RS11 Incidence and Management of Iliac Artery Aneurysms Associated With Endovascular Treatment of Juxtarenal and Thoracoabdominal Aortic Aneurysms

Abstract

Iliac artery aneurysms (IAA) associated with aortic aneurysms can complicate their management. The aim of this study was to evaluate the incidence, management, and outcomes of IAA associated with juxtarenal (JRAA) and thoracoabdominal aortic aneurysms (TAAA) treated with fenestrated/branched aortic endografts (F/B-EVAR). Data from 1118 patients (Table) enrolled in a physician-sponsored investigational device exemption trial (2001-2016) for treatment of JRAA or TAAA with F/B-EVAR were evaluated. Maximum iliac artery diameter was determined by an imaging core laboratory, and IAAs were defined as ≥21 mm in diameter. Clinical management, perioperative outcomes, and long-term outcomes were analyzed. Data are presented as mean ± standard deviation and were assessed using Kaplan-Meier, univariate, and multivariable analysis. Of 364 (33%) patients with IAA, 219 (60%) were unilateral and 145 (40%) were bilateral. Of the 509 IAA, 234 (46%) were treated with an iliac limb without coverage of the hypogastric artery, 103 (20%) had hypogastric artery coverage, 105 (21%) had placement of a hypogastric branched endograft (HBE), and 67 (13%) went untreated. Procedure duration was longer for those with IAA (5.3 ± 1.79 vs 4.6 ± 1.74 hours; P < .001), although hospital stay was not. Hazards of aneurysm-related mortality and all-cause mortality trended higher in unilateral and bilateral IAA groups. Treatment with a HBE had lower hazards of death than those without (adjusted for age, procedure duration, and repair class (HR 0.64, P = .017). Hazards of reintervention were higher in those with unilateral and bilateral IAA compared to no IAA (hazard ratio [HR], 1.45 and 2.09, respectively), but was not associated with the use of HBE. Spinal cord ischemia trended higher in unilateral and bilateral IAA than no IAA (HR 2.59 and 12.96; P = .259 and P = .056, respectively). Patients with unilateral and bilateral IAA comprised a substantial portion of those who underwent F/B-EVAR for JRAA and TAAAs. The complexity of the disease is supported by trends toward higher hazards of aneurysm-related mortality, all-cause mortality, reintervention, and spinal cord ischemia in patients with IAA compared to those with no IAA. Lower hazards of death were found in those treated for IAA with a hypogastric branch, with no difference in reintervention detected. These results suggest that F/B-EVAR including hypogastric branch may be a robust treatment option for complex patients with TAAA and concomitant IAA. Additional efforts are needed to improve outcomes and understand the utility of this treatment option for this complex subset of the TAAA population.TableDemographicsVariableaNo IAA (n = 754)IAA (n = 364)Age (years)74.6 ± 7.7174.7 ± 7.93Male545 (72)328 (90)Smoking Current141 (20)76 (22) Former518 (73)236 (69) Never50 (7)30 (9)Prior aneurysm repair144 (19)73 (20)CVD CHF104 (14)54 (15) MI or unstable angina226 (30)126 (35) AVR/MVR54 (7)19 (5) Hypertension639 (85)318 (87)COPD253 (34)94 (26)CRI122 (16)69 (19)Repair type Type I TAAA15 (2)3 (1) Type II TAAA126 (17)38 (10) Type III TAAA180 (24)101 (28) Type IV TAAA257 (34)138 (38) Juxtarenal176 (23)84 (23)AVR, Aortic valve replacement; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; CRI, chronic renal insufficiency (creatinine >2.0 g/dL); CVD, cardiovascular disease; IAA, iliac artery aneurysm; MI, myocardial infarction; MVR, mitral valve replacement; TAAA, thoracoabdominal aortic aneurysm.aData are shown as mean ± standard deviation or number (%). Open table in a new tab