Feasibility And Outcomes Of Endovascular Repair Of Internal Iliac Artery Aneurysms With Flow Preservation
Indrani Sen, Bernardo C. Mendes, Randall R. DeMartino, Colglazier JIll, Shuja Fahad, Thomas C. Bower, Gustavo Oderich, Manju Kalra.
Mayo clinic, Rochester, MN, USA.
OBJECTIVE: We evaluated feasibility and mid -term outcomes of endovascular repair of internal iliac artery aneurysms (IIAAs) with flow preservation (ERFP).
METHODS: Clinical data of consecutive patients undergoing ERFP between 2008 -2018 were retrospectively reviewed. ERFP was considered feasible when distal seal could be obtained in the distal IIA or a divisional branch. This remains outside IFU of iliac-branch devices. End-points were technical success, re-intervention rate, patency, mortality and freedom from pelvic ischemic symptoms.
RESULTS: Elective ERFP was performed for 37/42 IIAAs in 26 patients, (25 male; mean age 78 years). IIAAs were bilateral in 15 patients; with a mean diameter of 3±1 (1.3 - 6.5) cm. Contralateral IIA was normal in 8, coiled concomitantly in 4 , previously in 3. Bilateral ERFP was performed in 10 patients, concomitant EVAR in 18; 8 had undergone prior aortoiliac repair (AIR, open 5, EVAR 3). IIAA repair was performed with Gore Iliac-Branch Endoprosthesis (IBE, n = 16), Gore Excluder endograft (n=10), parallel covered stents (PCS, n=5), physician modified endografts (PMEG, n=5) and VBX stent (n=1). Distal seal was obtained in the distal IIA in 2 and posterior division of the IIA (pdIIA) in 34 procedures (with anterior division coil occlusion) with various bridging stent grafts. Median stent extension length was 1.7 (0.5-4) cm into the pdIIA. Access was femoral in all (percutaneous 19, open 7), additional open left brachial access in 7. Technical success was 97% (36/37); one IIA could not be excluded due to iliac tortuosity. There were no cases of ischemic colitis, spinal cord injury or 30-day death. Postoperative complications occurred in 6/26 patients. Bilateral IIA flow was preserved in 19 and unilateral in 7: No patients reported buttock claudication. During a median follow-up of 4 years(range 1-10, imaging FU 2.6 yrs) 4 re-interventions were performed. These were for thrombosis in 2 (treated with thrombolysis and femoro-femoral bypass in one each), and 2 endoleaks (Type 3 and Type 1b treated with covered stents). Type 2 endoleaks were seen in 5 patients, of which 3 have had mild sac enlargement and are being observed closely .
CONCLUSIONS: Endovascular repair of IIAAs with flow preservation can be safely performed with high technical success and favorable aneurysm-related outcomes in the mid-term, even in patients with prior aortoiliac reconstruction.
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