Internal Iliac Artery Embolization Research Articles

A Case of Pelvic Arteriovenous Malformation in a Male with Massive Bladder Bleeding which Caused Severe Hemorrhagic Hypovolemic Shock

Congenital arteriovenous malformation (AVM) in the male pelvis is extremely rare. We present a case of this disease with massive bladder bleeding which caused severe hemorrhagic shock. Diagnosis of pelvic AVM was confirmed by computed tomography and angiography. He was treated with transcatheter arterial embolization of the bilateral internal iliac arteries. We discuss the clinical course and the treatment for AVM in this case, and review the literature. # ja.

Effects of Prophylactic Coil Embolization of Pelvic Arteries on Surgical Outcomes in Hemodynamically Stable Patients with Complex Acetabular Fractures.

To investigate the efficacy of prophylactic embolization of the internal iliac artery (IIA) or superior gluteal artery (SGA) before open reduction and internal fixation (ORIF) in reducing intraoperative blood loss (IBL) in hemodynamically stable patients with complex acetabular fractures. A total of 136 patients with complex acetabular fractures were retrospectively included and divided into the prophylactic transcatheter arterial embolization (PTAE) group and non-PTAE group, depending on whether ipsilateral IIA or SGA was embolized using coils within 3 days before ORIF. Demographic characteristics, injury severity score (ISS), fracture classification, and intraoperative and postoperative data were compared between the two groups. Propensity score matching (PSM) was also performed to balance the baseline characteristics of the patients. The determinants of IBL were investigated using multivariate linear regression analysis. The PTAE and non- PTAE groups consisted of 64 and 72 patients, respectively. PSM yielded 43 matched pairs. Post-matching, IBL in the PTAE group was less than that in the non-PTAE group (median [interquartile range], 800 [400-1200] mL vs 1300 [1000-1600] mL, p < 0.001). Furthermore, the PTAE group showed a shorter ORIF duration and lower intraoperative and 24-h postoperative blood transfusion requirements (all p < 0.05). Multivariate analysis revealed that PTAE and the duration of surgery were associated with IBL (PTAE: β = -0.407, p < 0.001; duration of surgery: β = 0.237, p = 0.021). Prophylactic IIA or SGA embolization may be beneficial in reducing IBL during ORIF in hemodynamically stable patients with complex acetabular fractures.

Vascular rescue–minimally invasive management of a post-spinal surgery fistulized ilio-iliac pseudoaneurysm: a case report

BackgroundAortoiliac injury after intervertebral disc surgery is an uncommon but potentially fatal complication. This case study emphasizes how crucial it is to identify this uncommon complication, which can manifest itself in a variety of ways, including leg oedema, heart failure, and deep vein thrombosis. This case is unique in that it presents with an uncommon post-spinal surgery complication of fistulized pseudoaneurysm of the common iliac artery and vein. This combination calls for an immediate diagnosis and careful care.Case presentationA 36-year-old female patient presented with progressively worsening orthopnea, accompanied by chest pain and palpitations. Her medical history revealed gradually increasing right lower limb swelling since three months, following a discectomy procedure for the management of lower back pain associated with a herniated lumbar disc at the L5-S1 level. Doppler ultrasonography demonstrated an arterialized flow within the right common iliac vein. Subsequent computed tomography angiography identified a pseudoaneurysm of the right common iliac artery, which had formed a fistulous connection to the right common iliac vein. This uncommon complication was likely attributable to prior disc surgery. The patient received endovascular intervention, which was executed in two primary stages: first, embolization of the right internal iliac artery was performed, followed by the exclusion of the arteriovenous fistula through the deployment of a covered stent graft within the right common iliac artery. The intervention successfully resolved both the pseudoaneurysm and the arteriovenous fistula.ConclusionsThis case report underscores the importance of considering vascular complications in patients presenting with unusual symptoms following intervertebral disc surgery, even after a significant time lapse. While both open surgical and endovascular approaches can yield good results in treating such complications, the endovascular method, as demonstrated in this case, is associated with minimal morbidity. This approach offers a less invasive alternative that can effectively manage complex vascular injuries resulting from disc surgery. Clinicians should be aware of this rare but serious complication to ensure timely diagnosis and appropriate management, potentially improving patient outcomes in similar cases.

