Contrary to previous smaller reports of T2ELs and DU surveillance, parameters such as IFV did not correlate with increased post-EVAR sac diameter. The presence of multiple T2ELs and bidirectional SDW may be the strongest factors predictive of increased sac diameter.
This large series of DU surveillance for failing EVARs grafts suggests that graft limbs with PSVs <300 cm/s can be safely monitored. However, limbs with more elevated PSVs may benefit from prophylactic intervention or more frequent surveillance to prevent limb occlusion.
Results:Of 632 patients, 586 (522 group 1, 64 group 2) had data available for analysis with a mean follow-up of 26 months. During EVAR, 60 patients (94%) in group 2 underwent coil embolization and coverage of the internal iliac artery. In group 2 patients, the 5-year endoleak-free survival was significantly lower (57% Ϯ 10% vs 72 Ϯ 5%; P ϭ .018), incidence of distal iliac artery attachment site (type Ib) endoleak was significantly higher (0.7% vs 7.8%, P Ͻ .001), and reintervention-free survival was significantly lower (68% Ϯ 11% vs 77 Ϯ 4%, P ϭ .027). Anatomy in 42 patients (66%) was deemed suitable for use of iliac branched grafts, and presence of a hypogastric artery aneurysm was the most frequent reason restricting iliac branched grafts candidacy.Conclusions: Patients with aneurysms involving the iliac bifurcation usually require internal iliac artery sacrifice during EVAR and have worse long-term outcomes, with significantly higher rates of endoleak and reintervention. The anatomy in Ͼ50% of these patients is suitable for internal iliac preservation with an iliac branched graft, which could improve long-term outcomes after EVAR in patients with iliac involvement.
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