending the indications for endograft treatment in aortoiliac aneurysm disease

Abstract

EVAR spares the internal iliac arteries (IIA), and is a limited therapy when there is IIA aneurysm or no common iliac artery (CIA) landing zone. The iliac bifurcated graft (IBG) allows treatment of CIA and IIA aneurysms with preservation of IIA flow. This reduces the risk of buttock claudication and maintains collateral flow to the colon and spinal cord. We have reviewed and present our experience with IBG. We present a 10-year retrospective study of 53 consecutive patients who underwent aortoiliac EVAR plus unilateral or bilateral IBG insertion. Clinic notes, surgical and radiological procedure notes and imaging, and electronic patient records were reviewed. Patency was assessed by ultrasound and CTA, and statistically analyzed by Kaplan-Meier (KM) curve. 53pts (48M, 5F; mean age 75.3, SD 6.37) underwent aortoiliac EVAR plus 62 IBG device insertions (9 bilateral). Indications were: no EVAR CIA landing zone (40), IIA aneurysm (19), post-EVAR type 1b endoleak (E/L) (1), and to increase flow to IIA (1). Technical success in 49 patients was 59/62 IBG (CIA tortuosity [2], kinked IIA [1]). Serum creatinine increased temporarily following surgery, but no pt. developed renal failure. Fluoroscopy time (mean 66.2 min, range 13-209) and contrast load (mean 177.8 ml, range 40-335) improved with experience. Six patients died within 1 month of surgery (cardiac [2], bowel ischemia [2], pneumonia [1], iatrogenic aortic dissection [1]). At initial F/U by duplex ultrasound and CTA within 1 month in 40 patients (lost to F/U [3], expired [6]), 43 IBG were patent without endoleak (E/L) (type 1b [4], type 3 [3]); all E/L were successfully treated by re-stenting. At last clinical/imaging F/U in 37pts (mean 24.2-month, range 1-107), 39 IBG were patent without E/L (lost to F/U [1], thrombosed IBG branch [1], remote death [2]). All patients were asymptomatic without aneurysm rupture or buttock claudication. IBG patency at 1 and 6 mth by KM curve was 90% and 88% respectively. IBG is a useful adjunct to EVAR allowing preservation of internal iliac artery flow and effectively treats both common and internal iliac artery aneurysms.