Evolution of the upper and lower landing site after endovascular aortic aneurysm repair

Kaladji, Adrien; Cardon, Alain; Laviolle, Bruno; Heautot, Jean-François; Pinel, G.; Lucas, Antoine

doi:10.1016/j.jvs.2011.07.067

Cited by 34 publications

(47 citation statements)

References 33 publications

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“…Although they could not find a correlation with clinical events, the authors sent a word of caution. 2 Previously, Falkensammer et al had shown that dilatation was more pronounced in patients with previously existing iliac dilatation, 9 and both Hobo et al and Albertini et al reported a higher risk of complications in patients requiring bellbottom (!24 mm) iliac limbs, a finding corroborated by the present study. 6,10 Similarly, Schanzer et al reported a greater chance of sac enlargement in patients with larger (20 mm or greater) iliac diameter endografts.…”

Section: Discussionmentioning

confidence: 98%

Iliac Seal Zone Dynamics and Clinical Consequences After Endovascular Aneurysm Repair

Gonçalves

Oliveira

Rijn³

et al. 2017

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS Failure after EVAR is most often associated with loss of seal and consequent re-pressurisation of the aneurysm sac. This study explores the evolution of the iliac seal zones after implantation, showing that progressive dilatation and retraction are very common occurrences, which in turn have clinical consequences. Careful attention to planning to take full advantage of the potential iliac seal, avoidance of "bell-bottom" limbs whenever possible, and attention to signs of excessive dilatation and/or retraction over the course of follow-up are practical recommendations derived from the conclusions of this study that may improve outcomes.Objective: To evaluate the dynamics of the iliac attachment zone after EVAR, and the association with clinical events. Methods: A tertiary institution's prospective EVAR database was searched to identify common iliac arteries at risk. Internally validated measurements were made, using centre lumen line reconstructions. Iliac dilatation and endograft limb retraction were the main endpoints. Associations between dilatation, retraction, oversizing, and distal seal length were investigated. Association with clinical events (sealing or occlusion) was also explored. Results: Of 452 primary EVAR patients treated from 2004 to 2012, 341 were included (mean age 72 years, 12% female, 597 common iliac arteries). Median follow-up was 4.7 years. At 30 days, the mean iliac diameter increased from 14 mm to 15 mm (p < .001). Over follow-up, it increased to 18 mm (p < .001). Iliac dilatation !20% occurred in 295 cases (49.4%) and exceeded the implanted endograft diameter in 170 (28.7%). Limb retraction !5 mm was identified in 54 patients (9.1%) and was associated with iliac seal complications (p < 0.001). Iliac endograft extension diameter !24 mm (OR 3.3, 95% CI 1.7e6.4) and iliac artery dilatation beyond the endograft (OR 2.1, 95% CI 1.2e3.8) were independent risk factors. Overall, there were 34 (5.7%) iliac seal complications. Retraction of the iliac endograft (OR 1.17 per mm, 95% CI 1.10e1.24) and baseline AAA diameter (1.04 per mm, 95% CI 1.01e1.07) were independent risk factors for seal related complications. Greater initial post-operative iliac seal length was protective (OR 0.94 per mm, 95% CI 0.90e0.97). Conclusions: Iliac dilatation and endograft retraction are common findings during follow-up, potentially leading to adverse clinical events. Optimisation of the iliac seal zone providing a long distal seal length and added attention to patients with large aneurysms or receiving !24 mm diameter iliac extensions are recommended. Also, long-term surveillance including CTA is advised to reveal and correct loss of seal at the iliac attachments before adverse clinical events occur. Ó

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Section: Discussionmentioning

confidence: 98%

Iliac Seal Zone Dynamics and Clinical Consequences After Endovascular Aneurysm Repair

Gonçalves

Oliveira

Rijn³

et al. 2017

European Journal of Vascular and Endovascular Surgery

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“…All these studies suggest that arterial areas in contact with the endograft tend to remodel toward expansion in a non-negligible number of patients and that aneurysmal disease progresses, even after graft exclusion. 13 Consequently, one can assume that the natural evolution of an already enlarged CIA trends towards an even more progressive growth of diameter.…”

