Outcomes of Endovascular Repair of Aortoiliac Aneurysms and Analyses of Anatomic Suitability for Internal Iliac Artery Preserving Devices in Japanese Patients

Abstract

Background Understanding common iliac arteries (CIA) are shorter in Asian patients, we investigated whether this anatomical difference affects clinical outcomes of internal iliac artery (IIA) exclusion during endovascular repair (EVAR) of aorto-iliac aneurysm and limits the use of IIA preserving devices in Japanese patients. Methods and Results From 2008–2014, 69 Japanese patients underwent EVAR of aorto-iliac aneurysms with 53 unilateral and 16 bilateral IIA exclusion. One patient had persistent-buttock claudication during follow-up; however colonic or spinal cord ischemia was not observed. Anatomic suitability was investigated for the iliac branch device (IBD) by Cook Medical and iliac branch endoprosthesis (IBE) by WL Gore. Eighty-seven aorto-iliac segments were analyzed: 17% meet criteria for the IBD and 25% meet criteria for the IBE with 40% meeting criteria for either. Main exclusions for the IBD were IIA diameter >9 mm or <6 mm, (47%) and CIA length <50 mm, (39%). Main exclusions for the IBE were proximal CIA diameter <17 mm, (44%) and aorto-iliac length <165 mm, (24%). Conclusions EVAR with IIA exclusions in Japanese patients showed low incidence of persistent-buttock claudication and no major pelvic complications. Aorto-iliac morphology demonstrated smaller proximal CIA diameters and shorter CIA lengths, limiting the use of IIA preserving devices.

Two-Year Results of a Multicenter Prospective Observational Study of the Zenith Spiral-Z Limb Deployed in the External Iliac Artery During Endovascular Aneurysm Repair

“…23,24 The only problem with these iliac branch devices is that they can be accommodated by only approximately 30% of the population, when the IFU of these devices is strictly obeyed. 25,26 On the other hand, deployment of a stent-graft limb in the EIA is feasible for all types of patient anatomy, and we were able to demonstrate that buttock claudication associated with the procedure improved and almost diminished during the follow-up, just as in previous literature. 25…”

One Technique to Modulate a Device Implantation Path in a Short Treatment Length Using the Gore IBE Device

“…1) Another study reported that 24% of Japanese patients with aorto-iliac aneurysms were excluded because the AOL was too short for the device size. 2) Taking other anatomical factors into account, only 40% of patients could be treated by these devices. 2) In the case of insufficient common iliac length, even if the AOL was sufficient, the IBE can be used with the proximal end of the device located in the AAA, and the internal iliac component could be deployed using brachial or axillar access.…”

“…2) Taking other anatomical factors into account, only 40% of patients could be treated by these devices. 2) In the case of insufficient common iliac length, even if the AOL was sufficient, the IBE can be used with the proximal end of the device located in the AAA, and the internal iliac component could be deployed using brachial or axillar access. 9) However, with insufficient AOL, there seemed to be no alternative option but to modify the DIL in some way.…”

“…The GORE EXCLUDER Iliac Branch Endoprosthesis (IBE; W. L. Gore and Associates, Flagstaff, AZ, USA) was approved by the Japanese Food and Drug Administration in 2017 for endovascular treatment of common iliac aneurysms as an adjunct to endovascular aneurysm repair (EVAR). However, due to ethnic differences in iliac length among the Japanese population, 1,2) the IBE’s applicability is anatomically limited by the shorter aorto-iliac length (AOL). We present a unique application for the IBE device with a contra-lateral side of the limb wound around the ipsilateral limb.…”

Bilateral internal iliac branch device with ipsilateral deployment

“…The success of IBE in maintaining perfusion to the internal iliac arteries while treating iliac aneurysms or tybe 1b endoleaks following EVAR has been demonstrated by multiple studies. [1][2][3] As a result of the mounting evidence of pelvic ischemic complications and the quality of life implications for patients suffering from buttock claudication or erectile dysfunction following hypogastric artery embolization, maintaining internal iliac artery perfusion following EVAR is becoming increasingly common. [6][7][8] In patients with a previous EVAR, however, maintaining internal iliac perfusion with an IBE is technically challenging given the new anatomic constraints created by the endograft.…”