The use of iliac branch devices for preservation of flow in internal iliac artery during endovascular aortic aneurysm repair

Giosdekos, Alexandros; Antonopoulos, Constantine N.; Sfyroeras, George S.; Moulakakis, Konstantinos G.; Tsilimparis, Nikolaos; Kakisis, John D.; Lazaris, Andreas; Chatziioannou, Achilleas; Geroulakos, George

doi:10.1016/j.jvs.2019.10.087

Cited by 43 publications

(18 citation statements)

References 56 publications

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“…The re-intervention rate associated with IBDs was 7.0%. 27 These data are in line with the results, although both the re-intervention rate (3.0%) and the one year patency (91.3%) appears to be at the lower end of the spectrum, when compared with these studies.…”

Section: Discussionsupporting

confidence: 87%

One Year Outcomes of an International Multicentre Prospective Cohort Study on the Gore Excluder Iliac Branch Endoprosthesis for Aorto-Iliac Aneurysms

Veen

Holewijn

Bellosta

et al. 2021

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDSThe IceBERG study has included 100 patients treated with the Gore Excluder Iliac Branch Endoprosthesis for aorto-iliac aneurysms. Besides a satisfactory primary patency of the hypogastric branch and successful aneurysm exclusion, clinical outcomes were studied. Occlusions of the hypogastric branch occurred mostly during the first month after treatment but are not related to either buttock claudication, erectile function, walking ability or health status. However, a concomitant contralateral hypogastric occlusion is related to more erectile dysfunction.Objective: The Gore Excluder Iliac Branch Endoprosthesis (IBE) was developed to preserve perfusion in the hypogastric artery after endovascular repair of aorto-iliac aneurysms. This study reports the 12 month technical and clinical outcomes of treatment with this device. Methods: This study was a physician initiated international multicentre, prospective cohort study. The primary endpoint was primary patency of the hypogastric branch at 12 months. Secondary endpoints included technical and clinical outcomes. Patients with an indication for elective treatment with the Gore Excluder IBE were enrolled between March 2015 and August 2018. Baseline and procedural characteristics, imaging data, physical examinations and questionnaire data (Walking Impairment Questionnaire [WIQ], EuroQol-5-Dimensions [EQ5D], International Index of Erectile Function 5 [IIEF-5]) were collected through 12 month follow up. Results: One hundred patients were enrolled of which 97% were male, with a median age of 70.0 years (interquartile range [IQR] 64.5 e 75.5 years). An abdominal aortic aneurysm (AAA) above threshold for treatment was found in 42.7% and in the remaining patients the iliac artery diameter was the indication for treatment. The maximum common iliac artery (CIA) diameter on the Gore Excluder IBE treated side was 35.5 mm (IQR 30.8 e 42.0) mm. Twenty-two patients received a bilateral and seven patients had an isolated IBE. Median procedural time was 151 minutes (IQR 117 e 193 minutes) with a median hospital stay of four days (IQR 3 e 5 days). Primary patency of the IBE at 12 month follow up was 91.3%. Primary patency for patients treated inside and outside the instructions for use were 91.8% and 85.7%, respectively (p ¼ .059). Freedom from secondary interventions was 98% and 97% at 30 days and 12 months, respectively. CIA and AAA diameters decreased significantly through 12 months. IIEF-5 and EQ5D scores remained stable through follow up. Patency of the contralateral internal iliac artery led to better IIEF-5 outcomes. WIQ scores decreased at 30 days and returned to baseline values through 12 months. Conclusion: Use of the Gore Excluder IBE for the treatment of aorto-iliac aneurysms shows a satisfactory primary patency through 12 months, with significant decrease of diameters, a low re-intervention rate, and favourable clinical outcomes.

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Section: Discussionsupporting

confidence: 87%

One Year Outcomes of an International Multicentre Prospective Cohort Study on the Gore Excluder Iliac Branch Endoprosthesis for Aorto-Iliac Aneurysms

Veen

Holewijn

Bellosta

et al. 2021

European Journal of Vascular and Endovascular Surgery

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“…Buttock claudication can be prevented by using iliac branch devices, which have had good clinical results been reported. 23,24 The only problem with these iliac branch devices is that they can be accommodated by only approximately 30% of the population, when the IFU of these devices is strictly obeyed. 25,26 On the other hand, deployment of a stent-graft limb in the EIA is feasible for all types of patient anatomy, and we were able to demonstrate that buttock claudication associated with the procedure improved and almost diminished during the follow-up, just as in previous literature.…”

Section: Operative Resultsmentioning

confidence: 99%

Two-Year Results of a Multicenter Prospective Observational Study of the Zenith Spiral-Z Limb Deployed in the External Iliac Artery During Endovascular Aneurysm Repair

