EVAR with Flared Iliac Limbs has a High Risk of Late Type 1b Endoleak

Gray, Daphne; Shahverdyan, Robert; Reifferscheid, V.; Gawenda, M.; Brunkwall, Jan

doi:10.1016/j.ejvs.2017.05.008

Cited by 61 publications

(28 citation statements)

References 33 publications

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“…McDonnell et al 10 describe the higher rate of type Ib endoleak 7% after a mean follow-up of 30 months when flared iliac limb was used. Gray et al 14 recently published similar results of a 7.5% incidence with type Ib endoleak. These results also indicated that the limb graft with a diameter of !…”

Section: Discussionmentioning

confidence: 65%

Endovascular Treatment of Aorta-Iliac Aneurysms with a Flared Iliac Limb

Duvnjak

Balezantis

2019

Int J Angiol

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Endovascular abdominal aneurysm repair (EVAR) relies on the quality of the proximal and distal landing zone. Reinterventions are higher in patients with suboptimal landing zone. The study aimed to evaluate reintervention rate after endovascular treatment of an aorta-iliac aneurysm using the flared iliac limbs.The retrospective study included 179 patients treated with EVAR at a single university hospital institution from January 2011 to January 2014 of which 75 patients (42%) were treated with flared iliac limb stent graft and 104 patients (58%) were treated with a nonflared iliac limb stent graft. There were 165 male patients (92%), mean age was 75.8 ± 6.6 years.Thirty-six patients underwent secondary treatment accounting for overall reintervention rate of 20%. Endoleak type 1b occurred in 13 patients (7%), followed by endoleak type 1a in six patients (3%). Endoleak type 2 occurred in seven patients (4%) requiring the treatment due to abdominal aortic aneurysm (AAA) enlargement, endoleak type 3 in three patients (2%), and leg stent graft thrombosis in seven patients (4%). In 143 patients (80%), there were no secondary interventions during the follow-up period. Reintervention due to endoleak type 1b was statistically significantly higher in a flared iliac limb group (p < 0.02) with the rate of 7.2% compared with 1.9% rate in nonflared iliac limb group. The mean follow-up was 44.3 ± 20.4. Overall mortality was 33%.Flared iliac limb with a distal diameter of ≥ 20 mm, show a higher rate of iliac limb reintervention in a follow-up period due to endoleak type 1b.

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Section: Discussionmentioning

confidence: 65%

Endovascular Treatment of Aorta-Iliac Aneurysms with a Flared Iliac Limb

Duvnjak

Balezantis

2019

Int J Angiol

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“…In the long period the BBT results demonstrate worst trend: Gray et al (2017) presented 61 patients with a CIA diameter of > 20 mm with high type 1b rate endoleak (18%) compared with standard limbs (4%) with mean follow up of 53 months. Other reports (EURO-STAR database) (Griffin et al 2015;Hobo et al 2007) showed a high rate (9-14%) of late iliac complications in patients with BBT including type 1b endoleak and other iliac complications.…”

Section: Discussionmentioning

confidence: 98%

“…The bell-bottom technique (BBT) has been used for many years in patients with abdominal aortic aneurysm (AAA) and concomitant wide or aneurysmal CIA with distal landing zone diameter from 18 up to 25 mm and length more than 20 mm (Torsello et al 2010;Gray et al 2017). This anatomical feature can be suitable also for iliac branch device (IBD) that in the last years has become the most popular treatment (Donas et al 2017;Simonte et al 2017).…”

Section: Introductionmentioning

confidence: 99%

Bell-bottom technique in iliac branch era: mid-term single stent graft performance

et al. 2020

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Background: Endovascular abdominal aortic aneurysm repair (EVAR) is considered the primary option for abdominal aortic aneurysm but the management of concomitant wide or aneurysmal iliac arteries (CIAs) is still controversial. Methods: We retrospectively evaluated mid-term results of patients receiving standard EVAR combined with bellbottom technique (BBT) using Medtronic Endurant endograft between January 2009 and December 2018. Patients were followed up by CT scan performed 1 month after the procedure and by duplex ultrasound annually (with or without contrast medium) followed by CT scan in case of evolution. Results: Seventy-one patients (67 males; mean age of 77,1 years) with abdominal aortic aneurysm and wide or aneurysmal common iliac artery (distal landing zone diameter up to 25 mm and length more than 20 mm) were treated with standard EVAR and BBT (107 limbs) using Endurant stent graft. The median aortic diameter was 56, 1 mm (31.0-85.0). Technical success was obtained in 100%. Mean procedural time was of 100.1 min. No 30 days' mortality, renal failure or limb ischaemia occurred. The median follow-up was of 36.56 months (1-136). 5-year aneurysm related mortality was not found. At 5 years, the number of all-cause deaths was seven. The freedom from secondary intervention was 91.6% at 5 years. Three patients (4.4%) were treated for iliac related complications at 5 years: internal iliac artery aneurysm, iliac obstruction, type 1b endoleak, all successfully treated by endovascular technique. Conclusions: According with this study BBT using Endurant stent graft is effective and safe with good mid-term results, with low rate of iliac related complications and no aneurysm related mortality.

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“…Unfortunately, all of these solutions are associated with significant operation time and contrast amount [8] . In addition, the FL technique could be linked with a high rate of dilatation with Type Ib endoleak, five times more than the corresponding less than 20 mm CIA diameter [9] . Additionally, the difficulty in later usage of IBD necessitates the usage of trans-axillary access with increased risk of stroke [9,10] .…”

Section: Discussionmentioning

confidence: 99%