Fate assessment of the ectatic common iliac artery using flared limb during endovascular aneurysm repair.

This study aimed to evaluate the outcomes and anatomical predictors of the complications of flared limb (FL) use for ectatic common iliac arteries accompanied by abdominal aortic aneurysm treated with endovascular aneurysm repair (EVAR). In this single-center retrospective study, we reviewed data from 391 patients (638 limbs) treated between 2005 and 2020. The cohort was divided into two groups. The standard limbs (SLs, n = 403) included stent graft (SG) of <20mm in diameter and the FLs (n = 235) included stent graft of ≥20mm in diameter. Complications within 30days were investigated as the short-term outcome. Limb events during follow-up including type Ib endoleak (EL), type IIIa EL, and limb occlusion were compared between SLs and FLs using log-rank test. Early results indicated that the FL group had a significantly higher incidence of intraoperative type Ib EL at 5.1% (12), than 1.7% (7) in the SLs (p = .016). For 19 patients in whom intraoperative type Ib EL was discovered, SG extension alone or internal iliac artery embolization was all performed before completing the procedure. Overall, we noted one case of type Ib EL and two cases of limb events in each group at 30 days. Over a median follow-up of 39months, 31 (4.9%) events (17 type Ib EL, 2 type IIIa EL, and 12 limb events), 13 (5.5%) in FLs and 18 (4.5%) in SLs (p = .984), were observed. The FLs had significantly higher rates of aortic sac enlargement, with 46 (19.6%) cases for FLs and 36 (8.9%) for SLs (p < .001). The Kaplan-Meier analysis revealed significant differences at 5years in SLs versus FLs for freedom from type Ib EL (96.6% vs 82.4%, respectively; p < .001) and no difference in freedom from limb events (94.7% vs 84.5%, respectively; p = .519). Furthermore, no difference was observed for overall survival and aneurysm-related mortality. Although an FL for EVAR is used to treat dilated iliac arteries, there is an increased risk of intraoperative and late type Ib EL and aortic sac enlargement. Long-term close follow-up is mandatory, especially in the patients who undergo EVAR using FLs.

Embolization of Vessels With Irregular Lumen Using the Coil Packing Technique Between the Amplatzer Vascular Plug II Lobes.

The Amplatzer Vascular Plug(AVP) series enables precise positioning and high migration resistance, allowing embolization in short segments; however, inadequate embolization or recanalization may occasionally occur. We hypothesized that leaks may occur when AVPs are implanted in vessels with irregular lumen due to insufficient adherence to the vessel. This hypothesis was tested by experiments with a vascular model. We employed a coil packing technique between the AVP lobes to embolize internal iliac arteries with an irregular lumen. Saline was injected through the Y-shaped glass tubes of the stenotic and the smooth model (without stenotic lesion), and the amount of leakage was measured when the AVP was deployed. The feasibility and effectiveness of filling coils between the lobes of AVP II were evaluated. A total of 11 cases were retrospectively reviewed using this technique for internal iliac artery embolization prior to endovascular aortic repair. The amount of leakage was significantly higher in the presence of stenotic lesions.Insertion of a 2.2 F microcatheter from the side of the proximal lobe of AVP II and filling of coils was achieved in all 11 cases. Follow-up contrast-enhanced CT showed no recanalization, leakage, or other obvious complications. Coil packing technique around Amplatzer Vascular Plugs could be an effective method and a reliable option for arterial embolization, especially in vessels with irregular lumens.

A Case Series of Internal Iliac Artery Embolization During Endovascular Aortic Aneurysm Repair

A Case Series of Internal Iliac Artery Embolization During Endovascular Aortic Aneurysm Repair

Selective Transarterial Embolization for Intractable Hematuria Due to Bladder Carcinomas: A Single-Center Experience.

Malignant bladder neoplasms can cause life-threatening persistent hematuria. Selective transarterial embolization is an effective way to achieve hemostasis in such patients. The purpose of our study is to share our experience in these patients and to evaluate the short- and long-term effectiveness of this procedure. Twelve male patients with intractable hematuria due to bladder carcinoma were included in the study. A total of 17 selective transarterial embolization procedures (bilateral in 5 patients) were performed in 12 patients with microspherical particles and microcoils. Complete control of bleeding was achieved in 9 patients after the procedures whereas the need for transfusion continued in 3 patients. Approximately 75% bleeding control was achieved during our average 6-month (4- to 12-month) follow-up period. After the procedure, the patients had mild complaints that lasted for a few days, such as pain (66%), fever (42%), and nausea (50%). No major complications occurred. Selective transarterial internal iliac artery embolization is a reliable method that can be used for the palliative treatment of intractable hematuria due to bladder carcinomas.

Patent iliolumbar artery increase no risk of type II endoleaks after endovascular abdominal aortic aneurysm: a case-control study.

The aims of the present study were to explore the risk factors for type 2 endoleaks (T2ELs) after endovascular aneurysm repair (EVAR) and the association between T2ELs and the iliolumbar artery. A single-center, retrospective case-control study in West China Hospital was conducted among patients with infrarenal abdominal aortic aneurysm (AAA) who underwent EVAR between June 2010 and June 2019. The associations of patient characteristics, anatomical factors, internal iliac artery embolization, and ILA with the primary outcome were analyzed. The secondary objective was to analyze survival and reintervention between the T2EL group and the non-T2EL group. Kaplan-Meier survival, propensity matching analysis and multivariate logistic regression analysis were used. A total of 603 patients were included. The median follow-up was 51 months (range 5.0-106.0). There was a significant difference in the diameter of the lumbar artery (LA), middle sacral artery (MSA) and inferior mesentery artery (IMA), proportion of thrombus and LA numbers. The univariate analysis showed that T2ELs were more likely to develop more thrombus in aneurysm cavity (OR = 0.294, p = 0.012), larger MSA (OR = 1.284, p = 0.04), LA (OR = 1.520, p = 0.015), IMA (OR = 1.056, p < 0.001) and more LAs (OR = 1.390, p = 0.019). The multivariate analysis showed that the number of LAs (HR: 1.349, 95% CI: 1.140-1.595, p < .001) and the diameter of the IMA (HR: 1.328, 95% CI: 1.078-1.636, p = 0.008) were significantly associated with T2ELs. There were no new findings from the propensity score matching. The reintervention-free survival rates were significantly different between the two groups (p = 0.048). Overall survival and AAA-related death rates were not different between the two group. This was consistent with the PSM analysis. The iliolumbar artery and the different internal iliac artery interventions may not increase the incidence of T2ELs. But the numbers of LAs and IMA diameter were independent risk factors for T2Els. T2ELs was associated with the reintervention but did not affect long-term survival or increase aneurysm-related mortality after EVAR.

Simultaneous aortoiliac kissing Endovascular stenting for management of isolated monolateral common iliac artery aneurysm with no proximal landing zone.

