Durability of iliac artery preservation associated with endovascular repair of infrarenal aortoiliac aneurysms

J Vasc Surg. 2017 Oct;66(4):1028-1036.e18. doi: 10.1016/j.jvs.2017.02.042. Epub 2017 May 11.

Abstract

Objective: This study evaluated and compared the long-term clinical outcomes of endovascular repair of infrarenal aortoiliac aneurysms (EVAR) vs EVAR with preservation of antegrade internal iliac artery (IIA) perfusion using iliac branched devices (EVAR-IBDs).

Methods: From October 1998 to August 2015, patients with infrarenal aortoiliac aneurysmal (AIA) disease at high risk for conventional open surgery were enrolled in a prospective physician-sponsored investigational device exemption trial. Clinical data of 75 patients treated with EVAR-IBD and 255 with standard EVAR were analyzed. Technical success, perioperative outcomes, mortality, device patency, endoleak rates, and reinterventions during a follow-up of 10 years were analyzed.

Results: There were 87 IBDs deployed in 75 patients. Technical success rate was 97%. Mortality at 30 days was 1.3%. Freedom from aneurysm-related mortality at 3, 5, and 10 years was 99%. Freedom from a type I or III endoleak at 3, 5, and 10 years was 99%. Freedom from secondary reinterventions at 3, 5, and 10 years was 86%, 81%, and 81%, respectively. Primary patency of the IBDs at 3, 5, and 10 years was 94%, 94%, and 77%, respectively. Twenty-four percent of patients underwent EVAR for concomitant AIA disease (EVAR-AIA), and 78% were managed by staged IIA embolization before EVAR. No statistically significant difference in freedom from aneurysm-related mortality, limb occlusions, or endoleak rates was identified in patients with EVAR-AIA vs EVAR-IBD (P > .05). There were significantly more secondary reinterventions in the EVAR-AIA group compared with the EVAR-IBD group (hazard ratio, 0.476, 95% confidence interval, 0.226-1.001; P = .045).

Conclusions: EVAR of infrarenal AIAs with preservation of antegrade flow to the IIA using IBDs is feasible with long-term sustained durability. Serious considerations should be given to the use of IBDs in patients with infrarenal AIAs meeting appropriate anatomic criteria.

Trial registration: ClinicalTrials.gov NCT00583414.

Publication types

  • Comparative Study
  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Aneurysm, Abdominal / diagnostic imaging
  • Aortic Aneurysm, Abdominal / mortality
  • Aortic Aneurysm, Abdominal / physiopathology
  • Aortic Aneurysm, Abdominal / surgery*
  • Blood Vessel Prosthesis
  • Blood Vessel Prosthesis Implantation / adverse effects
  • Blood Vessel Prosthesis Implantation / instrumentation
  • Blood Vessel Prosthesis Implantation / methods*
  • Blood Vessel Prosthesis Implantation / mortality
  • Disease-Free Survival
  • Endovascular Procedures / adverse effects
  • Endovascular Procedures / instrumentation
  • Endovascular Procedures / methods*
  • Endovascular Procedures / mortality
  • Feasibility Studies
  • Female
  • Humans
  • Iliac Aneurysm / diagnostic imaging
  • Iliac Aneurysm / mortality
  • Iliac Aneurysm / physiopathology
  • Iliac Aneurysm / surgery*
  • Iliac Artery / diagnostic imaging
  • Iliac Artery / physiopathology
  • Iliac Artery / surgery*
  • Kaplan-Meier Estimate
  • Male
  • Ohio
  • Postoperative Complications / mortality
  • Postoperative Complications / therapy
  • Prospective Studies
  • Prosthesis Design
  • Regional Blood Flow
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Vascular Patency

Associated data

  • ClinicalTrials.gov/NCT00583414