title: Perioperative evaluation of iliac ZBIS branch devices: a French multicenter study.
abstract: BACKGROUND
  The purpose of this study was to evaluate short-term results of endovascular treatment of common iliac artery (CIA) aneurysms without a distal neck by using iliac branch devices (IBDs), which enable maintenance of antegrade perfusion to the internal iliac artery (IIA).
  
  
  METHODS
  Our investigation was done in a prospective, multicenter, nonrandomized manner. IBD were implanted to exclude CIA aneurysms with a diameter >25 mm in patients unfit for open repair. The stent grafts were designed based on preoperative angio-CT findings. A covered stent implantation between the IBD and the target IIA was performed during the same surgical procedure. Angio-CT was performed within the 30 days after the procedure. From January 2009 to April 2010, 39 patients were included in our study (38 men and 1 woman, mean age 73 years).
  
  
  RESULTS
  The CIA aneurysm (mean diameter 32.3 mm) was isolated in 15 patients and associated with an abdominal aorta aneurysm (mean diameter 66 mm) in 24 patients. The IBD was systematically connected to a bifurcated aortobiiliac stent graft. The bifurcated stent graft was implanted during the same procedure in all patients, except for two who had a bifurcated stent graft history. Median surgery time, fluoroscopy time, and volume of contrast product were 192 (range 90-360) minutes, 32 (10-120) minutes, and 150 (60-352) mL, respectively. In 37 patients (95%), the internal iliac branch was patent at the end of the surgery. In two patients (5%), it was occluded, entailing a subischemic colic episode and buttock claudication in one of them. To treat a type I endoleak, a proximal extension partially covering a renal artery was implanted during the same surgery. A type III endoleak was diagnosed on the postoperative angio-CT. In three patients, a cross-over femorofemoral bypass was performed for an external iliac leg thrombosis (and for an internal iliac branch thrombosis in one case). In all, at 30 days, no death was reported and the success rate was 90% (three leg stenoses and a type III endoleak).
  
  
  CONCLUSIONS
  IBD implantation to maintain an antegrade internal iliac perfusion is possible and has shown promising early success. Our results can be compared with those in the published literature. A learning curve will be needed to improve the technical success rate.
authors: Service de Chirurgie Vasculaire, Hôpital Cardiologique, Lille, France.
authors: Blandine
authors: B
authors: Maurel
authors: Michel A
authors: MA
authors: Bartoli
authors: Elixène
authors: E
authors: Jean-Baptiste
authors: Thierry
authors: T
authors: Reix
authors: Alain
authors: A
authors: Cardon
authors: Yann
authors: Y
authors: Goueffic
authors: Robert
authors: R
authors: Martinez
authors: Fréderic
authors: F
authors: Cochennec
authors: Jean-Noël
authors: JN
authors: Albertini
authors: Xavier
authors: X
authors: Chauffour
authors: Eric
authors: E
authors: Steinmetz
authors: Stéphan
authors: S
authors: Haulon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D005602:France; D006801:Humans; D017543:Iliac Aneurysm / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011183:Postoperative Complications / Q000601:surgery; D011446:Prospective Studies; D011474:Prosthesis Design; D012086:Reoperation; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome