AA10. Safety, Feasibility, and Efficacy of the Gore Excluder Side Branch Endoprosthesis in the Treatment of Aortobi-Iliac Aneurysms With Preservation of the Internal Iliac Artery in 23 Consecutive Patients

Abstract

The Gore Excluder (W. L. Gore & Associates, Flagstaff, Ariz) side branch endoprosthesis for iliac arteries (iliac branch endoprosthesis [IBE]) is a new device for the treatment of solitary or combined aortobi-iliac arterial aneurysms, mainly to prevent major complications occurring from an occluded internal iliac artery. The objective of our study was to evaluate the safety, feasibility, and efficacy of the Gore Excluder IBE in the treatment of iliac artery aneurysms. All consecutive patients who underwent iliac artery repair using the Gore Excluder IBE device in our clinic since 2016 were included. Indication, localization, operation time, blood loss, and hospitalization time as well as complication, reintervention, and patency rates were evaluated. All values are given as median (range). Statistical analysis was performed by non parametric paired tests. Between February 2016 and December 2017, there were 29 asymptomatic iliac aneurysms (4 solitary, 25 combined; 5 double sided) treated in 23 consecutive patients (age, 68 [53-82] years; body mass index, 29 [23-29] kg/m2; 1 female) using the Gore Excluder IBE. The implantation was successful in 28 of 29 cases (97%); in one case, implantation failed because of distinctive atherosclerosis of the internal iliac artery. Hospitalization time was 7 (5-15) days, operation time, 179 (80-541) minutes; and blood loss, 400 (100-3000) mL. Hemoglobin concentration was 14 (11-16) g/dL preoperatively and 12 (9-14) g/dL directly postoperatively (P = .0001). The transfusion of two (two patients) and four, respectively, red cell concentrates was necessary in three patients. Creatinine concentration was 1.02 (0.5-1.62) mg/dL preoperatively and 0.88 (0.39-1.51) mg/dL directly postoperatively (P = .07). Perioperative mortality rate and 30-day reintervention rate were 0%. Double platelet aggregation was used for 6 months postoperatively. Major complications were one cholesterol embolism and one contrast agent-induced nephropathy, not requiring dialysis. The median follow-up time was 5 months (2 weeks-1 year), with an overall patency rate of 96% of the IBEs (27/28 devices) as one patient refused the double platelet inhibitor application. The treatment of aortobi-iliac arterial aneurysms using the Gore Excluder IBE is safe and feasible and results in high short-term patency rates. To validate long-term results, long-term follow-up of the treated patients is required, ideally using duplex ultrasound and contrast-enhanced ultrasound or computed tomography angiography.