Early experience with the Excluder® iliac branch endoprosthesis.

AIM: Dilation of one or both common iliac arteries (CIAs) is a major concern in endovascular aneurysm repair (EVAR). One option for CIA aneurysm repair is hypogastric embolization followed by endograft extension into the external iliac artery. However, hypogastric occlusion does not always go unpunished and it may lead to ischemic complications. Aim of the paper was to evaluate early results with the Gore® Excluder® Iliac Branch Endoprosthesis (IBE) in the treatment of iliac aneurysms associated or not with abdominal aortic aneurysms. METHODS: Between November 2013 and April 2014, in our Institution 7 Gore IBE were implanted in 5 patients. Technical success, 30-day mortality and complications were investigated. RESULTS: Technical success and branch patency was 100%. There was no 30-day mortality. In 1 of the 2 bilateral cases an endovascular relining with bare stents was required due to a compression of iliac legs at level of aortic bifurcation. CONCLUSION: Use of Gore IBE device in the treatment of aorto-iliac disease is feasible and safe. Late results are necessary to evaluate the performance of this endograft in the long term.

Current results of total endovascular repair of thoracoabdominal aortic aneurysms.

Minimally invasive surgical solutions for patients with extensive aortic disease are eagerly awaited, since open repair is often associated with high rates of morbidity and mortality. In the last decade, the development of fenestrated and branched aortic endografts has offered a therapeutic option to patients deemed unsuitable for major surgery. Preliminary studies showed promising early results, while mid- and long- term data are scarce. The aim of this paper was to review current results of total endovascular repair of thoracoabdominal aortic aneurysms (TAAA) with a single model of endograft in the published literature. A literature search was conducted, and our two-center experience with fenestrated and branched endografts in the treatment of TAAA, with the Cook Zenith endograft, is presented. Early results show perioperative mortality rates ranging from 0% to 21%, spinal cord ischemia from 0% to 33.3%. At a mean follow up ranging from 9 to 19 months, reinterventions are needed in 3.3% to 25% of the cases, with a mid term visceral branch patency of 90% to 100%. Current experiences with total endovascular TAAA repair show promising results, in selected centers with large experience in complex aortic endografting. With increasing follow- up times, need for reintervention is growing, while aneurysm-related deaths remain rare. Long-term results are still lacking, but these encouraging data and further technological developments will support wider adoption of the technique.

Long-term results of iliac aneurysm repair with iliac branched endograft: a 5-year experience on 100 consecutive cases.

BACKGROUND: Iliac branch device (IBD) technique has been introduced as an appealing and effective solution to avoid complications occurring during repair of aorto-iliac aneurysm with extensive iliac involvement. Nevertheless, no large series with long-term follow-up of IBD are available. The aim of this study was to analyse safety and long-term efficacy of IBD in a consecutive series of patients. METHODS: Between 2006 and 2011, 100 consecutive patients were enrolled in a prospective database on IBD. Indications included unilateral or bilateral common iliac artery aneurysms combined or not with abdominal aneurysms. Patients were routinely followed up with computed tomography. Data were reported according to the Kaplan-Meier method. RESULTS: There were 96 males, mean age 74.1 years. Preoperative median common iliac aneurysm diameter was 40 mm (interquartile range (IQR): 35-44 mm). Sixty-seven patients had abdominal aortic aneurysm >35 mm (IQR: 40-57 mm) associated with iliac aneurysm. Eleven patients presented hypogastric aneurysm. Twelve patients underwent isolated iliac repair with IBD and 88 patients received associated endovascular aortic repair. Periprocedural technical success rate was 95%, with no mortality. Two patients experienced external iliac occlusion in the first month. At a median follow-up of 21 months (range 1-60) aneurysm growth >3 mm was detected in four iliac (4%) arteries. Iliac endoleak (one type III and two distal type I) developed in three patients and buttock claudication in four patients. Estimated patency rate of internal iliac branch was 91.4% at 1 and 5 years. Freedom from any reintervention rate was 90% at 1 year and 81.4% at 5 years. No late ruptures occurred. CONCLUSIONS: Long-term results show that IBD use can ensure persistent iliac aneurysm exclusion at 5 years, with low risk of reintervention. This technique can be considered as a first endovascular option in patients with extensive iliac aneurysm disease and favourable anatomy.