Endovascular Treatment of Abdominal Aortic Aneurysms Involving Iliac Bifurcation: Role of Iliac Branch Graft Device in Prevention of Buttock Claudication

• Published in: Annals of vascular surgery Vol. 27; no. 7; pp. 851 - 855
• Main Authors: Fernández-Alonso, Leopoldo, Fernández-Alonso, Sebastián, Grijalba, Fermín Urtasun, Fariña, Estéfana Santamarta, Aguilar, Esther Martínez, Alegret Solé, Jorge Francisco, Pascual, Margarita Atienza, Centeno, Roberto
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.10.2013
• Subjects: Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal - complications; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - surgery; Aortography - methods; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Buttocks - blood supply; Endoleak - diagnostic imaging; Endoleak - etiology; Endoleak - therapy; Endovascular Procedures - adverse effects; Endovascular Procedures - instrumentation; Feasibility Studies; Humans; Iliac Aneurysm - complications; Iliac Aneurysm - diagnostic imaging; Iliac Aneurysm - surgery; Intermittent Claudication - etiology; Intermittent Claudication - physiopathology; Intermittent Claudication - prevention & control; Ischemia - etiology; Ischemia - physiopathology; Ischemia - prevention & control; Length of Stay; Male; Middle Aged; Prosthesis Design; Registries; Retrospective Studies; Stents; Surgery; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Vascular Patency
• ISSN: 0890-5096; 1615-5947
• DOI: 10.1016/j.avsg.2012.08.012

Background The aim of this study was to describe our early experience with the use of iliac branch grafts (IBGs) in aortoiliac aneurysm repair at our institution and to evaluate the technical feasibility, short-term patency rate, and potential clinical benefits, with special focus on prevention of buttock claudication. Methods From March 2009 to November 2010, 9 consecutive patients (all men), mean age 71.1 years (range 62–80 years), underwent IBG implantation at our institution. Indications were abdominal aortic aneurysm (AAA) with common iliac artery (CIA) involvement ( n = 7), bilateral CIA aneurysm ( n = 1), and AAA with bilateral CIA and unilateral IIA involvement ( n = 1). Postoperative endoleaks and patency rate were determined with computed tomography (CT) within 1 month of implantation and 1 year thereafter, with concurrent clinical evaluation for pelvic ischemia. Mean follow-up period was 14.7 (range 9–29) months. Results Technical success rate, as defined by successful implantation of the iliac branch graft (IBG) with no intraprocedural type I or type III endoleak, was 100%. The mean hospitalization duration was 4 days (range 3–6 days), with 0% mortality at 30 days. There were 3 cases of type II endoleak detected perioperatively, which were treated conservatively. Two endoleaks sealed spontaneously on the 1-month CT scan and 1 persists without aneurysm sac expansion. All stent-implanted aortic and iliac aneurysms remained stable in size during follow-up, with no aneurysm rupture or death recorded. All stent-implanted iliac branches remained patent on follow-up and all patients were asymptomatic. Conclusions Iliac branch graft placement is a feasible technique with excellent short-term results in the treatment of abdominal aortic aneurysms involving the iliac bifurcation. This technique can efficiently prevent buttock claudication.