Preservation of Antegrade Internal Iliac Artery Flow Using Heilical Branch Devices in Challenging Anatomic Situations: Technical Succss, Survival and Patency

Abstract

Technical success and patency of iliac branch devices (IBD) for aortoiliac aneurysms are scarce and isolated to highly anatomically selected cohorts. Exclusion of patients with internal iliac artery (IIA) stenosis, narrow common iliac artery (CIA) diameters and IIA aneurysm has precluded hypogastric preservation in most cases. Data was prospectively collected on patients with infrarenal or thoracoabdominal aortoiliac aneurysms treated with helical-IBDs (H-IBD). Preoperative aneurysmal characteristics, technical success, patency, reinterventions and endoleaks were noted in accordance with endovascular reporting standards. Survival and patency were evaluated with life-table analyses and differences among anatomic groups compared with log-rank tests. T-tests and Fisher's exact tests were used to compare simple variables. Between 2003 and 2012, 138 Helical-IBD devices were placed into 130 patients, beginning in 2008 with a novel device intended for short CIA aneurysms. Median follow up was 16.2 months (range, 1-72 months) with 30 day, 1 and 5 year survival rates of 99%, 90%, and 62% respectively. Overall technical success, endoleak and branch patency, and outcomes between anatomically select groups are summarised in the Table. No stent fractures or component separations were noted in the IBDs or mating devices. Based upon instructions for use for other devices, only 20% of the patients in this study were candidates for treatment with an IBD. The H-IBD has high technical success, which is detrimentally affected by tight IIA stenosis. Patency was unaffected by challenging anatomy. The minority of patients in this trial had anatomy amenable for treatment with other devices.TableAllII aneurysm (35%)IIA stenosis (20%)CIA < 16 mm (46%)Technical success, %(n = 138) 93Yes 93No 93nsYes 82No 96P = .015Yes 95No 92nsEndoleak, %371ns04ns05nsPatency, %, 30d 1yr 5yr95 86 8298 87 7893 86 83ns89 81 8196 88 82ns92 84 8497 89 80ns Open table in a new tab