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Does iliac artery aneurysm increase secondary intervention rates after EVAR?
Mohsen Bannazadeh, Christina Jenkins, Andrew Forsyth, Jason Kramer, Paul Bove, Ankur Aggarwal, Graham Long.
Beaumont Hospital, Royal oak, MI, USA.

OBJECTIVES:
The purpose of this study was to evaluate the morbidity from common iliac artery aneurysm (CIA) after endovascular aortic aneurysm repair (EVAR).
METHODS:
This is a retrospective review of all patients who underwent elective EVAR from June 2006 through June 2012 at a single institution. Patient demographics, hospital course, radiographic imagings, and follow-up visits were analyzed. Patients with CIA were treated with either flared endograft limb (FL; iliac limb >20 mm) or CIA exclusion (CIAE) with endograft limb extension into the external iliac artery. Outcomes between these groups were compared using χ2 tests and the Kaplan-Meier method with Log-rank tests.
RESULTS:
Of 627 patients who underwent elective EVAR during this period, 422 underwent standard EVAR with endograft limb <20 mm (group A), 143 were treated with FL (group B), 38 had CIAE (group C), and 24 were managed with a combination of FL in one limb and CIAE in the other (group D). There was no difference in secondary intervention rate between groups (group A= 13%; group B= 9.1%; group C= 15.8%; group D= 16.7%; p=0.47). Similarly, no difference was noted in major complication (endoleak, thrombosis, rupture, endograft infection) rates amongst the groups (p = 0.38). Overall perioperative mortality was 1.45 %. The average iliac growth rate was 2.2 ± 4.7 mm per year despite intervention with FL or CIAE. Overall median survival was 103 months (interquartile range, 92-115 months) with no difference between the groups (p=0.68). The median follow-up was 30 months.
CONCLUSIONS:
Management of iliac artery aneurysm at the time of EVAR by flared limbs or external iliac extension does not increase the rates of secondary intervention or major complications.


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