title: Anatomic suitability of aortoiliac aneurysms for next generation branched systems.
abstract: BACKGROUND
  Preservation of internal iliac flow is an important consideration to prevent ischemic complications during endovascular aneurysm repair. We sought to determine the suitability of aortoiliac aneurysms for off-the-shelf iliac branched systems currently in clinical trial.
  
  
  METHODS
  Patients undergoing abdominal aortic aneurysm repair from 2004 to 2013 at 2 institutions were reviewed. Centerline diameters and lengths of aortoiliac morphology were measured using three-dimensional workstations and compared with inclusion/exclusion criteria for both Cook and Gore iliac branch devices.
  
  
  RESULTS
  Of the nearly 2,400 aneurysm repairs performed during the study period, 99 patients had common iliac aneurysms suitable for imaging review. Eighteen of the 99 (18.2%) patients and 25/99 (25.3%) patients fit the inclusion criteria and would have been able to be treated using the Cook and Gore iliac branch devices, respectively. The most common reason for exclusion from Cook was internal iliac diameter of <6 or >9 mm (68/99, 68.7%). The most common reason for exclusion from Gore was proximal common iliac diameter of <17 mm (39/99, 39.4%) and inadequate internal iliac artery diameter of <6.5 or >13.5 mm (37/99, 37.3%). Comparing the included patients across both devices, a total of 35/99 (35.4%) of patients would be eligible for the treatment of aortoiliac aneurysms based on anatomic criteria.
  
  
  CONCLUSIONS
  Only 35% of the aneurysm repairs involving common iliac arteries would have been candidates for the 2 iliac branch devices currently in trial based on anatomic criteria. The major common reason for exclusion is the internal iliac landing zone for both devices. Design modifications for future generation iliac branch technology should focus on diameter accommodations for the hypogastric branch stent and proximal and distal sizes of the iliac branch components. Familiarity with alternate branch preserving techniques is still needed in the majority of cases.
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL. Electronic address: bjpearce@uabmc.edu.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Pearce
authors.affiliation: Division of Vascular Surgery and Endovascular Surgery, Stanford University, Palo Alto, CA.
authors.forename: Vinit N
authors.initials: VN
authors.lastname: Varu
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Roan
authors.initials: R
authors.lastname: Glocker
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Zdenek
authors.initials: Z
authors.lastname: Novak
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: William D
authors.initials: WD
authors.lastname: Jordan
authors.affiliation: Division of Vascular Surgery and Endovascular Surgery, Stanford University, Palo Alto, CA.
authors.forename: Jason T
authors.initials: JT
authors.lastname: Lee
mesh_terms: D000407:Alabama; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D002140:California; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D017543:Iliac Aneurysm / Q000175:diagnosis / Q000601:surgery*; D011474:Prosthesis Design; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome