Mid-term Results of Iliac Branched Endografting with Self-expandable Bridging Stents-grafts

Abstract

Introduction: Iliac artery aneurysms may pose therapeutic challenges when considering an endovascular approach. The ideal treatment scenario involves preservation of both internal and external iliac arteries while ensuring an adequate fixation of the endograft. To this purpose iliac branched devices (IBDs) have been developed with several reports demonstrating good technical results and short-term durability. Distal landing in the internal iliac artery may take place with a balloon-expandable or a self-expandable bridging stent-graft (BSG). Our aim was to report mid-term results of patients treated with IBDs in combination with a self-expandable BSG. Methods: We analyzed a prospectively maintained database including all patients with iliac artery aneurysms that underwent IBD implantation within the period January 2004 - January 2014 in a vascular institution experienced in endovascular techniques. Results: A total of 72 patients (66 male, mean age 71 ± 8.1 years) were treated with 89 IBDs in the aforementioned period. In 67 cases (75.3%) treatment was carried out due to a common iliac artery aneurysm, in 5 cases (5.6%) due to an internal iliac artery aneurysm and in 17 cases (19.1%) due to a combination of both. Technical success was achieved in 85 cases (95.5%). In 81 cases self-expandable BSGs were used for the internal iliac artery. Additional endolining of the BSG with a self-expandable stent was carried out in 41/81 (50.6%) cases. In-hospital mortality was 2 patients (2.8%) and perioperative morbidity 6 patients (8.4%). Mean follow-up (FU) was 46.3 ± 15.5 months. An in-stent stenosis of the internal iliac BSG was detected in 3 (3.7%) and an occlusion in another 3 (3.7%) IBDs during FU. Endoleaks were detected in 6 (7.4%) cases, (Type Ib n=4; Type II n=2). Reinterventions were carried out in 8 (9.8%) cases due to a stenosis or endoleak. Buttock claudication occurred in 3 patients. Conclusion: Implantation of IBDs for iliac artery aneurysms is associated with low perioperative mortality and morbidity. Mid-term results demonstrate a high patency rate and a low rate of endoleaks and reinterventions for IBDs in combination with self-expandable BSGs for the internal iliac artery. Disclosure: Piotr Kasprzak is a consultant for Cook Inc., W.L. Gore & Associates, Bard, Maquet, Medtronic, and Vascutek.