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The Use of Iliac Branched Devices in the Acute Endovascular Repair of Ruptured Aortoiliac Aneurysms

Karelis, Angelos LU ; Dijkstra, Martijn L ; Singh, Bharti LU ; Vaccarino, Roberta LU ; Sonesson, Björn LU and Dias, Nuno V LU (2020) In Annals of Vascular Surgery 67. p.171-177
Abstract

BACKGROUND: The objective of this study was to evaluate the feasibility and midterm outcomes of iliac branch devices (IBDs) to preserve the internal iliac artery perfusion in emergent endovascular repair of ruptured aorto-iliac aneurysms.

METHODS: Between December 2012 and July 2017, a total of 8 IBDs were implanted in 6 patients (the median age 65 years; all men) in a single tertiary referral center. The indication for IBD implantation was a ruptured abdominal aortic aneurysm with a concomitant common iliac artery aneurysm (n = 4) or isolated CIA aneurysms (n = 2). The main outcome measures were technical and clinical success. The secondary outcomes were primary and primary assisted patency, the occurrence of type I/III... (More)

BACKGROUND: The objective of this study was to evaluate the feasibility and midterm outcomes of iliac branch devices (IBDs) to preserve the internal iliac artery perfusion in emergent endovascular repair of ruptured aorto-iliac aneurysms.

METHODS: Between December 2012 and July 2017, a total of 8 IBDs were implanted in 6 patients (the median age 65 years; all men) in a single tertiary referral center. The indication for IBD implantation was a ruptured abdominal aortic aneurysm with a concomitant common iliac artery aneurysm (n = 4) or isolated CIA aneurysms (n = 2). The main outcome measures were technical and clinical success. The secondary outcomes were primary and primary assisted patency, the occurrence of type I/III endoleaks, and reinterventions.

RESULTS: All patients were hemodynamically stable during the procedures, which were performed under local anesthesia. Technical success was achieved in all cases (the median total procedure time of 188 min and the median IBD procedure time of 28 min). The median follow-up was 34 months (interquartile range 19-78). There were no deaths during the follow-up and no major complications unrelated to the IBD. Two (25%) secondary interventions were performed for IBD occlusion in patients with bilateral IBDs. The other reintervention was a type II endoleak embolization in 1 of these 2 patients. The freedom from reintervention estimate was 75% through 2 years. The overall primary assisted patency was 100% through 3 years.

CONCLUSIONS: The use of IBDs in the acute setting is feasible to exclude ruptured aortoiliac aneurysms while maintaining pelvic circulation. The secondary intervention rate is considerable; however, the midterm assisted primary patency rates are promising. Further studies are needed to guide patient selection and to evaluate longer term outcomes.

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type
Contribution to journal
publication status
published
subject
keywords
Adult, Aged, Aged, 80 and over, Aortic Aneurysm, Abdominal/diagnostic imaging, Aortic Rupture/diagnostic imaging, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation/adverse effects, Endoleak/etiology, Endovascular Procedures/adverse effects, Feasibility Studies, Graft Occlusion, Vascular/etiology, Hemodynamics, Humans, Iliac Aneurysm/diagnostic imaging, Male, Middle Aged, Prosthesis Design, Retreatment, Retrospective Studies, Stents, Time Factors, Treatment Outcome, Vascular Patency
in
Annals of Vascular Surgery
volume
67
pages
171 - 177
publisher
Springer
external identifiers
  • scopus:85083318062
  • pmid:32205247
ISSN
1615-5947
DOI
10.1016/j.avsg.2020.02.019
language
English
LU publication?
no
additional info
Copyright © 2020 Elsevier Inc. All rights reserved.
id
3e36d169-1817-41b3-93f6-4d84e06e5766
date added to LUP
2020-11-12 09:51:01
date last changed
2021-04-13 02:08:11
@article{3e36d169-1817-41b3-93f6-4d84e06e5766,
  abstract     = {<p>BACKGROUND: The objective of this study was to evaluate the feasibility and midterm outcomes of iliac branch devices (IBDs) to preserve the internal iliac artery perfusion in emergent endovascular repair of ruptured aorto-iliac aneurysms.</p><p>METHODS: Between December 2012 and July 2017, a total of 8 IBDs were implanted in 6 patients (the median age 65 years; all men) in a single tertiary referral center. The indication for IBD implantation was a ruptured abdominal aortic aneurysm with a concomitant common iliac artery aneurysm (n = 4) or isolated CIA aneurysms (n = 2). The main outcome measures were technical and clinical success. The secondary outcomes were primary and primary assisted patency, the occurrence of type I/III endoleaks, and reinterventions.</p><p>RESULTS: All patients were hemodynamically stable during the procedures, which were performed under local anesthesia. Technical success was achieved in all cases (the median total procedure time of 188 min and the median IBD procedure time of 28 min). The median follow-up was 34 months (interquartile range 19-78). There were no deaths during the follow-up and no major complications unrelated to the IBD. Two (25%) secondary interventions were performed for IBD occlusion in patients with bilateral IBDs. The other reintervention was a type II endoleak embolization in 1 of these 2 patients. The freedom from reintervention estimate was 75% through 2 years. The overall primary assisted patency was 100% through 3 years.</p><p>CONCLUSIONS: The use of IBDs in the acute setting is feasible to exclude ruptured aortoiliac aneurysms while maintaining pelvic circulation. The secondary intervention rate is considerable; however, the midterm assisted primary patency rates are promising. Further studies are needed to guide patient selection and to evaluate longer term outcomes.</p>},
  author       = {Karelis, Angelos and Dijkstra, Martijn L and Singh, Bharti and Vaccarino, Roberta and Sonesson, Björn and Dias, Nuno V},
  issn         = {1615-5947},
  language     = {eng},
  pages        = {171--177},
  publisher    = {Springer},
  series       = {Annals of Vascular Surgery},
  title        = {The Use of Iliac Branched Devices in the Acute Endovascular Repair of Ruptured Aortoiliac Aneurysms},
  url          = {http://dx.doi.org/10.1016/j.avsg.2020.02.019},
  doi          = {10.1016/j.avsg.2020.02.019},
  volume       = {67},
  year         = {2020},
}