Large diameter limbs for dilated common iliac arteries in endovascular aneurysm repair: is it safe?
In this prospective study we examined whether dilated common iliac arteries (CIAs) can provide a safe distal seal in endovascular aneurysm repair (EVAR) with the use of bifurcated stent grafts with large diameter limbs. Sixteen patients with 26 dilated CIAs with a diameter of > or =6 mm who were offered EVAR using stent grafts with large diameter limbs were included in the study (Group A). Forty-two patients who also underwent EVAR without iliac dilatation, matched for age, sex and surgical risk were used for comparison (controls-Group B). In group A mean CIA diameter was 18.2 mm (16-28) and mean abdominal aortic aneurysm (AAA) diameter was 6.87 +/- 1.05 cm; mean age was 77.2 +/- 4.8 yrs (67-81). Mean follow-up was 33.6 months (2.8 yrs). CIA diameter changes and development of endoleaks were assessed by CT angiography (CTA). Overall iliac dilatation was present in 16/58 of our patients (27.6%). In 10 patients dilatation was bilateral (17.3%). Partial or complete flow to the internal iliac artery (IIA) territories was preserved in all patients post-EVAR. On follow-up, stable caliber of the dilated CIAs was observed in 21 patients (84%), enlargement of 1mm in 3 (16%), and failure of the distal attachment in 1 (6.2%). Compared to the control group there was no statistical significance in the incidence of complications. Dilated common iliac arteries provide a safe distal seal in patients who have undergone EVAR, thus obviating the need for additional endovascular procedures and sparing flow in the IIA vascular bed.
Malagari
Katerina
K
2nd Department of Radiology, University of Athens, Greece. kmalag@aias.gr
Brountzos
Elias
E
Gougoulakis
Alexandros
A
Papathanasiou
Matilda
M
Alexopoulou
Efthymia
E
Mastorakou
Renata
R
Kelekis
Dimitris
D
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D021721:Balloon Occlusion / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002406:Catheterization, Peripheral; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D018709:Statistics, Nonparametric; D015607:Stents; D016896:Treatment Outcome