Section: Discussionmentioning

confidence: 99%

Volume Change after Endovascular Treatment of Common Iliac Arteries ≥ 17 mm Diameter: Assessment of Type 1b Endoleak Risk Factors

Rouby

Kuntz

Delay

et al. 2020

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS Volumetric evolution of common iliac artery !17 mm diameter differs regarding the type of endovascular technique performed: mean common iliac artery volume increased with the bell bottom technique whereas it decreased with other techniques such as external iliac artery endograft landing or iliac branched endograft. The bell bottom technique was associated with later type 1b endoleak, and consequently this technique might be avoided if an iliac branched endograft is possible. Biomechanical studies are mandatory, because later aneurysmal evolution observed with the bell bottom technique could be related to properties of the dilated common iliac artery wall as well as the forces applied to the wall. Objective: The aim of this study was to assess the post-operative volumetric evolution of common iliac arteries (CIA) ! 17 mm diameter with respect to the type of endovascular technique performed and to assess type 1b endoleak risk factors. Methods: All consecutive patients presenting with aneurysmal disease with CIA !17 mm treated endovascularly from 2008 to 2016 were included. Patients were divided into two groups dependent upon the type of endovascular technique performed: bell bottom technique (BBT group), vs. other techniques (non-BBT group). Volumetric evolution of the CIA was assessed for each patient by computed tomography angiographic reconstructions performed pre-operatively, at six months, one year, and two years. Multivariable analysis was performed to identify risk factors for type 1b endoleak. Results: From 2008 to 2016, 74 patients with 110 CIA !17 mm were treated (BBT group: n ¼ 58; non-BBT group: n ¼ 52). Mean follow up was 48.1 months (median 39.0, IQR 38.1). Mean volumetric evolution significantly differed in the BBT group þ14.2% (median 19.9%, IQR 24.6) compared with the non-BBT group: À20.9% (median À20.1%, IQR À26.0), p < .001. The five year type 1b endoleak related re-intervention rate was 16.1% and 7.7% in the BBT and non-BBT groups, respectively (p ¼ .04), mean time to type 1b endoleak was 24.8 months and 54.3 months, respectively. The BBT appeared as a risk factor for type 1b endoleak (OR: 7.13; 95% CI: 1.58e3.04; p < .001). Conclusion: The BBT is associated with an increase in CIA volume post-operatively and consequently can be considered a risk factor for type 1b endoleak. It might be avoided if an iliac branched endograft is possible.

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“…24 This aneurysmal degeneration of the distal sealing zone after EVAR with the consequent type Ib endoleak as well as the development of a para-anastomotic aneurysm after open aortoiliac reconstruction is another frequent phenomenon that can complicate the follow-up of AAA patients and increase the risk of post-treatment rupture. 25 Several reports on successful treatment of these complications with commercially available IBDs are published. 15,26,27 We have identified two patients in our cohort who had developed a pseudoaneurysm after a bilateral open aortoiliac reconstruction and two other patients with type Ib endoleak after EVAR.…”

Section: Discussionmentioning

confidence: 99%

A multicenter 12-month experience with a new iliac side-branched device for revascularization of hypogastric arteries

Mylonas

Rümenapf

Schelzig

et al. 2016

Journal of Vascular Surgery

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Evolution of the upper and lower landing site after endovascular aortic aneurysm repair

Cited by 34 publications

References 33 publications

Iliac Seal Zone Dynamics and Clinical Consequences After Endovascular Aneurysm Repair

Iliac Seal Zone Dynamics and Clinical Consequences After Endovascular Aneurysm Repair

Volume Change after Endovascular Treatment of Common Iliac Arteries ≥ 17 mm Diameter: Assessment of Type 1b Endoleak Risk Factors

A multicenter 12-month experience with a new iliac side-branched device for revascularization of hypogastric arteries

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