Isolated iliac artery aneurysm (IIAA) is an uncommon finding. It, accounts for 0.03% of all patients and 2% of all abdominal aneurysm. Endovascular approach represents the treatment of choice for most patients with IIAA. We reported our experience on iliac aneurysm with no proximal landing zone by simultaneous aortoiliac kissing endovascular (S.A.K.E.) covered stenting. This is a retrospective analysis of nine consecutive patients with IIAA with no proximal landing zone, who underwent endovascular kissing covered stenting (Gore®Viabahn®VBX) The median aneurysm diameter was 4.1cm, with a median 3-mm proximal neck length. In 3/9 aneurysms involving the internal iliac arteries the origin of the internal iliac artery was covered after its embolization and a stent graft extending to the external iliac artery (EIA) was placed. All stents were flared with semi-compliant balloon. Iliac aneurysm exclusion was obtained in all cases (100%), no graft migration or endo-leak were recorded. The median operative time was 28min; the median fluoroscopy time was 9min and a median 70mL of contrast was used. At a median 24-month follow-up, all patients are alive, and no endo-leak or migration, infection, distal embolization, limb loss were observed. Moderate buttock claudication was experienced in 1/9 patients with internal iliac artery embolization. In 6/9 patients a shrinkage of the aneurysmal sac was recorded after 1year. Endovascular management of IIAAs cases has been reported in literature and it was confirmed to be safe and successful. The IAA usually progresses into expansion which eventually leads into rupture. Adequate long proximal and distal landing zones were the most important feature related to better outcomes. Short proximal neck (˂10mm) represents a real challenge for iliac aneurysm treatment and, nowadays, a classical bifurcated aortoiliac endograft deployment represents the treatment of choice. Endovascular repair of isolated CIA aneurysms with no proximal neck is safe and successful using the SAKE stenting technique with VBX adequately flared and it represents effective and minimally invasive alternative to aortobiliac endograft implantation in the treatment of these aneurysms. To the best of our knowledge, this is the first report which describes this approach in the treatment of IIAA with no adequate proximal landing zone. Our approach overcomes the need to aortic bifurcation graft implantation and reduces procedure time, contrast dose and radiation exposure. It also preserves relevant collaterals vessels thanks to inferior mesenteric artery and lumbar arteries sparing. A proximal aortic bifurcation endograft allows proximal sealing to be regained. Large population study with longer follow-up are needed to establish this approach as a new standard.

Clinical Outcomes of Internal Iliac Artery Interruption during Endovascular Aneurysm Repair.

This study aimed to investigate the clinical outcomes of internal iliac artery (IIA) interruption during endovascular aneurysm repair (EVAR) and to identify the risk factors for ischemic complications. Endovascular treatment was performed in 316 patients with aneurysms or pseudoaneurysms of the abdominal aorta or iliac arteries between March 2006 and January 2022. Medical records and radiological imaging studies were retrospectively reviewed. The incidences of buttock claudication, ischemic colitis, and spinal cord ischemia after IIA interruption were investigated as clinical outcomes. Binary logistic regression analysis were performed to identify the risk factors. IIA embolization was performed in 78 patients. Among the 42 patients who underwent IIA flow preservation procedures, the one-month computed tomography detected early failure in five patients. The origin of the IIA was covered with an endograft in ten patients who did not undergo embolization. Eventually, interruption of the IIA by EVAR was observed in 93 patients. Considering preoperative IIA occlusion, there was a total of six patients who did not have at least one IIA patency. Buttock claudication occurred in 32.6% of the patients, and none of the patients had ischemic colitis or spinal cord ischemia. In multivariable analysis, age ≤80 years and isolated iliac artery aneurysm were associated with the development of postoperative buttock claudication. The most common complication after IIA interruption is buttock claudication; however, critical complications such as ischemic colitis or spinal cord ischemia are rare, even in bilateral IIA occlusion. Adjunctive procedures to preserve bilateral IIA perfusion should be adopted selectively.

Pivotal Role of Management of Postpartum Haemorrhage by Using Intrauterine Pack during Caesarean Section

