Degree Of Progressive Dilation Of The External Iliac Artery After Endovascular Stent Placement
Camilo Martinez, MD, James Kaan, MD, Shang Loh, MD, Rahul Kanade, MD, Apostolos Tassiopoulos, MD, Nicos Labropoulos, PhD.
Stony Brook University Hospital, Stony Brook, NY, USA.
Objective Endovascular aneurysm repair (EVAR) has become the standard of care for treating abdominal aortic aneurysms (AAA). However, the distal seal zone, usually in the common iliac arteries (CIA), has been shown to be at risk for degeneration over time due to progression of aneurysmal disease, perhaps exacerbated by radial forces exerted by the stent graft. Recently, there has been more recognition of compromised CIAs that may not be suitable for sealing of an endograft. These would be optimally treated with branched iliac devices or coil embolization and extension into the EIA. The objective of this study was to evaluate the degree of progressive dilation in both stented and non-stented EIAs in comparison to CIAs over time.
Methods CPT codes from the past ten years were utilized to identify patients that had EVAR with limb extension into the EIA, either primarily or on subsequent intervention. Pre- and post-operative coronal CT scans were used to measure the EIAs at 1cm from iliac bifurcation, end of stent, and 2cm past stent with corresponding distances in the non-stented preoperative or contralateral artery. A control group consisting of patients who had bifurcated EVARs with distal seal in the CIA and no re-interventions was collected to measure the CIAs at end of stent with corresponding distances in the non-stented preoperative artery, and EIAs at 1cm from iliac bifurcation, mid-EIA, and distal-EIA.
ResultsA total of 28 endovascular repairs with limb extension into the EIA and 20 traditional EVARs with both limbs in the CIA were included in this study. Average diameters of the CIA and EIA were recorded, as well as interval pathologic growth between studies (Table 1). There was a significant difference between the change in diameter over time in both the control group and experimental group when comparing CIA to EIA (p < 0.001).
Conclusions Both stented and non-stented EIAs demonstrate less progressive dilatation relative to CIAs. This may be due to their different embryologic origins. EIAs may be more suitable distal landing targets for patients with larger or high-risk CIAs. 
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