title: Endovascular aneurysm repair of aortoiliac aneurysms with an iliac side-branched stent graft: studying the morphological applicability of the Cook device.
abstract: OBJECTIVE
  Endovascular aneurysm (EVAR) repair of an aortic aneurysm extending to the iliac artery remains a challenge. Interventional occlusion of the internal iliac artery (IIA) intending to create a distal landing zone in the external iliac artery is a common approach with inherent morbidity (e.g., buttock claudication, impotence). Alternatively, iliac side-branched stent grafts can maintain pelvic blood supply, but the applicability is limited. The objective was to investigate the morphological applicability of the Cook Zenith branched graft (ZBIS) among patients with aorto-iliac or isolated iliac aneurysms.
  
  
  METHODS
  This was a retrospective single centre analysis of 66 patients (60 men; median age 74 years, range 53-90 years) undergoing repair of aorto-iliac aneurysms (open repair, IIA occlusion prior to EVAR and ZBIS) between January 2008 and December 2012. All available computed tomography angiograms with post-processing imaging were compared with the criteria for morphological applicability to (i) the manufacturer's instruction for use (IFU), and (ii) to criteria published in the literature, as well as (iii) to the institutional protocol.
  
  
  RESULTS
  In 66 patients, 88 targeted iliac aneurysms were studied. Of these, 36/88 (40.9%) were compliant with the manufacturer's IFU, 35/88 (39.8%) were compliant with the published criteria, and 51/88 (58.0%) were compliant with the in house protocol. The most common morphological exclusion criterion was an aneurysmal IIA.
  
  
  CONCLUSIONS
  In the present cohort with aorto-iliac aneurysm, a maximum of 58% could have been treated with an iliac side branch based on the current experience. In particular, an aneurysmal IIA seems to be a limiting factor for the use of the iliac side-branched stent graft.
authors: Department of Vascular and Endovascular Surgery, University Hospital of Cologne, 50937 Cologne, Germany.
authors: D
authors: D
authors: Gray
authors: Department of Vascular and Endovascular Surgery, University Hospital of Cologne, 50937 Cologne, Germany.
authors: R
authors: R
authors: Shahverdyan
authors: Department of Vascular and Endovascular Surgery, University Hospital of Cologne, 50937 Cologne, Germany.
authors: C
authors: C
authors: Jakobs
authors: Department of Vascular and Endovascular Surgery, University Hospital of Cologne, 50937 Cologne, Germany. Electronic address: jan.brunkwall@uk-koeln.de.
authors: J
authors: J
authors: Brunkwall
authors: Department of Vascular and Endovascular Surgery, University Hospital of Cologne, 50937 Cologne, Germany.
authors: M
authors: M
authors: Gawenda
mesh_terms: D000368:Aged; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D005858:Germany; D006801:Humans; D017543:Iliac Aneurysm / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010388:Pelvis / Q000098:blood supply*; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012039:Regional Blood Flow; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome