Dilated Internal Iliac Artery Confers a Higher Risk of Endoleak in Iliac Branch Devices in a Single Centre Retrospective Experience

Abstract

Iliac branch devices (IBDs) have shown good results but there is little evidence for the risk of internal iliac artery (IIA) endoleak, so there are no clear recommendations on the maximum diameter it should be. Based on limited evidence, we hypothesised that an IIA of ≥ 11 mm in diameter presents an increased risk of type Ic endoleak. This was a single centre, retrospective case-control study. Patients undergoing an IBD with the main trunk of the IIA as the target vessel between 2015 and 2021 were identified. Two groups were created: a non-dilated IIA group, with a main trunk diameter of < 11 mm; and a dilated IIA group, with a diameter of ≥ 11 mm. Technical success, freedom from type Ic endoleak, and re-intervention rates were compared. A receiver operating characteristic (ROC) curve was performed to show a cutoff IIA diameter value for risk of type Ic endoleak. Pearson correlation was performed to assess the risk of type Ic endoleak and the presence of calcification, stenosis, and landing zone length in the IIA. There were 182 IBDs identified. The dilated IIA group (54 IBDs) had significantly lower technical success (91% vs. 98.4%; p = .002), lower freedom from type Ic endoleak (77% vs. 97.1% at 24 months; p = .001), and lower freedom from re-interventions (70% vs. 92.4% at 24 months; p = .002). The ROC curve showed that 10.5 mm was the cutoff diameter for type Ic endoleak. Moderate/severe calcification as well as landing zone length < 5 mm also correlated with the occurrence of type Ic endoleak. IBDs have a statistically significantly higher rate of technical failure, lower freedom from type Ic endoleak, and lower freedom from re-intervention when the IIA is dilated to ≥ 11 mm.