Long Term Outcome of Internal Iliac Artery Revascularization Performed During Common and Internal Iliac Aneurysm Repair
Indrani Sen, Manju Kalra, Himanshu Verma, Gustavo S. Oderich, Randall R. DeMartino, Courtney N. Day, Peter Gloviczki, Thomas C. Bower.
Mayo clinic, Rochester, MN, USA.
OBJECTIVES: Internal iliac artery (IIA) preservation during IIA aneurysm (IIAA) repair is challenging. The aim of this study was to evaluate outcomes of IIA-revascularization (IIAR) performed during internal and common iliac artery aneurysm (CIAA) repair.
METHODS: Clinical data of consecutive patients undergoing open (OR) and endovascular (iliac branch device, IBD) IIAR for iliac aneurysm repair between 1996 and 2016 were retrospectively reviewed. End-points were mortality, graft patency, and freedom from pelvic ischemic symptoms (buttock claudication, ischemic colitis and spinal cord injury).
RESULTS: A total of 1253 patients with IAA (1128 CIAAs, 125 IIAAs) were treated during the study period; of these 164 patients (155 male, 9 female, mean age 70.35 years), undergoing IIIR were included in this study. Group I comprised 94 patients with CIAAs (unilateral 41, bilateral 53) and Group II 70 patients with IIAAs (unilateral 39, bilateral 31, IIAA with CIAA 62 isolated IIAA 8). Abdominal aortic aneurysm (AAA) was repaired concomitantly in 129 patients. Repair was elective in 161 (98%) patients. Group I included 104 IIA bypasses; OR, 67 (51 antegrade, 16 retrograde) in 61 pts and endovascular ( ER) with IBD, 37 (33 pts). Group II included 83 IIA bypasses; OR, 67 (64 antegrade, 3 retrograde) in 57 pts and ER with IBD, 16 (12 pts). Early mortality was 1.2% (1/128 OR). Ischemic colitis occurred in 2 patients (1 in each group, both with sacrifice of contralateral IIA). Median imaging follow-up was 1.3 years. Patient survival at 1 and 5 years was 96%, 79% in Group I and 93%, 69% in Group II (p=0.33). On Kaplan Meier analysis primary IIA graft patency at 1 and 5 years was not significantly different between Groups 1 and II; 96%, 88% and 89%, 86% respectively (p=0.48), nor between OR and ER: (p=0.84). Risk of buttock claudication at last follow-up was significantly higher in Group II compared to Group I, (HR = 3.7, p=0.03) and with preservation of one IIA vs both IIAs, (24% vs 8%; HR=2.2, p=0.13), the latter achieved in 62% of patients in Group I vs 47% in Group II.
CONCLUSIONS: IIAR for IIAA repair is safe, with excellent long-term patency, similar to results of CIAA repair. Preservation of IIA flow is associated with higher freedom from buttock claudication, and should be the preferred goal.
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