The sandwich technique to treat complex aortoiliac or isolated iliac aneurysms: Results of midterm follow-up

Abstract

To ascertain midterm outcomes of the sandwich technique (ST) for internal iliac artery endorevascularization (ER). All consecutive patients with complex aortoiliac aneurysms, isolated common iliac artery aneurysms, and abdominal aortic aneurysms with bilateral short, nondiseased common iliac artery undergoing elective endovascular aneurysm repair (EVAR) with the ST at our center, between October 2008 and March 2011, were invited to participate in the present study. Patients were considered eligible for this procedure only when their aneurysm features did not fulfill the requirements for standard EVAR. Follow-up assessments were carried out at 1 month and every 6 months thereafter and included computed tomographic angiography or duplex ultrasound. The study was approved by the Institutional Review Board, and all patients gave written informed consent. A cohort of 40 patients (95% male; mean age, 72.2 years) was followed over a mean follow-up period of 12 ± 4.4 months (range: 6-30 months); 48 internal iliac artery (IIA) ER with ST were undertaken. Internal iliac artery aneurysm (IIAA) ER technical success rate was 100%. Primary patency rate was 93.8% on account of three IIA ER occlusions, occurring early in the study. Early and late related mortality rate was 0% and late unrelated mortality rate was 2.5%. Iliac aneurysm sac evolution demonstrated a significant (at least 5 mm) decrease in diameter in 16 (34.8%) common iliac artery aneurysms, no change in 29 (63%) common iliac artery aneurysms, and an increase in one patient (2.2%). Statistical significance was reached only for comparisons between baseline and 30 months (P = .039). Late buttock claudication rate was 0% after IIA ER with ST and 14.3% after IIA coil embolization. The ST expands the limits of EVAR for complex aortoiliac aneurysms or IIAA in a safe, easy to perform, and cost-effective manner.