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Use of Secondary Iliac Branch Devices after Previous Endovascular Abdominal and Thoraco-Abdominal Aortic Aneurysm Repair

Published:January 24, 2023DOI:https://doi.org/10.1016/j.ejvs.2023.01.033
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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.

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