Iliac Branch Devices in the Repair of Ruptured Aorto-iliac Aneurysms: A Multicenter Study

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Iliac Branch Devices in the Repair of Ruptured Aorto-iliac Aneurysms: A Multicenter Study

Karelis, Angelos (författare): Skane Univ Hosp, Sweden; Skane Univ Hosp, Sweden

Sonesson, Bjorn (författare): Skane Univ Hosp, Sweden

Gallitto, Enrico (författare): Univ Bologna, Italy

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Tsilimparis, Nikolaos (författare): Univ Heart & Vasc Ctr Hamburg, Germany

Forsell, Claes (författare): Region Östergötland, Thorax-kärlkliniken i Östergötland

Leone, Nicola (författare): Univ Modena & Reggio Emilia, Italy

Silingardi, Roberto (författare): Univ Modena & Reggio Emilia, Italy

Mesnard, Thomas (författare): CHU Lille, France; Univ Lille, France

Sobocinski, Jonathan (författare): CHU Lille, France

Isernia, Giacomo (författare): Santa Maria Misericordia Hosp, Italy

Resch, Timothy (författare): Univ Copenhagen, Denmark

Gargiulo, Mauro (författare): Univ Bologna, Italy

Dias, Nuno V. (författare): Skane Univ Hosp, Sweden

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2023
2023
Engelska.
Ingår i: Journal of Endovascular Therapy. - : SAGE PUBLICATIONS INC. - 1526-6028 .- 1545-1550.

Relaterad länk:: https://urn.kb.se/re...; visa fler...; https://doi.org/10.1...; visa färre...

Tidskriftsartikel (refereegranskat)

Abstract Ämnesord

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Purpose: To evaluate the outcomes of preserving the internal iliac artery (IIA) with iliac branched devices (IBDs) during acute endovascular repair of ruptured aortoiliac aneurysms. Material and Methods: This is a multicenter retrospective review of all consecutive patients undergoing acute endovascular repair of ruptured aortoiliac aneurysm with an IBD at 8 aortic centers between December 2012 and June 2020. A control group was used where the IIA was intentionally occluded from the same study period. The main outcome measures were 30-day mortality, major adverse events, technical success, and clinical success. Secondary outcomes were buttock claudication, primary patency, primary-assisted and secondary patency of the IBD, occurrence of endoleak types I/III, and reintervention. Values are presented as numbers and percentages or interquartile range in parenthesis. Results: Forty-eight patients were included in the study: 24 with IBD and 24 with IIA occlusion. There was no difference in demographics, cardiovascular risk factors, and aneurysm extent. Twenty (83%) of them were hemodynamically stable during the procedure as opposed to 14 (58%, p=.23) with the IIA occlusion. Technical success was achieved in all cases with a procedure time of 180 (133-254) minutes, 45 (23-65) of which were from IBD. There were 2 (8%) deaths during the first 30 days and 2 (8%) major complications unrelated to the IBD, whereas in the IIA occlusion, the figures were 10 (42%) and 7 (29%), respectively. No patient in the IBD group developed buttock claudication compared to 8 (57%, p<.0001) in the IIA occlusion group; 1 (4%) patient developed bowel ischemia on both groups, with 1 in the IIA occlusion group needing resection. The median follow-up duration was 17 months (interquartile range 2-39) for the IBD group, with a primary patency of 60 +/- 14% at 3 years that went up to 92 +/- 8% with reinterventions (8 reinterventions in 6 patients). When the first 90 days were disregarded, there were no differences in survival between the groups. Conclusion: IBD is a valid alternative for maintaining the pelvic circulation for endovascular aortic aneurysm repair of ruptured aortoiliac aneurysms. The technical success and midterm outcomes are very satisfactory but require patient selection particularly regarding hemodynamic stability. The reintervention rate is considerable, mandating continuous follow-up. Clinical Impact This multicenter study demonstrates that ruptured aortoiliac aneurysms do not necessarily require mandatory occlusion of hypogastric arteries. Iliac branch devices are shown to be a valid alternative in highly selected cases, with good midterm results, even if reinterventions are required in a significant proportion of patients.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)

Nyckelord

abdominal aortic aneurysm; iliac branch device; common iliac artery aneurysm; endovascular aneurysm repair; hypogastric artery

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Av författaren/redakt...: Karelis, Angelos; Sonesson, Bjorn; Gallitto, Enrico; Tsilimparis, Nik ...; Forsell, Claes; Leone, Nicola; visa fler...; Silingardi, Robe ...; Mesnard, Thomas; Sobocinski, Jona ...; Isernia, Giacomo; Resch, Timothy; Gargiulo, Mauro; Dias, Nuno V.; visa färre...

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Av lärosätet: Linköpings universitet

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