Use of Iliac Branch Endoprosthesis (IBE) to Repair Internal Iliac Artery Aneurysms and Preserve Pelvic Blood Flow
Raj Patel1, Javairiah Fatima1, Steven Abramowitz1, Cameron Akbari1, Misaki Kiguchi1, Kyle Reynolds1, Joshua Dearing1, Krystal Maloni1, Raghuveer Vallabhaneni2
1MedStar Washington Hospital Center, Washington, DC;2MedStar Union Memorial Hospital, Baltimore, MD
INTRODUCTION: Internal iliac artery aneurysms (IIAA) can occur in isolation (0.03 to 0.05%) or in conjunction with aortoiliac artery aneurysms (AIAA; 15%). Preservation of flow within the internal iliac artery (IIA) is imperative, especially in patients with contralateral disease. The complications of acute occlusion of the IIA during repair is well described, including pelvic ischemia, buttock claudication, ischemic colitis, sexual dysfunction, and paraplegia. This study describes the safety and efficacy of IIAA repair with IBE.
METHODS: A retrospective review of all patients in which IBE was placed for IIAA between June 2016 and August 2023 were included. Primary end point was technical success, and secondary end points included mortality, patency of internal iliac limb at follow-up, endoleaks at follow-up, and reintervention rates.
RESULTS: There was a total of 32 IBEs placed in 27 patients during the study period. Mean age of patients was 71.3 +/- 7.6 (89% were males). The average diameter of treated IIAA was 3.0 cm (range 1.5 - 6.5 cm). Isolated IIAAs were repaired in 11% of patients; twenty-four patients (89%) had concomitant placement or previous placement of an EVAR device for aneurysmal aortic disease. Bilateral IBEs were placed for bilateral IIAA in 5 patients (19%). Technical success was 100%. No patients developed symptoms consistent with pelvic ischemia. At median follow-up of 12 months (range 1-57 months), IIA patency was noted to be 100% by imaging. Endoleaks were observed in 3 patients (11%). Reinterventions were performed in 7% treating a Type 2 endoleak with transvenous embolization and a Type 1b endoleak requiring distal extension. Type 2 endoleak was repaired due to sac expansion and Type 1b was repaired for better apposition.
CONCLUSIONS:In this largest reported series of patients treated with IBE in patients with IIAAs preservation of arterial flow within IIAA is safe and feasible with favorable short-term outcomes.
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