Background: Postpartum Haemorrhage (PPH) is a potentially life-threatening complication after delivery by both vaginal and caesarean section (CS). Different types of management options have been available in clinical settings including the use of oxytocin, prostaglandin analogues, ergometrine, surgical exploration of genital tract, ligation or angiographic embolization of uterine or internal iliac arteries and hysterectomy. Another simple and effective measure to manage PPH is to control the bleeding with intrauterine packing by mop during CS. This intrauterine packing during CS is very easy &amp; quick method to perform and it has pivotal role to save the patient need of major surgical procedures.&#x0D; Objective: To determine effectiveness of uterine packing by mop in control of post-partum hemorrhage, its safety and complications associated with it.&#x0D; Materials and Methods: This study was carried out in Obstetrics &amp; Gynaecology department of Eastern Medical College &amp; Hospital, Cumilla, Bangladesh from January 2020 to July 2020. It was a prospective interventional study. the patients presenting with postpartum haemorhage during CS due to atonic uterus. Patients who had PPH due to genital tract trauma were excluded from this study. Frequencies and proportions of complications were calculated along with rate of successful cessation of bleeding by the use of intrauterine mop. Data was analyzed by SPSS.&#x0D; Results: 100 patients included in the study. Among them 63% were 25-34 years, 26% were 15-24 years, 11% were 35-45 years. 73% patients were p &gt;3 and 27% were p 1-3. 77% patients belong to poor class family, 18% belong to middle class and 5% belong to high class family. These patients went through LUCS and had atonic uterus. Mop was used in those patients and successes rate were 87%. In 13% cases we needed others management. These were 11% case uterotonic drugs, 1% B-Lynch suture, 1% internal iliac artery ligation but none out of 100 patients underwent hysterectomy.&#x0D; Conclusion: Uterine packing by mop effectively controls PPH with fewer complications and its role in emergency obstetric scan not be denied.&#x0D; EMCJ. July 2022; 7(2): 1-5

A Giant Left Common Iliac Artery Aneurysm with Endovascular Repair: A Case Report

Common iliac artery aneurysm (CIAA) is a very rare entity, but with potentially disastrous evolution, aneurysm rupture or distal embolization. A specific management, surgical or endovascular procedure, is required. We present a case with a huge distal left common iliac artery aneurysm, in which the diagnosis was made incidentally during a weekly ultrasound examination, in spite of impressive dimensions, 9 cm diameter. The patient was then examined by 128- Slices computed tomography and angio-coronarography. Despite the attractive anatomy for direct surgery with resection of the aneurysm and restoration of the iliac tract through the interposition of a tubular prosthesis, due to the previous pathology of the patient with necrotizing fasciitis in the left lower limb and abdominal wall, endovascular intervention was decided. Because, the big size of the left common iliac artery aneurysm, located distally, with tortuosity of the left common iliac artery as well external iliac artery (EIA), permeable left internal iliac artery (IIA), extensive intra-aneurysmal thrombosis, endovascular procedure was complex and particular. The peculiarities of the case and the complex endovascular technique, with the placement of a stent graft on the infrarenal abdominal aorta, extended on both common iliac arteries, embolization of the left internal iliac artery and extension of the left arm on the external iliac artery, are described in this presentation.

The anesthetic approach to a patient with placenta accreta spectrum.

Placenta accreta poses significant risk of morbidity and mortality to a laboring patient. Here we review available treatment options, highlight trends in bleeding prevention and diagnosis that have been shown to improve patient outcome, and provide best practice suggestions. We also discuss the decision-making process for choice of anesthesia, as it is not based on a gold-standard paradigm. The use of resuscitative endovascular balloon occlusion of the aorta has been gaining popularity around the world. It has been shown to cause an equivocal reduction in perioperative bleeding in placenta accreta spectrum (PAS), reduce the rate of hysterectomies, and is a safe and relatively easy technique. There are other invasive radiology techniques that have also proven to be beneficial in bleeding prevention: balloon occlusion of hypogastric arteries intraoperatively, internal iliac artery embolization, and intraoperative ligation of the hypogastric or uterine arteries. Optimal management of PAS begins with early and definitive diagnosis. A multidisciplinary approach along with preparation of special equipment and the use of a check-list maximize the chance for success. Anesthesia could be done with all types of regional or under general, considering case-by-case factors but most importantly choosing according to the institution's best facility and skill.

Off-label use of an iliac branch device and a reversed iliac limb for a patient with a unilateral common iliac artery aneurysm and a narrow distal aorta: A case report.

