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A Multi-institutional Collaboration Evaluating The Use Of Iliac Branch Endoprosthesis (IBE) To Repair Internal Iliac Artery Aneurysms (IIAA)
Raj Patel, MD1, Javairiah Fatima, MD
1, Lucas Kanamori, MD
2, Gustavo Oderich, MD
2, Naveed Saqib, MD
2, Rebecca Treffalls, DO
3, Guilherme Lima, MD
3, Bernardo Mendes, MD
3.
1MedStar Washington Hospital Center, Washington, DC, USA,
2Department of Cardiothoracic & Vascular Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA,
3Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA.
OBJECTIVES: Internal iliac artery aneurysms (IIAAs) are a rare pathology. When present they have traditionally been treated with coil and cover technique, however, this can be associated with significant morbidity and mortality. Preservation of blood flow is imperative to prevent pelvic ischemia complications. The Gore Iliac Branch Endoprosthesis (IBE) has been increasingly used to preserve the internal iliac artery blood flow in IIAA.
METHODS: A multi-institute retrospective review was performed for patients that underwent placement of IBE for internal iliac artery aneurysms between January 2013 and June 2024. The primary endpoint of this study included technical success and secondary endpoints included rates of pelvic ischemia, in-hospital mortality, endoleaks at follow-up associated with IBE, patency of internal iliac limb at follow-up, and reintervention rates. This study describes the safety and efficacy of IIAA repair with IBE.
RESULTS: There were 110 IBEs placed in 95 patients during the study period. Mean age of patients was 73.8 +/- 7.9 (92% male). The average diameter of treated IIAA was 30.7mm +/- 1.03. Technical success was achieved in 98% of IBEs deployed (108/110). There were no in-hospital mortalities and there was 1 aortic related death related to endograft infection necessitating explantation 11 months after implantation. A total of 3 patients (3%) developed buttock claudication after IBE during initial hospitalization that all required extensive side branch embolization. No other patients developed signs/symptoms of pelvic ischemia during follow up period. In terms of internal iliac branch selection, 50% were the Gore IBE branch, 41% were the VBX, and 9% were other. A total of 78 patients (82%) had concomitant placement or previous placement of an EVAR device for aneurysmal aortic disease. Bilateral IBEs were placed for bilateral IIAA in 15 patients (16%). There were 7 patients (7%) that had endoleak associated with IBE device and 5 patients required intervention. Endoleaks consisted of 2 type 1b requiring distal extension, 1 type 2 requiring coil embolization, and 2 type 3 requiring relining of internal iliac stent. Patency of internal iliac limb was observed in 83 patients (98%).
CONCLUSIONS: This multi-institutional collaboration demonstrates that endovascular repair to preserve internal iliac artery branches using the Gore IBE device is safe and feasible.
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