Original title: Endovascular Treatment of Aorto-iliac Aneurysms: Four-year Results of Iliac Branch Endograft. Reference: G. Pratesi et al. Eur J Vasc Endovasc Surg. 2013 Jun;45(6):607-9.
Iliac bifurcated devices have proven to be effective in treating common iliac aneurysms but the findings are based on small series, generally from a sole center experience. This multicenter registry included 85 patients with aorto-iliac aneurysms who received bifurcated devices, (most of them, Zenith Bifurcated Iliac sidebranch, Cook, Bloomington, IN, USA). Technical success was achieved in 98.7% with no perioperative mortality. The only case that could not be implanted was probably due to a very challenging anatomy.
During the first 30 days only a single occlusion of iliac branch was observed and at follow-up CT scan, three patients (3.7%) had distal type I endoleak. These patients were managed conservatively with strict surveillance protocol but thus far showed no sac growth. At follow-up (20.4 ± 15.4), seven unrelated deaths occurred leaving an estimated 24-month survival of 89.5% and 76.7% after 48 months. During follow-up there were no aneurysm-related deaths, need for conversion to conventional surgery or aneurysmatic rupture. No new branch thrombosis was registered.
Seven patients (8.6%) progressed with buttock claudication, six of them were bilateral iliac aneurysms cases where one hypogastric was protected with a bifurcated branch and the other was embolized. The symptoms were always confined to the side of the embolized hypogastric and did not improve with time.
Conclusion:
Iliac bifurcated devices were effective in preserving the internal iliac artery implant in the context of an abdominal aortic stent. This represents a valid technique in the case of bilateral iliac aneurysms.
Commentary:
All patients who developed a distal type I endoleak had an ectatic internal iliac artery. Perhaps the compromise of this artery by the common iliac aneurysm should be considered as a limitation of the technique.
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