Technical aspects and midterm patency of iliac branched devices

Abstract

This study presents technical aspects and initial results with iliac bifurcated devices (IBDs). Since 2006, 47 IBDs were scheduled for 37 patients who were followed up between 2 and 31 months. Iliac aneurysms were unilateral in 27 patients and bilateral in 10. Two patients with bilateral common iliac artery aneurysms (CIAAs) did not have a simultaneous aortic aneurysm. Two patients underwent combined thoracoabdominal aneurysm treatment with branched stent grafts, and one underwent combined juxtarenal aneurysm repair with a fenestrated device. The helical iliac side branch device was used in 11 CIAA (23.4%), and the Zenith bifurcated iliac side branch device was used in the remaining 36 (76.6%). The technical success rate was 97.3% within the 47 intended-to-treat CIAAs (failure to introduce the delivery system in one case, converted to femorofemoral bypass). During follow-up, five (10.6%) hypogastric branch occlusions occurred in five patients. Two patients with bilateral repair had unilateral internal iliac artery side branch occlusions without ischemic symptoms. In contrast, of the three patients with unilateral side branch occlusion and simultaneous contralateral internal iliac artery occlusion (2 chronic and 1 coil embolization), persistent buttock claudication and sexual dysfunction developed in one. The secondary patency, including one redo case, was 87.3% at 22 months (standard error <10%). The use of branched stent grafts is a feasible procedure, including for patients with bilateral iliac aneurysmal disease or concomitant juxtarenal or thoracoabdominal aortic disease.