Ectatic Iliac Arteries Research Articles

Long Term Outcomes of Endovascular Aortic Repair in Patients With Abdominal Aortic Aneurysm and Ectatic Common Iliac Arteries

The purpose of this study was to evaluate the long term results of endovascular aneurysm repair (EVAR) in patients with abdominal aortic aneurysm (AAA) and ectatic common iliac arteries (CIAs). In a retrospective analysis of a prospectively collected database in two high volume centres, patients with AAAs undergoing elective standard EVAR were divided into two groups: those with both CIA diameters <18mm, and those with at least one ectatic iliac artery (CIA≥18mm). Patients with an intentional external iliac artery landing zone were excluded. Primary outcomes were survival and freedom from re-intervention. Secondary end points were EVAR failure and iliac related endoleak and iliac re-intervention. From 2000 to 2015, 648 patients were included in the study, 277 (43%) had at least one CIA≥18mm. Pre-operative risk factors were similar between the two groups, with the exception of chronic renal insufficiency (p=.010) and cerebrovascular events (p=.040), which were higher in the ectatic CIA group. At 30 days from primary procedure, there was a higher rate of type Ib endoleak in patients with ectatic iliacs (p=.020). A statistically significant increase in the incidence of late type Ib endoleak in patients with ectatic iliac arteries was confirmed at a mean follow up of 74.8 months (p=.01). The need for iliac related re-intervention was higher in patients with CIAs ≥18mm (odds ratio 1.94; 95% confidence interval 1.1-3.2). Ectatic iliac arteries are considered suitable landing zones for EVAR, although there is an increased risk of secondary interventions in time mainly due to late CIA dilation and secondary type Ib endoleak. Patients receiving EVAR with flared iliac limbs may benefit a more intensive surveillance to avoid late failures.

Long Term Results After Endovascular Aorto-Iliac Repair in Patients with Abdominal Aortic Aneurysms and Ectatic Iliac Arteries

Long Term Results After Endovascular Aorto-Iliac Repair in Patients with Abdominal Aortic Aneurysms and Ectatic Iliac Arteries

Medium-term Outcome of Ectatic Iliac Arteries in Patients Treated by EVAR with Large Diameter Iliac Limbs

Medium-term Outcome of Ectatic Iliac Arteries in Patients Treated by EVAR with Large Diameter Iliac Limbs

Natural History of the Iliac Arteries after Endovascular Abdominal Aortic Aneurysm Repair and Suitability of Ectatic Iliac Arteries as a Distal Sealing Zone

To investigate the natural history of dilated common iliac arteries (CIA) exposed to pulsatile blood flow after endovascular abdominal aortic aneurysm repair (EVAR) and the suitability of ectatic iliac arteries as sealing zones using flared iliac limbs. Follow-up computed tomograms of 102 CIAs in 60 EVAR patients were investigated. Diameter changes in CIAs < or =16 mm (group 1) were compared with changes in vessels where a dilated segment >16 mm in diameter continued to be exposed to pulsatile blood flow (group 2). Within group 2, cases in which the stent terminated proximal to the dilated artery segment (2a) were compared with those that had been treated with a flared limb (2b). The mean CIA diameter increased by 1.0+/-1.0 mm in group 1 (p<0.001 versus immediately after EVAR) and by 1.5+/-1.7 mm in group 2 (p<0.001 versus immediately after EVAR) within an average follow-up of 43.6+/-18.0 months. Diameter increase was more pronounced in dilated CIAs (p=0.048), and it was not significantly different between groups 2a and 2b (p=0.188). No late distal type I endoleak or stent-graft migration associated with CIA ectasia was observed. Dilatation of the CIA is significant after EVAR, and it is more pronounced in ectatic iliac arteries. Although ectatic iliac arteries appear to be suitable sealing zones in the short term, continued follow-up is mandatory.

Natural History of the Iliac Arteries After Endovascular Abdominal Aortic Aneurysm Repair and Suitability of Ectatic Iliac Arteries as a Distal Sealing Zone

Natural History of the Iliac Arteries After Endovascular Abdominal Aortic Aneurysm Repair and Suitability of Ectatic Iliac Arteries as a Distal Sealing Zone

Endovascular Aortic Aneurysm Repair with the Zenith Endograft in Patients with Ectatic Iliac Arteries

Endovascular aortic aneurysm repair (EVAR) in patients with ectatic iliac arteries is feasible; however, most studies have reported experience from single institutions where distal flare techniques with endograft components were used on an "off-label basis." The Zenith endovascular graft allows adequate seal in ectatic common iliac arteries (CIAs) with diameters up to 20 mm. To determine whether large or ectatic CIAs are a risk factor for early and late endograft failure, we analyzed data from the Zenith U.S. multicenter trial. Among 352 patients receiving the endograft in the Zenith u.s. clinical study, 156 patients (44%) had at least one ectatic iliac artery (maximum diameter between 14 and 20 mm), whereas 22 (6.3%) had bilateral CIAs of normal diameter (< 14 mm). Variables analyzed included those defined by the reporting standards for EVAR (SVS/AAVS) as well as iliac-related outcome and indications for secondary iliac interventions. Univariate (Kaplan-Meier [KM] receiver operating characteristics curve, and Cox regression analyses were used to determine the association between CIA diameter and iliac-related complications. The median follow-up period was 24 months. Technical success was similar (>99%) for patients with ectatic and normal CIAs. Only one late type I distal endoleak was reported and was attributed to failure of distal iliac seal in a patient with ectatic CIAs. Freedom from iliac-related secondary intervention (IRSI) was not significantly different between the groups (KM, log-rank test, p = 0.98) with rates at 1, 12, and 24 months of 98%, 97%, and 95% for patients with ectatic CIAs, and 100%, 95%, and 95% for patients with normal iliac arteries, respectively. Moreover, Cox regression analysis revealed that the maximum CIA diameter was not a significant predictor of freedom from IRSI (hazard ratio, 0.98; 95% confidence interval, 0.7-1.4; p = 0.98). In patients with large CIAs, indications for IRSI included distal type I endoleak (1, 0.6%), type III endoleak (1, 0.6%), graft limb occlusion (4, 2.6%), and device stenosis (1, 0.6%). The only IRSI in a patient with normal CIAs was performed for device stenosis (4.6%). In conclusion, the Zenith endograft is effective for EVAR in patients with ectatic CIAs. Moreover, the presence of large CIAs was not associated with an increased risk of adverse iliac-related outcome or subsequent IRSI. Long-term surveillance, however, is mandatory, as IRSIs may be necessary.