Parallel VBX Stents For Complex Common Iliac Aneurysm Treatment in Patients Ineligible for Iliac Branch Endoprosthesis

Abstract

Endovascular treatment of common iliac aneurysms (CIAs) has evolved, with the iliac branch endoprosthesis (W. L. Gore & Associates, Flagstaff, Ariz) allowing for treatment of CIA aneurysms with preservation of flow to the external iliac artery (EIA) and internal iliac artery (IIA). The hypogastric artery is critical for collateral flow to the spinal cord, perfusion to the pelvis and buttocks, and the avoidance of impotence. We offer a novel approach using parallel VBX grafts in the CIA, EIA, and IIA to seal iliac aneurysms and preserve flow to both vessels. Patients with a CIA aneurysm with abdominal aortic aneurysms or short CIA landing zones for endovascular aneurysm repair were identified. The patients were not candidates for IBE therapy or had had contraindication to hypogastric embolization. Measurements of the CIA, EIA, and IIA were performed using three-dimensional reconstructive software and centerline imaging studies. To determine the combined sizing of the VBX stents, the CIA diameter was divided by 0.7 to achieve an adequate seal of the two VBX stents (a 15-mm CIA stent requires the combined diameters of the EIA and IIA stents to be >21.5 mm; Fig). The patients were scheduled for follow-up at 1, 3, and 6 months with arterial duplex ultrasound or computed tomography angiography. A total of six patients had undergone complex endovascular double barrel stenting of the CIA, EIA, and IIA. The pathologic indications included type Ib endoleak from prior endovascular aneurysm repair, an iliac aneurysm, and a short common iliac artery for the seal. Seven VBX stents were deployed in the EIA, and seven VBX stents were deployed in the IIA. At the 1-month postoperative follow-up examination, 100% of the VBX stents had demonstrated primary patency without evidence of an endoleak. At 3 months of follow-up, 100% of the EIA VBX stent and 100% of the IIA VBX stent were patent without an endoleak or migration. One patient had died (three VBX stents total) secondary to nonvascular pathology. The use of double barrel VBX grafts is a safe and effective method to treat CIA pathology with preservation of flow to the EIA and IIA. Further long-term follow-up is required to continue to assess for endoleaks, stent migration, and other complications. The limitations of the present study included the small sample size, single-center experience, and limited follow-up.