The Use of Iliac Side Branch Devices in Patients with Aortoiliac Aneurysm

Abstract

Purpose: The aim of this study was to evaluate the technical feasibility and short-time patency rate of iliac side branch devices based on the authors? institution?s experience. Materials and Methods: Data of 17 patients (all men) with an aortoiliac aneurysm (median age 72.5 years) who underwent endovascular repair between October 2013 and June 2015 (20 months) at our institution was analyzed retrospectively. Primary endpoint was primary technical success, defined as adequate implantation of the iliac branch device with patency of the hypogastric side branch without the need of further re-interventions within 30 days. Mean follow-up was 8.2???5.4 months. Results: Eighteen iliac side branch devices were implanted with a branch patency of 100?% and a primary technical success rate of 94.4?% (n?=?17). Perioperative 30 days mortality was 0?%. The mean diameter of treated abdominal aorta and common iliac artery was 41???14 and 30???8?mm. In one case partial dislocation of the iliac side branch device occurred due to severe kinking of iliac arteries with development of an iliac endoleak type Ib that had to be treated in a second intervention. Three patients (15?%) showed an endoleak type II from the inferior mesenteric artery without the need of re-intervention. After three months one patient suffered from subtotal thrombotic occlusion of the?bridging stent that was successfully resolved through intra-arterial fibrinolytic therapy and additional stent graft implantation. Conclusion: Summarized, implantation of iliac side branch devices is a feasible technique with favourable short-term results in patients with aortoiliac aneurysm. Key Points: ??Implantation of iliac side branch devices is a feasible technique. ??Distinguish short-term results of side branch endografting in patients with aortoiliac aneurysm. ??Carefully patient selection is necessary to avoid complications and re-interventions. Citation Format: ??Maus V, Kurz P, Sommer CM et?al. The Use of Iliac Side Branch Devices in Patients with Aortoiliac Aneurysm.. Fortschr R?ntgenstr 2016; 188: 746???752

Tratamento endovascular do aneurisma aortoilíaco: relato do primeiro caso utilizando endoprótese brasileira com ramo ilíaco

“…17,18 Studies have been published showing good results in terms of preservation of flow to an iliac branch and reporting technical success and low morbidity with the procedure. 10,11,19,20 The majority of significant complications described after implantation of these devices are related to acute occlusion of the iliac branch. While incidence is relatively low, there are reports of extremely serious and even fatal complications, 7 which underscores the need for multidisciplinary assessment, strict adherence to indications, and deployment of these devices by a trained medical team.…”

“…The initial results from these devices are favorable and promising. 11,13,14 The objective of this article was to describe the first case of endovascular treatment of aortoiliac aneurysm using a Brazilian endoprosthesis with an iliac branch.…”

Internal iliac artery preservation strategies in the endovascular treatment of aortoiliac aneurysms

“…7 Type 3 endoleak is less frequent, affecting up to 7,14% of the patients, 8 although, unlike type 2, requires a more active and immediate treatment to prevent aneurysm rupture as a consequence of its continuous pressurization. 8,27 Type 1 endoleak may also occur in up to 5% 28 and requires immediate intervention as well. 29 Unlike the bell-bottom technique, there are long-term follow-up studies available regarding iliac branches, which generally report favorable outcomes for this technique.…”