The Use of Iliac Side Branch Devices in Patients with Aortoiliac Aneurysm

Abstract

Purpose: The aim of this study was to evaluate the technical feasibility and short-time patency rate of iliac side branch devices based on the authors’ institution’s experience.

Materials and Methods: Data of 17 patients (all men) with an aortoiliac aneurysm (median age 72.5 years) who underwent endovascular repair between October 2013 and June 2015 (20 months) at our institution was analyzed retrospectively. Primary endpoint was primary technical success, defined as adequate implantation of the iliac branch device with patency of the hypogastric side branch without the need of further re-interventions within 30 days. Mean follow-up was 8.2 ± 5.4 months.

Results: Eighteen iliac side branch devices were implanted with a branch patency of 100 % and a primary technical success rate of 94.4 % (n = 17). Perioperative 30 days mortality was 0 %. The mean diameter of treated abdominal aorta and common iliac artery was 41 ± 14 and 30 ± 8 mm. In one case partial dislocation of the iliac side branch device occurred due to severe kinking of iliac arteries with development of an iliac endoleak type Ib that had to be treated in a second intervention. Three patients (15 %) showed an endoleak type II from the inferior mesenteric artery without the need of re-intervention. After three months one patient suffered from subtotal thrombotic occlusion of the bridging stent that was successfully resolved through intra-arterial fibrinolytic therapy and additional stent graft implantation.

Conclusion: Summarized, implantation of iliac side branch devices is a feasible technique with favourable short-term results in patients with aortoiliac aneurysm.

Key Points:

• Implantation of iliac side branch devices is a feasible technique.

• Distinguish short-term results of side branch endografting in patients with aortoiliac aneurysm.

• Carefully patient selection is necessary to avoid complications and re-interventions.

Citation Format:

• Maus V, Kurz P, Sommer CM et al. The Use of Iliac Side Branch Devices in Patients with Aortoiliac Aneurysm.. Fortschr Röntgenstr 2016; 188: 746 – 752

Zusammenfassung

Ziel: Ziel der Studie ist die Evaluation der technischen Durchführbarkeit und der Kurzzeitergebnisse endovaskulär mittels iliakaler Bifurkationsprothesen versorgter Patienten mit aorto-iliakalem Aneurysma.

Material und Methoden: Zwischen Oktober 2013 und Juni 2015 wurden insgesamt 17 Patienten (17 männlich; Durchschnittsalter 72,5 Jahre) mit einem behandlungsbedürftigen aorto-iliakalem Aneurysma endosvaskluär mittels einer iliakalen Bifurkationsprothese versorgt und retrospektiv ausgewertet. Primärer Endpunkt war der primäre technische Erfolg, definiert als adäquate Implantation der iliakalen Bifurkationsprothese mit Durchgängigkeit des internen Prothesenschenkels ohne Notwendigkeit einer Re-Intervention innerhalb 30 Tage. Der mittlere Nachsorgezeitraum betrug 8,2 ± 5,4 Monate.

Ergebnisse: Insgesamt wurden 18 iliakale Bifurkationsprothesen implantiert mit einer Offenheitsrate von 100 % und einer primären technischen Erfolgsrate von 94,4 % (n = 17). Die perioperative Mortalität lag bei 0 %. Der durchschnittliche Durchmesser der Aneurysmata von Aorta und Arteria iliaca communis betrug 41 ± 14 bzw. 30 ± 8 mm. In einem Fall kam es peri-interventionell zu einer partiellen Dislokation der Bifurkationsprothese aufgrund erheblich elongierter Iliakalgefäße, wodurch ein iliakales Endoleak Ib entstand, das in einer zweiten Intervention behoben wurde. Bei drei Patienten wurde ein Endoleak Typ II über die Arteria mesenterica inferior festgestellt, die konservativ behandelt wurden. Nach drei Monaten kam es bei einem Patienten zu einem subtotalen thrombotischen Verschluss des Brücken-Stents, der durch intraarterielle Lyse und eine zusätzliche Stentimplantation erfolgreich behoben wurde.

Schlussfolgerung: Zusammenfassend ist die endovaskuläre Versorgung aorto-iliakaler Aneurysmata mittels iliakaler Bifurkationsprothesen eine sichere und erfolgreiche Therapie.

Kernaussagen:

• Implantation von iliakalen Bifurkationsprothesen ist technisch durchführbar.

• Vielversprechende Kurzzeitergebnisse nach Implantation von iliakalen Bifurkationsprothesen bei Patienten mit aorto-iliakalem Aneurysma.

• Sorgfältige Patientenauswahl wichtig, um Komplikationen und Re-Interventionen zu vermeiden.

Key Words

endovascular aortic repair - aortic aneurysm - iliac artery aneurysm - iliac side branch device - endoleak

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