Current bifurcated aortic endografts are unsuitable for patients with a narrow distal aorta except AFX2, which is unavailable in South Korea. An iliac branch device (IBD) was introduced to exclude iliac aneurysms while preserving the pelvic circulation. With advancements in endovascular techniques, various attempts for outside instructions for use have been reported to be practicable in certain patients. A 58-year-old man was referred to our emergency room with an incidentally found left common iliac artery aneurysm (CIAA) in a general checkup. Computed tomography angiogram showed a narrow distal aorta that tapered from 20 mm just below the renal artery to 13 mm at aortic bifurcation and a left isolated CIAA with a maximal diameter of 40 mm and 70 mm in length. After left hypogastric artery embolization, the Cook IBD was placed at the aortic bifurcation, and the Bard Covera Plus stent-graft was deployed from the IBD cuff to the left external iliac artery. Then, a reversed Medtronic Endurant iliac limb was implanted into the infrarenal aorta down to the proximal IBD. The stent grafts were patent without endoleak at the 6-month follow-up. In selected patients with an isolated CIAA with a narrow distal aorta, IBD can be used as a main body at the aortic bifurcation for successful aneurysm exclusion. However, considering the application of outside instructions for use, special attention and careful planning must be taken before the procedure.

A case report of vulvar embryonal rhabdomyosarcoma in an adult pregnant woman

Embryonal rhabdomyosarcoma (ERMS) is the most common soft tissue sarcoma in children, but it is rare in adults, where cases are reported as individual cases or series. We present an ERMS found in the vulva of a 24-year-old pregnant woman who complained of a painless soft tissue mass in her left vulva. The mass grew rapidly within a month, and abortion, internal iliac artery embolization, and chemotherapy were performed. Despite an initially good response, cancer unfortunately progressed, and the patient passed away within one year after diagnosis. Adults with ERMSs tend to have poorer outcomes than children, and our case suggests that in some cases, pregnancy may accelerate the deterioration of the tumor.

A Case of Complete False Lumen Thrombosis of Chronic Dissecting Aortic Aneurysm Followed by Endovascular Entry/Re-entry Closure and Internal Iliac Artery Embolization

A Case of Complete False Lumen Thrombosis of Chronic Dissecting Aortic Aneurysm Followed by Endovascular Entry/Re-entry Closure and Internal Iliac Artery Embolization

The Use of an Iliac Branch Device: Single-Center Study of Endovascular Preservation of Internal Iliac Artery Flow.

To determine the efficacy and safety of iliac branch device (IBD) implantation and to evaluate its limitations based on 7 years of experience in a single center. This single-center study included patients with bilateral common iliac artery aneurysms (CIAAs). We investigated follow-up CT and reviewed the internal iliac artery (IIA) patency and complications related to IBD. A retrospective analysis was performed and the overall survival rate and freedom from reintervention rate were reported according to the Kaplan-Meier method. Of the 38 patients with CIAAs, only 10 (12 CIAAs) were suitable for IBD treatment. Five patients underwent unilateral IBD insertion with contralateral IIA embolization, and three (60%) showed claudication; however, symptoms resolved within 6 months. The 7-year freedom from IBD-related reintervention rate was 77.8%. No procedure-related deaths occurred. IBD has good technical success and long-term patency rates; however, anatomical factors frequently limit its application, particularly in Asians. Additionally, unilateral IIA embolization showed relatively mild complications and a good prognosis; therefore, it can be performed safely for anatomically complex aortoiliac aneurysms.

Surgical Treatment of Small Intestinal Bleeding Caused by Arterial Gastrointestinal Fistula: A 2-Case Report

Background: This study aims to better understand diagnosing and treating arterial gastrointestinal fistulas. Methods: The diagnosis and treatment of two patients with arterial gastrointestinal fistulas were reported, and the experience with diagnosis and treatment was summarized. Results: In these two cases, both patients were admitted with bleeding as the primary complaint, both underwent emergency laparotomies, and both patients were diagnosed with small intestinal bleeding before surgery. the first patient died as a result of an abdominal aortic aneurysm rupture caused by chronic vascular repair and postoperative implant infection; the second patient underwent vascular repair on time, we treated him with third-generation cephalosporin, and after he was stabilized, we performed left total iliac stent placement and left internal iliac artery embolization; he had no fever after surgery, his incision was healed, and he was successfully discharged from the hospital. Conclusion: Aortic gastrointestinal fistula is rare and has a high mortality rate, attention should be paid to distinguishing it from small intestinal bleeding. Timely diagnosis and rapid surgical treatment are keys to improving survival.

