title: 8-Year Long-Term Outcome Comparison: Two Ways to Exclude the Internal Iliac Artery during Endovascular Aorta Repair (EVAR) Surgery.
abstract: OBJECTIVE
  To evaluate the 8-year long-term outcome after internal iliac artery (IIA) coverage with or without embolization in EVAR.
  
  
  METHODS
  From January 2006 to December 2013, abdominal aortic aneurysm (AAA) subjects that underwent EVAR and IIA exclusion were recruited and analyzed retrospectively. All the subjects were divided into group A or B based on the presence or absence of intraoperative IIA embolization before coverage (group A: without embolization; group B: with embolization). The 30-day mortality, stent patency, and the incidences of endoleaks and ischemia of the buttocks and lower limbs were compared. The follow-up period was 96 months.
  
  
  RESULTS
  There were 137 subjects (A: 74 vs. B: 63), 124 male (91.1%) and 13 female (9.5%), with a mean age of 71.6 years. There were no significant differences in the early outcomes of intraoperative blood loss (87.23±14.07 ml; A: 86.53±9.57 ml vs. B: 88.06±18.04 ml, p = .545) and surgery time (87.13±9.25 min; A: 85.99±7.07 min vs. B: 88.48±11.19 min, p = .130). However, there were significant differences in contrast consumption (65.18±9.85 ml; A: 61.89±7.95 ml vs. B: 69.05±10.50 ml, p<.001) and intraoperative X-ray time (5.9±0.86 min; A: 5.63±0.49 min vs. B: 6.22±1.07 min, P<.001). The 30-day mortality was approximately 0.73%. In the follow-up analysis, no significant differences were identified in the incidence of endoleak (22 subjects; type I: A: 2 vs. B: 2, p = 1.000; type II: A: 8 vs. B: 4, p = .666; type III: A: 4 vs. B: 3, p = 1.000), occlusion (5 subjects; 4.35%; A: 1 vs. B: 4, p = .180), or ischemia (9 subjects; 7.83%; A: 3 vs. B: 6, p = .301). In the analysis of group B, although there were no significant differences between subjects with unilateral and bilateral IIA embolization, but longer hospital stays were required (P<.001), and a more severe complication (skin and gluteus necrosis) occurred in 1 subject with bilateral IIA embolization.
  
  
  CONCLUSIONS
  IIA could be excluded during EVAR. IIA coverage without embolization had a good surgical and prognostic outcome, and this procedure was not different significantly from coverage with embolization in terms of endoleaks, patency and ischemia.
authors.affiliation: West China Medical School of Sichuan University, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China.
authors.forename: Han
authors.initials: H
authors.lastname: Luo
authors.affiliation: Department of Vascular Surgery, West China Hospital, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Huang
authors.affiliation: Department of Vascular Surgery, West China Hospital, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China.
authors.forename: Ding
authors.initials: D
authors.lastname: Yuan
authors.affiliation: Department of Vascular Surgery, West China Hospital, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Vascular Surgery, West China Hospital, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Xiong
authors.affiliation: Department of Vascular Surgery, West China Hospital, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China.
authors.forename: Guojun
authors.initials: G
authors.lastname: Zeng
authors.affiliation: Department of Vascular Surgery, West China Hospital, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China.
authors.forename: Zhoupeng
authors.initials: Z
authors.lastname: Wu
authors.affiliation: Department of Vascular Surgery, West China Hospital, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China.
authors.forename: Xiyang
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Vascular Surgery, West China Hospital, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China.
authors.forename: Xiaojiong
authors.initials: X
authors.lastname: Du
authors.affiliation: Department of Ultrasound, West China Hospital, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China.
authors.forename: Xiaorong
authors.initials: X
authors.lastname: Wen
authors.affiliation: Department of Ultrasound, West China Hospital, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China.
authors.forename: Chuncheng
authors.initials: C
authors.lastname: Liu
authors.affiliation: West China Medical School of Sichuan University, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China.
authors.forename: Hongliu
authors.initials: H
authors.lastname: Yang
authors.affiliation: Department of Vascular Surgery, West China Hospital, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China.
authors.forename: Jichun
authors.initials: J
authors.lastname: Zhao
mesh_terms: D000368:Aged; D001012:Aorta, Abdominal / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D015331:Cohort Studies; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome