Midterm result of custom-made iliac branch device for common iliac aneurysm with and without abdominal aortic aneurysm

Abstract

OBJECTIVES Although commercial iliac branch devices offer a new and valid endovascular approach to treating iliac aneurysm and effectively preserve antegrade flow of the internal iliac artery, their use may not be suited for all types of challenging anatomy, especially isolated common iliac artery aneurysm. Our custom-made iliac bifurcation device has a unique design and excludes both combined and isolated iliac branch aneurysm. This study validated the efficacy and safety of the custom device by comparing clinical outcomes between groups receiving commercial and custom devices. METHODS Data of consecutive patients receiving iliac bifurcation device implantation for iliac aneurysm with or without concomitant endovascular repair for abdominal aortic aneurysm from January 2010 to May 2019 were reviewed. RESULTS Iliac bifurcation device implantation with or without concomitant abdominal aortic aneurysm stent grafting was completed in 46 patients (commercial, n = 35; custom, n = 11). No significant differences were observed regarding postoperative complications, occlusion or endoleak. Comparisons of primary (80.8% vs 85.7%, P = 0.88) and secondary (86.5% vs 85.7%, P = 0.85) patency and freedom from reintervention (88.2% vs 100%, P = 0.33), all-cause mortality (78.6% vs 100%, P = 0.25) and aneurysm-related mortality (100% vs 100%, P = 1.00) also indicated no differences at a 5-year surveillance point. Furthermore, the iliac aneurysms of the groups displayed similar shrinkage 1 year after procedures. CONCLUSIONS For iliac aneurysm, the novel custom-made iliac bifurcation device is an adaptable design not inferior to commercial devices with regard to postoperative complications, bridge occlusion, endoleak and short-term aneurysm remodelling. It provides an alternative for treatment, particularly when certain anatomic challenges are present. Clinical trial registration 2018-07-050BC, 2017-01-023ACF.

Endovascular repair of bilateral isolated common iliac artery aneurysms with unsuitable anatomy utilizing an aortic bifurcated unibody endograft and modified sandwich technique to preserve pelvic blood flow: a case series

“…When commercial IBDs are deemed inappropriate for CIAA management, custom IBDs are available as an alternative. Although a restricted number of studies [ 29 , 30 ] have provided evidence regarding the safety and effectiveness of this method, there is a scarcity of substantiating evidence to support its application.…”

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

“…Another approach, when patients with challenging anatomy require iliac aneurysm treatment, could be the use of a custom-made iliac branch device. Huang et al found non-inferior results when comparing their custom-made devices to commercial devices in a cohort of 46 patients [ 18 ].…”

“…It is possible that differences in peri-operative or late performances among the grafts may exist, but we did not have enough data in this study to perform subgroup analyses. Nonetheless, to our best knowledge, no relevant differences were detected among the current IBDs regarding patient outcomes [ 12 , 18 ]. Finally, the low event rate did not make the evaluation of the adjusted risk factors for the primary and secondary endpoints possible.…”