Early Feasibility And Outcomes Of Bifurcated Unibody Aortic Endografts Facilitating Favorable Aortoiliac Anatomy For Deployment Of Iliac Branch Endoprostheses
Anand Brahmandam, MD, Arash Fereydooni, BS, Christine Deyholos, MD, RPVI, Uwe Fischer, MD, PhD, Naiem Nassiri, MD, RPVI.
Yale University School of Medicine, New Haven, CT, USA.
OBJECTIVES: Endovascular treatment of common iliac artery (CIA) aneurysms using Iliac Branch Endoprosthesis (IBE) is known to be safe and effective. Currently, instructions for use (IFU) require that the IBE be used in conjunction with a modular bifurcated endograft. Concomitant aortoiliac disease, inadequate renal artery to iliac bifurcation length, and narrow distal aortic domain preclude IBE use. We present the technical feasibility and short-term outcomes of bifurcated unibody endografts circumventing aortoiliac anatomical constraints for IBE deployment. METHODS: In 4 consecutive patients with CIA aneurysms, computed tomography angiography (CTA) and center-line 3D reconstruction revealed aortoiliac anatomy incompatible with IBE IFU due to inadequate renal artery to iliac bifurcation length, inadequate proximal CIA seal-zone, and narrow abdominal aorta. Aortoiliac reconstruction was achieved using the Endologix AFX aortic stent-graft to facilitate deployment of the Gore IBE and the VBX stent-grafts within the iliac circulation. (Figure 1.)Technical success was defined as successful delivery of all aortoiliac components without migration or endoleak.
RESULTS: The mean patient age was 71 years (range 61 to 82 years) and majority were male (n=3/4). There were two patients with bilateral CIA aneurysms (3.5cm-4cm and 4.6cm-7.1cm) and two patients with unilateral CIA aneurysms (4.7cm and 4.8cm). Both patients with bilateral CIA aneurysms had inadequate renal artery to iliac bifurcation lengths. One patient with a unilateral CIA had an abdominal aortic aneurysm previously repaired with an AFX stent-graft. One patient with a unilateral CIA had a narrow aortic lumen and inadequate CIA proximal seal-zone. There were 8 internal iliac artery (IIA) VBX stent-grafts used for a total of 6 IIAs treated. Technical success was 100%. There were no perioperative complications. Mean hospital length of stay was 1.75 days (range 1 to 3 days). Follow-up ranged from 50 to 191 days (mean=132 days). At last follow-up, all patients were alive without cardiovascular morbidity; and post-operative CTA revealed stable or decreased CIA aneurysms, patent stent grafts, and no evidence of endoleak or migration.
CONCLUSIONS: In patients with CIA aneurysms not meeting IFU criteria for IBE, bifurcated unibody aortic endografts can safely and effectively overcome specific aortoiliac anatomic constraints to facilitate IBE deployment. 
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