Endovascular aneurysm repair with preservation of the internal iliac artery using the iliac branch graft device.
OBJECTIVE
Aortoiliac aneurysms comprise up to 43% of the specialist endovascular caseload. In such cases endovascular aneurysm repair (EVAR) requires distal extension of the aortoiliac endograft beyond the ostium of the internal iliac artery (IIA) and into the external iliac artery, conventionally necessitating the embolisation of one or both IIA. This has been associated with a wide range of complications, and the use of an Iliac Branch-graft Device (IBD) offers an appealing endovascular solution.


METHODS
Medline, trial registries, conference proceedings and article reference lists were searched to identify case series reporting IBD use. Data were extracted for review.


RESULTS
Nine series have reported the use of IBD in a total of 196 patients. Technical success was 85-100%. Median operating times were 101-290min and median contrast dose was 58-208g, with no aneurysm-related mortality. Claudication developed in 12/24 patients after IBD occlusion. One type I endoleak and two type III endoleaks occurred and were managed endovascularly. Re-occlusion occurred in 24/196 patients.


CONCLUSIONS
IBD was performed with high technical success rates and encouraging mid-term patency. Formalised risk stratification and morphological data are required to identify the group of patients who will benefit most. Cost-effectiveness appraisals are needed for this technique.
Karthikesalingam
A
A
St George's Vascular Institute, London SW17 0QT, UK.
Hinchliffe
R J
RJ
Holt
P J E
PJ
Boyle
J R
JR
Loftus
I M
IM
Thompson
M M
MM
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000000981:diagnostic imaging / Q000191:economics / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D017543:Iliac Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000191:economics / Q000601:surgery*; D008875:Middle Aged; D018579:Patient Selection; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome