Anatomical Suitability of the GORE EXCLUDER Iliac Branch Endoprosthesis in Japanese Patients with Common Iliac Aneurysms Treated by Standard EXCLUDER Endografts

Abstract

The EXCLUDER iliac branch endoprosthesis (IBE) is designed to exclude a common iliac artery (CIA) aneurysm (CIAA), preserving the internal iliac artery (IIA) during endovascular aneurysm repair (EVAR). We assessed the anatomical suitability of the IBE in patients whose aortoiliac aneurysms (AIAs) had already been treated with a standard EXCLUDER endograft, compromising their IIAs. From June 2007 to January 2017, 202 patients underwent elective EVAR for AIAs with the EXCLUDER endograft at our institute. Among them, patients whose IIAs were embolized for the external iliac artery (EIA) landing were included in this study. Patients with solitary or small CIAAs of <25mm in diameter were excluded. Preoperative computed tomography scans were analyzed using a 3D workstation to evaluate the suitability of the IBE when following its instructions for use. Twelve patients with bilateral CIAAs and 24 patients with unilateral CIAAs were enrolled in this study. Among the 48 iliac segments, 15 (31.3%) were eligible for unilateral IBE implantation. A total of 40% of the CIAAs did not have a large enough luminal diameter, which was the most common barrier to the use of the unilateral IBE in our patients. Among the iliac segments of the 12 patients with bilateral CIAAs, 2 (16.7%) were suitable for bilateral implantation. An insufficient length between the renal artery (RA) and the IIA was the major barrier to the use of bilateral IBE. A total of 31.3% of the compromised IIAs could have been preserved if the IBE was used. Bilateral implantation seemed possible in a limited number of cases. In addition to a small CIA lumen, an insufficient length between the RA and the IIA was also a predominant anatomical limitation, especially when bilateral implantation was planned.