Internal Iliac Artery Embolization within EVAR Procedure: Safety, Feasibility, and Outcome.

This study is focused on Internal Iliac Artery (IIA) embolization in patients undergoing Endovascular Aneurysm Repair (EVAR). Our aims were: to establish the feasibility of the procedure; to assess the presence of endoleak (EL) and increase in the size of the sac at follow-up; to define the need for reintervention; and to evaluate mortality rate. In this retrospective single-center study, EVAR-treated patients with an embolization of IIA were chosen. Coils and vascular plug were used as embolizing agents. A total of 49 participants were enrolled in the study (48 men and one woman) with a median age of 76 ± 12 years. Patients had no early EL in 87.75% of cases, 8.16% had type 1a EL, 2.04% type 1b EL, and 2.04% type 2 EL, with a comprehensive technical success of 95.91%. In the follow-up, at 1 month 72.22% remained without EL, at 6 months 70.97%, and at 1 year 81.48%. In the same period, the trend of type 1 EL was 5.56% (1 month), 3.23% (6 months), and 0% (1 year). For EL type 2: 22.22% at 1 month, 25.81% at 6 months, and 16.7% at 1 year. The overall mortality was 35.58% and the re-intervention rate was 16.33%. IIA embolization is a feasible and safe procedure. The presence of EL is not superior to EVAR procedures that do not involve embolization.

Outcomes of the Gore Excluder Iliac Branch Endoprosthesis for Japanese Patients With Aortoiliac Aneurysms: A Study Based on J-Preserve Registry

Purpose: To evaluate the clinical utility of the Gore Excluder iliac branch endoprosthesis (IBE) for Japanese patients with aortoiliac aneurysms. Materials and Methods: This was a multicenter retrospective cohort study (J-Preserve Registry). Patients undergoing endovascular aortic repair using the Gore Excluder IBE for aortoiliac aneurysms between August 2017 and June 2020 were enrolled. Data pertaining to the baseline and anatomical characteristics, technical details, and clinical outcomes were collected from each institution. The primary endpoints were technical success, IBE-related complications, and reinterventions. Secondary endpoints were mortality, aneurysm size change, and reintervention during follow-up. Technical success was defined as accurate deployment of the IBE without type Ib, Ic, or III endoleaks on the IBE sides on completion angiography. A change in aneurysm size of 5 mm or more was taken to be a significant change. Results: We included 141 patients with 151 IBE implantations. Sixty-five IBE implantations (43.0%) had at least one instruction for use violation. Twenty-two patients (15.6%) required internal iliac artery (IIA) embolization for external iliac artery extension on the contralateral side. Of 151 IBE implantations, 19 exhibited IIA branch landing zones due to IIA aneurysms. Mean maximum and proximal common iliac artery (CIA) diameters were 32.9±9.9 mm and 20.5±6.9 mm, respectively. The mean CIA length was 59.1±17.1 mm. The IIA landing diameter and length were 9.0±2.3 mm and 33.8±14.6 mm. The overall technical success rate was 96.7%. There were no significant differences in IBE-related complications (2.3% vs 5.3%, p=0.86) or IBE-related reinterventions (1.5% vs 5.3%, p=0.33) between the IIA trunk and IIA branch landing groups. The mean follow-up period was 635±341 days. The all-cause mortality rate was 5.0%. There were no aneurysm-related deaths or ruptures during the follow-up. Most patients (95.7%) had sac stability or shrinkage. Conclusion: The Gore Excluder IBE was safe and effective for Japanese patients in the midterm. Extending the IIA device into the distal branches of the IIA was acceptable, which may permit extending indications for endovascular aortic aneurysm repair of aortoiliac aneurysms to more complex lesions. Clinical Impact This study suggests clinical benefits of the Gore Excluder IBE for Japanese patients, despite 43% of the IBE implantations having at least one IFU violation.