Fujimura

Imazuru

Matsumura

et al. 2020

Circ J

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However, there have been reports that stent-graft limbs with an expanded polytetrafluoroethylene (ePTFE) graft surrounded by a helical stent structure perform better than those with polyester surrounded by a Z-stent with unsupported gaps when deployed in the EIA. 6,7 L imb occlusion is the third most common etiology for reintervention after endovascular aneurysm repair (EVAR), with a reported incidence between 2.6% and 7.4%, 1,2 and the risk sharply increases when the stent-graft limb is deployed in the external iliac artery (EIA). Stent-graft limb deployment in the common iliac artery (CIA) reports an incidence of limb occlusion between 1.0%

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“…6 Based on the literature, the performance of IBDs is apparent, with technical success of 97% and 94% patency in follow-up. 15 However, these outcomes have been evaluated in combination with standard EVAR procedures, not with more complex repairs involving fenestrated/branched endografts. Our study has shown that treatment of complex aortic aneurysms with f/bEVAR+IBD is a safe procedure, with a technical success similar to that for standard EVAR.…”

Section: Discussionmentioning

confidence: 99%

Iliac Branch Devices With Standard vs Fenestrated/Branched Stent-Grafts: Does Aneurysm Complexity Produce Worse Outcomes? Insights From the pELVIS Registry

et al. 2020

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Purpose: To compare the outcomes of iliac branch devices (IBD) used in combination with standard endovascular aneurysm repair (EVAR) vs with fenestrated/branched EVAR (f/bEVAR) to treat complex aortoiliac aneurysms. Materials and Methods: The pELVIS Registry database containing the outcomes of IBD use at 8 European centers was interrogated to identify all IBD procedures that were combined with either standard EVAR or f/bEVAR. Among 669 patients extracted from the database, 629 (mean age 72.1±8.8 years; 597 men) had received an IBD combined with standard EVAR vs 40 (mean age 71.1±8.0 years; 40 men) who underwent f/bEVAR with an IBD. The mean aortic aneurysm diameters were 46.4±13.3 mm in the f/bEVAR patients vs 45.0±15.5 mm in the standard EVAR cases. The groups were similar in terms of baseline clinical characteristics and aneurysm morphology. The Kaplan-Meier method was used to compare patient survival, IBD occlusion, type III endoleak, and aneurysm-related reinterventions in follow-up. The estimates are presented with the 95% confidence interval (CI). Results: Technical success was 100% in the f/bEVAR+IBD group and 99% in the EVAR+IBD group (p=0.85). The 30-day mortality was 0% vs 0.5%, respectively (p=0.66), while the 30-day reintervention rates were 7.5% vs 4.1% (p=0.31). The mean follow-up was 32.1±21.3 months for f/bEVAR+IBD patients (n=30) and 35.5±26.8 months for EVAR+IBD patients (n=571; p=0.41). The 12-month survival estimates were 93.4% (95% CI 93.2% to 93.6%) in the EVAR+IBD group vs 93.6% (95% CI 93.3% to 93.9%) for the f/bEVAR+IBD group (p=0.93). There were no occlusions or type III endoleaks in the f/bEVAR+IBD group at 12 months, while the estimates for freedom from occlusion and from type III endoleak in the EVAR+IBD group were 97% (95% CI 96.8% to 97.2%) and 98.5% (95% CI 98.4% to 98.6%), respectively. The 12-month estimates for freedom for aneurysm-related reintervention were 93% (95% CI 92.7% to 93.3%) in the EVAR+IBD group vs 86.4% (95% CI 85.9% to 86.9%) in the f/bEVAR+IBD patients (p=0.046). Conclusion: Treatment of complex aortoiliac disease with f/bEVAR+IBD can achieve equally good early and 1-year outcomes compared to treatment with IBDs and standard bifurcated stent-grafts, except for a somewhat higher reintervention rate in f/bEVAR patients.

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The use of iliac branch devices for preservation of flow in internal iliac artery during endovascular aortic aneurysm repair

Cited by 43 publications

References 56 publications

One Year Outcomes of an International Multicentre Prospective Cohort Study on the Gore Excluder Iliac Branch Endoprosthesis for Aorto-Iliac Aneurysms

One Year Outcomes of an International Multicentre Prospective Cohort Study on the Gore Excluder Iliac Branch Endoprosthesis for Aorto-Iliac Aneurysms

Two-Year Results of a Multicenter Prospective Observational Study of the Zenith Spiral-Z Limb Deployed in the External Iliac Artery During Endovascular Aneurysm Repair

Iliac Branch Devices With Standard vs Fenestrated/Branched Stent-Grafts: Does Aneurysm Complexity Produce Worse Outcomes? Insights From the pELVIS Registry

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