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Mid-term Outcomes Of Endovascular Repair Of Aortoiliac Aneurysms Using A Dedicated Iliac Branch Endoprosthesis
Rebecca N. Treffalls, DO
1, Guilherme B. Lima, MD
1, Randall R. DeMartino, MD, MS
1, Jill J. Colglazier, MD
1, Manju Kalra, MBBS
1, Todd E. Rasmussen, MD
1, Melinda S. Schaller, MD
1, Fahad Shuja, MBBS
1, Gustavo S. Oderich, MD
2, Bernardo C. Mendes, MD
1.
1Mayo Clinic, Rochester, MN, USA,
2The University of Texas at Houston, Houston, TX, USA.
OBJECTIVES: This study aimed to evaluate the mid-term outcomes of endovascular repair of aortoiliac and isolated iliac artery aneurysms using iliac branch endoprosthesis (IBE, WL Gore, Flagstaff AZ).
METHODS: We reviewed the clinical data and outcomes of consecutive patients treated by IBE in a single center (2014-2024). End-points were technical success, 30-day major adverse events (MAEs), 30-day mortality, and stent-graft related late outcomes, including primary and secondary iliac branch patency, secondary intervention, target vessel instability (TVI), endoleaks, aneurysm sac regression, new-onset buttock claudication, and aortic-related mortality.
RESULTS: There were 147 patients (73 ± 8 years old, 93% male) treated with 185 IBE (109 unilateral, 38 bilateral). 119 (81%) had concomitant aortic repair (69% infrarenal, 12% fenestrated-branched), and 28 (19%) had isolated IBE repair. Of these, 47 patients (32%) had internal iliac artery aneurysms (Table I). Technical success was achieved in 143 patients (97%) with no 30-day mortality. Within 30 days, the rates of reintervention were 5.4%, aortic-related mortality was 0%, and major adverse events were 4.7%. After a median follow-up of 24 months (interquartile range, 10 to 35 months), aneurysm sac regression (>5 mm) was noted in 27% of patients, stability in 70%, and growth in 2.7%. Cumulative incidence of buttock claudication was 3.1% at 3-years. Primary target vessel patency was 97% ± 2%. Freedom from TVI was 72% ± 5.7% and freedom from endoleaks was 77% ± 7.9% at 5 years; specifically, freedom from type I and type II was 96% ± 3.6% and 72% ± 5.4%, respectively, at the same interval. Secondary reinterventions were required in 5.1% of patients with 5-year freedom from secondary intervention of 91% ± 5.8%. There were no aortic-related deaths.
CONCLUSIONS: This study demonstrated favorable early and mid-term outcomes with the use of the IBE device for elective endovascular repair, achieving high patency and minimal aortoiliac-related complications. There were no aortoiliac-related deaths, and freedom from reintervention was high. These results reinforce the safety and durability of endovascular repair using the IBE device for aortoiliac or iliac artery aneurysms.
Table I. Cardiovascular risk factors and pre-operative characteristics| Tobacco use, % | 47% |
| Coronary artery disease, % | 44% |
| Congestive heart failure, % | 17% |
| Diabetes mellitus type 2, % | 17% |
| Chronic kidney disease III/IV, % | 28% |
| Prior open aortic repair, % | 6.1% |
| Prior endovascular aortic repair, % | 22% |
| Aortic diameter (mm), Mean±SD | 49 ± 18 |
| Right common iliac artery diameter (mm), Mean±SD | 32 ± 12 |
| Left common iliac artery diameter (mm), Mean±SD | 31 ± 13 |
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