Iliac branch devices can safely and effectively treat common iliac artery aneurysms by preserving internal iliac artery reperfusion, according to recent findings.
In the study, researchers evaluated 140 patients (mean age, 71 years; 130 men) seen at seven vascular centers who were implanted with bifurcated iliac side devices (Zenith, Cook Medical) as part of a large Dutch multicenter cohort between September 2004 and August 2015.
Patients eligible for iliac branch device implantation had a common iliac artery aneurysm with diameter > 30 mm or an abdominal aortic aneurysm with diameter > 55 mm for men or > 50 mm for women, with an associated common iliac artery aneurysm > 20 mm in diameter. Also included were patients who needed endovascular revision of a type Ib endoleak using an iliac branch device, as well as patients with distal para-anastomotic aneurysm after open aortic surgery. The researchers collected patient data retrospectively from electronic medical records. Patients were seen for imaging follow-up 6 weeks after iliac branch device implantation and yearly thereafter.
Outcomes included technical success, freedom from type I and III endoleaks, morbidity, major complications, internal iliac artery patency, and aneurysm sac regression or enlargement.
Technical success achieved
A total of 162 iliac branch device implantations were performed, and technical success was achieved in 157 (96.9%) of these procedures, according to the researchers.
Ten (7.1%) patients developed complications within the first 30 days after the procedure, and six (4.3%) had complications considered major. There were two (1.4%) deaths due to postoperative complications.
uplex ultrasound data available; in 107 (76.4%) of those patients, preoperative and postoperative CTAs were compared, the researchers wrote.
Sac regression of the AAA or common iliac artery aneurysm was seen in 55 (51.3%) patients, and sac enlargement was documented in 14 (13.1%) patients. Six of these cases of sac enlargement were due to a type I endoleak, and one case was due to a type III endoleak. There were no type Ia endoleaks in isolated common iliac artery aneurysms. During follow-up, the researchers identified seven internal iliac artery type Ib endoleaks. In four cases, a covered stent was used to successfully extend the internal iliac artery side branch; in two patients, the branch and the internal iliac artery were excluded with Amplatzer plugs (St. Jude Medical) or coils due to persistent growth of the common iliac artery aneurysm. One patient experienced a perforation of the internal iliac artery during endovascular treatment of a type Ib endoleak, and this was treated through emergency laparotomy and ligation. There were three type III endoleaks due to the disconnection of the covered internal iliac artery stent from the iliac branch device branch; these branches demonstrated no kinking or angulation, according to the researchers.
There were seven cases of external iliac artery occlusion during follow-up, resulting in three successful treatments with thrombolysis, three additional stent placements and three surgical thrombectomies. There were 15 (9.3%) internal iliac artery branch occlusions, and in six of these patients, buttock claudication developed, according to the researchers. One patient was treated with a balloon-expandable stent (Palmaz, Cordis) for proximal stenosis in one iliac branch device, leading to 17 (12.1%) device-associated secondary treatments. Estimated freedom from secondary interventions at 60 months was 75.9% (95% CI, 59.7-86.3)
“[Common iliac artery] aneurysms can be treated safely and effectively using [iliac branch devices] to preserve antegrade flow to the [internal iliac artery],” the researchers wrote. “Secondary interventions are indicated in > 10% of patients during follow-up but can be performed using endovascular techniques in most patients.” – by Jennifer Byrne
Disclosure: The researchers report no relevant disclosures.