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Objective
To assess safety and effectiveness of iliac branch devices (IBDs), as secondary procedure,
for the treatment of type Ib endoleak or evolution of iliac arteries disease after
prior endovascular aortic repair (EVAR) for thoraco-abdominal aortic aneurysms (TAAAs)
or abdominal aortic aneurysms (AAAs).
Methods
Multicentre observational study of three European centres. Study included 75 patients
(age 71 ± 9 years, 96% men) with previous EVAR (n = 64, 85%) or fenestrated/branched (FB) EVAR (n = 11, 15%). Overall, 88 IBDs were implanted to treat aneurysmatic evolution of iliac
arteries in 40 (53%) and type Ib endoleak in 35 (47%) cases, respectively. Thirteen
(17%) patients received bilateral IBDs. Catheterisation of the internal iliac arteries
(IIAs) was done through transaxillary access (n = 82, 93%) or “up and over” (n = 6, 7%) technique. Primary endpoint was technical success. Secondary endpoints were
30 day major adverse event, early/long-term freedom from reinterventions and target
vessel instability.
Results
All procedures reached technical success (100%). During hospitalisation, 4 (5%) major
adverse events and 3 (4%) early re-interventions occurred, but no mortality, stroke,
or damage on previous endografts. Median follow up was 47 (interquartile range 42)
months, and survival rate at five years was 78 ± 6% with no aortic related mortality.
Cox’s regression analysis showed pre-operative renal function impairment (hazard ratio
[HR] 3.4; 95% confidence interval [CI] 1.1 – 10.1; p = .033), and primary TAAA repair (HR 6.1; 95% CI 1.6-22-3; p = .006) as independent factors for long term mortality. Freedom from re-interventions
was 85 ± 4% at five years with 11 (12%) cases (five endoleaks, four IBD thrombosis,
two stenoses). IIA instability was reported in three (3%) limbs and freedom from IIA
instability was 95 ± 3% after 60 months.
Conclusion
Secondary IBD after EVAR is a safe and effective procedure with high technical success
and low complication rates. The technique of choice to revascularise the IIA seems
to not affect early and follow up results. Long term durability of IBD repair is acceptable
with low rates of IIA re-interventions.
Keywords
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Article info
Publication history
Accepted:
January 19,
2023
Received in revised form:
November 20,
2022
Received:
May 12,
2022
Publication stage
In Press Accepted ManuscriptFootnotes
☆WHAT THIS PAPER ADDS: This study presents the largest available series on the use of secondary iliac branch devices after endovascular aortic repair, with a safe and effective procedure showing 100% of technical success, 0% early mortality, and no issue on the previously implanted endograft. Results were unbiased by the choice of access to revascularise hypogastric artery. The durability of the repair with secondary iliac branch device is acceptable, long term mortality is not affected by aorto-iliac repair, and the revascularised hypogastric arteries show low rates of internal iliac artery instability and reinterventions. Thus, the repair can be effectively carried out in a population with reasonable life expectancy.
Identification
Copyright
© 2023 Published by Elsevier B.V. on behalf of European Society for Vascular Surgery.
