TAA5. Technical Feasibility and Early Results of a Custom-Made Iliac Fenestrated Device

Abstract

Iliac branch devices (IBDs) are undergoing rapid popularization. They allow salvage of an iliac aneurysm while preserving blood flow to the hypogastric artery. Certain anatomic criteria are necessary for the use of an iliac side branch device to be technically feasible. Custom-made fenestrated iliac stent grafts may provide an alternative when anatomic criteria for an IBD are not met. There is a paucity of data on the technical performance of these new devices. The objective of this study was to present a case series and to report immediate technical and clinical results for patients treated with custom-made Anaconda iliac fenestrated devices (Vascutek/Terumo, Inchinnan, Scotland, United Kingdom). Five cases (Table) of either iliac artery aneurysm or type IB endoleak after endovascular aneurysm repair were treated at a single department of vascular and endovascular surgery from July 1, 2017, until March 31, 2018. Technical and clinical success was defined as successful treatment of the iliac aneurysm while preserving blood flow to the internal iliac artery without occurrence of severe adverse events. Of the five included patients, none met criteria for treatment with an off-the-shelf IBD. Three were treated for type IB endoleak after endovascular aneurysm repair (Fig 1), and the remaining two patients underwent primary repair of an aortoiliac aneurysm. All procedures were technically successful using a custom-made fenestrated iliac stent graft (Fig 2), and no immediate perioperative severe adverse events were encountered. This study adds to a growing body of literature on the performance of custom- made devices for aneurysm repair. Special emphasis is on treatment options for patients not eligible for an off-the-shelf IBD. Technical and immediate clinical results were excellent, which further establishes the feasibility of fenestrated devices in the iliac artery.TableDemographic and anatomic patient dataAge at procedure, yearsSexIndication for surgeryMaximum diameter of common iliac arteryType of in situ endograft if post EVARPatient 155MThoracoabdominal and iliac aneurysm37 mm (with 45-mm internal iliac artery aneurysm)Cook BEVARPatient 279MPararenal and iliac aneurysm39 mmAnaconda FEVARPatient 370MType IB endoleak21 mmJotec E-tegraPatient 487MType IB endoleak26 mmMedtronic Endurant IIPatient 581MType IB endoleak and common iliac aneurysm42 mmNellixMean or total74.45 menN/A33 mmN/ABEVAR, Branched endovascular aneurysm repair; EVAR, endovascular aneurysm repair; FEVAR, fenestrated endovascular aneurysm repair; N/A, not applicable. Open table in a new tab Fig 2Angiography of the ostium of the hypogastric artery (A) and deployment of the fenestrated iliac device (B). Cannulation of the hypogastric artery through the fenestration (C) and sheath insertion over a semistiff wire (D). Length measurement (E) and deployment (F) as well as flaring (G) of the connecting stent graft are followed by completion angiography (H).View Large Image Figure ViewerDownload Hi-res image Download (PPT)