Secondary Procedures Following Iliac Branch Device Treatment of Aneurysms Involving the Iliac Bifurcation: The pELVIS Registry

• Published in: Journal of endovascular therapy 2017-06, Vol.24 (3), p.405-410
• Main Authors: Donas, Konstantinos P., Inchingolo, Mirjam, Cao, Piergiorgio, Pratesi, Carlo, Pratesi, Giovanni, Torsello, Giovanni, Pitoulias, Georgios A., Ferrer, Ciro, Parlani, Gianbattista, Verzini, Fabio, Austermann, Martin, Weiss, Kristin, Bosiers, Michel, Barbante, Matteo, Simonte, Gioele, Fargion, Aaron, Masciello, Fabrizio
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic Aneurysm - diagnostic imaging; Aortic Aneurysm - surgery; Aortography; Blood Vessel Prosthesis - adverse effects; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Endoleak - diagnostic imaging; Endoleak - etiology; Endoleak - surgery; Endovascular Procedures - adverse effects; Endovascular Procedures - instrumentation; Europe; Female; Graft Occlusion, Vascular - diagnostic imaging; Graft Occlusion, Vascular - etiology; Graft Occlusion, Vascular - surgery; Humans; Iliac Aneurysm - diagnostic imaging; Iliac Aneurysm - surgery; Kaplan-Meier Estimate; Male; Middle Aged; Prosthesis Design; Prosthesis Failure; Prosthesis-Related Infections - diagnostic imaging; Prosthesis-Related Infections - etiology; Prosthesis-Related Infections - surgery; Registries; Reoperation; Retrospective Studies; Risk Factors; Stents - adverse effects; Time Factors; Treatment Outcome
• ISSN: 1526-6028; 1545-1550
• DOI: 10.1177/1526602817705134

Purpose: To evaluate the incidence and reasons for secondary procedures in patients treated with iliac branch devices (IBDs) for isolated iliac aneurysm or aortoiliac aneurysms involving the iliac bifurcation. Methods: Between January 2005 and December 2015, 575 surgical-high-risk patients (mean age 72.0±8.4 years; 558 men) with isolated iliac aneurysms (n=79) or aortoiliac aneurysms involving the iliac bifurcation (n=496) were treated with placement of 650 ZBIS or Gore IBDs (75 bilateral) in 6 European centers. The primary outcome was procedure-related reinterventions for occlusion or high-grade (>70%) stenosis of the bridging device, occlusion of the ipsilateral common or external iliac artery (EIA), type I/III endoleak, rupture, or infection following IBD implantation. Clinical and radiological data were analyzed based on preset definitions of comorbidities, aneurysm morphology, intraoperative variables, and follow-up strategies. Results: Nine (1.6%) reinterventions were performed within 30 days for occlusion or endoleak. Among 10 (1.5%) occluded EIAs ipsilateral to a deployed IBD, 6 underwent a reintervention with additional stent placement after thrombolysis (n=4) or a femorofemoral or iliofemoral crossover bypass (n=2). Three of 14 patients with early type I endoleak had a reintervention for an insufficient proximal sealing zone (stent-grafts in 2 common iliac arteries and 1 bifurcated endograft). Mean clinical and radiological follow-up were 32.6±9.9 and 29.8±21.1 months, respectively. Forty-two (7.3%) patients underwent reinterventions in the follow-up period. The overall postoperative reintervention rate was 8.9%. Both external and common iliac segments occluded in 30 (4.6%) IBDs; 2 patients had a crossover bypass and 14 were treated with endovascular techniques. In the other 14 patients, no specific treatment was performed. Seven (1.2%) patients with isolated EIA occlusion were treated during follow-up. Nineteen of the overall 28 patients with type I endoleak underwent endovascular repair. The other 9 were under radiological surveillance due to less significant (