Feasibility And Outcomes Of Endovascular Repair Of Internal Iliac Artery Aneurysms With Flow Preservation
Indrani Sen, Manju Kalra, Bernardo C. Mendes, Randall R. DeMartino, Jill J. Colglazier, Fahad Shuja, Gustavo S. Oderich.
Mayo clinic, Rochester, MN, USA.
OBJECTIVE: Evaluate 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- 2020 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, freedom from pelvic ischemic symptoms, patency, mortality and re-intervention rate. RESULTS: Elective ERFP was performed for 40/45 IIAAs in 28 patients (25 male; mean age 78 years). IIAAs were bilateral in 16; with a mean diameter of 3±1 (1.3 - 6.5) cm. Contralateral IIA was normal in 9, coiled concomitantly in 4, previously in 3. Bilateral ERFP was performed in 11, concomitant EVAR in 19; 8 had undergone prior aortoiliac repair (open 5, EVAR 3). IIAA repair was performed with Gore Iliac-Branch Endoprosthesis in 18, Gore-Excluder endograft in10, parallel covered stents in 5, physician modified endografts in 5 and VBX stent in 2. Distal seal was obtained in the distal IIA in 2 and posterior division of the IIA (pdIIA) in 37 procedures (with anterior division coil occlusion and various bridging stent grafts). Median stent extension length was 1.7 (0.5-4) cm into the pdIIA. Access was femoral in all (percutaneous 21, open 7), additional open left brachial access in 7. Technical success was 97% (39/40); one IIAA 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 6/28 patients. Bilateral IIA flow was preserved in 21 and unilateral in 7. No patients reported buttock claudication. Freedom from internal iliac limb re-intervention was 97% and 83% at 1 and 3 (median FU 3.2) years; thrombolysis in 1, covered stents in 2 for Type 1 and 3 endoleaks. Secondary patency was 100%. Freedom from endoleak related to internal iliac reconstruction was 89% and 71% at 1 and 3 years. In addition to those requiring re-interventions, 5 Type 2 endoleaks are under observation, with minimal (1-2mm) sac enlargement in 4. 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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