title: Conformability of GORE Excluder Iliac Branch Endoprosthesis and COOK Zenith Bifurcated Iliac Side Branched Iliac Stent Grafts.
abstract: BACKGROUND
  Forty percent of the abdominal aortic aneurysms present an extension to the iliac axes. The access to a distal neck requiring an embolization of the internal iliac artery (IIA) may cause buttock claudication, colic ischemia, perineal necrosis, erectile dysfunction, and spinal cord ischemia. The aim of the branched iliac stent grafts is to preserve pelvic vascularization while adapting to the constraints of arterial tortuosity which generate type Ib endoleaks, plications, and limb thromboses. The objective was to analyze and compare the in vivo anatomical conformability of the Gore Excluder®Iliac Branch Endoprosthesis (IBE) and the Zenith Bifurcated Iliac Side®(ZBIS) Cook Iliac Endovascular Device branched stent grafts.
  
  
  METHODS
  This was a monocentric retrospective therapeutic study including 13 IBE and 9 ZBIS stent grafts. Three indices of tortuosity were measured with EndoSize: common iliac artery, pelvic artery index (PAI), and the double iliac sign (DIS). The centerline lengths of the iliac axes and the iliac axis and the IIA were measured by 2 different operators as a blind fashion.
  
  
  RESULTS
  The interoperator correlation of the measurements was r = 0.841 (P < 0.0001). Twenty-two patients had a high iliac tortuosity: PAI ≥ 1.14 (mean PAI 1.43 [1.16-2.09]). The IBE stent graft modified neither the ipsilateral length nor tortuosity of the common iliac axis or the PAI (P ≤ 0.17, P ≤ 0.16, and P ≤ 0.23, respectively). The ZBIS stent graft significantly modified (P ≤ 0.02) the length and the tortuosity measured by the PAI compared with the IBE group (P ≤ 0.02). The use of IBE or ZBIS did not modify the postoperative length of the IIA (P ≤ 0.34). Three patients of the IBE group presented one DIS. Postoperatively, they did not present any DIS without significant modification of the postoperative PAI (P ≤ 0.07).
  
  
  CONCLUSIONS
  In patients with a severe iliac tortuosity, the IBE Gore branched iliac stent graft is more conformable than the ZBIS Cook. IBE, more conformable with the anatomy of the patient, could thus make it possible to decrease the incidence of distal endoleaks without increasing the risk of limb thrombosis related to the anatomical constraints.
authors.affiliation: Service de Chirurgie Vasculaire, Groupement Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
authors.forename: Nellie
authors.initials: N
authors.lastname: Della Schiava
authors.affiliation: Service de Chirurgie Vasculaire, Groupement Edouard Herriot, Hospices Civils de Lyon, Lyon, France. Electronic address: matthieu.arsicot@chu-lyon.fr.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Arsicot
authors.affiliation: Service de Chirurgie Vasculaire, Groupement Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
authors.forename: Tarek
authors.initials: T
authors.lastname: Boudjelit
authors.affiliation: Service de Chirurgie Vasculaire, Groupement Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Feugier
authors.affiliation: Service de Chirurgie Vasculaire, Groupement Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Lermusiaux
authors.affiliation: Service de Chirurgie Vasculaire, Groupement Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Millon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D000072226:Computed Tomography Angiography; D057867:Endoleak / Q000209:etiology; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D005602:France; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006801:Humans; D017543:Iliac Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D013927:Thrombosis / Q000209:etiology; D016896:Treatment Outcome