Comparison of Two Iliac Branch Devices and Their Midterm Performance in Maintaining Blood Flow to the Internal Iliac Artery

Abstract

Purpose: To compare and contrast the midterm outcomes of the E-liac and Zenith (ZBIS) iliac branch devices (IBDs) for the preservation of the internal iliac artery (IIA) in aneurysms involving the iliac bifurcation. Materials and Methods: Between January 2014 and December 2018, 84 consecutive patients (median age 74 years; 76 men) were electively treated with the E-liac (n=44) or ZBIS (n=40) IBDs and were retrospectively analyzed to evaluate the technical success, patency, need for reintervention, and mortality associated with these devices. Results: Technical success was achieved in 95 of 99 implantations (95.9%) without any statistically significant difference between the groups (93.7% vs 98.0%, p=0.114). During the first 30 days, 3 occlusions in the ZBIS group and 1 in the E-liac group were identified. There was 1 perioperative death in the ZBIS group. The median follow-up was 37 months for the ZBIS group and 28 months for the E-liac group (p=0.657). Six patients from the ZBIS group and 7 from the E-liac group were lost to follow-up. Among the remaining, there were 2 further deaths recorded, 1 in each group. Four further reinterventions in the E-liac group and 2 in the ZBIS group were performed during follow-up. The Kaplan-Meier estimates of freedom from reintervention were 87.2% (95% CI 82.6% to 90.2%) for the ZBIS group and at 86.0% (95% CI 83.7% to 89.1%) for the E-liac group (p=0.563); the freedom from occlusion estimates were 89.7% (95% CI 85.8% to 94.5%) and 95.3% (95% CI 92% to 98.7%; p=0.317), respectively. Conclusion: The E-liac and the ZBIS IBDs showed equally high technical success, midterm patency, and low reintervention rates.

Midterm Results of Iliac Branch Devices in a Newly Established Aortic Center

“…Haulon et al and Karthikesalingam et al both reported similar, slightly elevated occlusion rates of 11.3–12.2% [ 4 , 19 ]. However, our iliac patency rate was lower than what was mostly found in other similar studies, where the internal iliac branch patency was between 89.7% and 100% [ 12 , 20 ].…”

“…Haulon et al achieved a technical success rate of 94% [ 4 ]. Mylonas et al demonstrated an outstanding technical success rate of 100%, although they reported their results in accordance with more permissive criteria [ 12 ].…”

Commentary: Time to Preserve the Iliac Arteries During EVAR

“…6 One of the most common causes of failure is kinking secondary to the increasing diameter and length of the growing aortoiliac aneurysm, which can occur in almost any of the joints involving the iliac branch, the bridging stent, or the iliac limb extension. 4 Most kinking-related occlusions occur within the first month, as Mylonas and colleagues 4 also noticed. Balloon-expandable or selfexpanding bridging stents can be used.…”

“…Another challenge is the risk of external iliac graft limb kinking in the first segment of the EIA. In the study by Mylonas et al, 4 4 patients suffered from EIA thrombosis during the first month and needed a reintervention. Takeoff artery angle may be increased after deployment in some cases, especially in the presence of severe calcification.…”

“…In recent years, the literature shows a trend toward more endovascular procedures for IIA revascularization during EVAR. 3 In the October 2020 issue of the JEVT, Mylonas et al 4 presented a comparative single-center study of 2 commercially available iliac branch devices (IBDs). Despite their differences in technical characteristics, the devices performed equally well, showing high technical success (96%), midterm patency, and low reintervention rates.…”