PS48. Long Term Outcomes after Coverage of the Internal Iliac Artery without Coil Embolization during Abdominal Aortic Aneurysm Endovascular Repair

Abstract

Objectives: When abdominal aortic aneurysms (AAA) and common iliac artery (CIA) aneurysms undergo endovascular repair, endograft limb extension into the external iliac artery (EIA) is often necessary. Internal iliac artery (IIA) is usually embolized to prevent endoleak. However IIA embolization is associated with longer operative time. It has been our practice not to routinely coil embolize IIA. The purpose of this study is to review long term outcomes with this approach.Methods: Between April 1997 and June 2010 117 patients (111 men; mean age 70.8 years, range 45-92) underwent endovascular AAA repair and had IIA coverage without coil embolization, unilateral in 112 and bilateral in 5 cases. Postoperative computed tomography (CT) scanning was performed at 1, 6, 12 months, and yearly thereafter.Results: Preoperative AAA size was a mean 62 mm (range 35-120), and mean CIA diameter was 37 mm (range 20-80).Primary technical success was achieved in 108 patients (93.1%). Thirty day mortality was 0.8% (1/116 patients). A patient presented gluteal skin necrosis (0.8%) and 15 buttock claudication (12.9%). Patients were followed up for 34 Ϯ 31 months (range 1-130), 23 of them for more than 60 months. During follow up 39 patients died (33.3%), in three, death was AAA-related (including 30-day mortality). Cumulative proportion of survival was 93%, 84%, 71%, 59%, 53% at 1, 2, 3, 4 and 5 years respectively. Secondary interventions were performed in 19 of 116 patients (16.3%), including three conversions for failed endografts. Kaplan-Meier estimates revealed freedom from reintervention of 91%, 90%, 83%, 81% and 75% at 1, 2, 3, 4 and 5 years respectively. Ten patients (8.5%) presented a type II endoleak during follow up.Conclusions: Stent-graft coverage of the IIA without coil embolization is a safe and effective adjunct during the treatment of aortoiliac aneurysms, with a low incidence of postoperative complications and reinterventions and acceptable mid and long term results.