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Endovascular Treatment of Iliac Aneurysm: Concurrent Comparison of Side Branched Endograft vs. Hypogastric Exclusion

Fabio Verzini, Lydia Romano, Paola De Rango, Gianbattista Parlani, Gustavo Iacono, Piergiorgio Cao.
Vascular and Endovascular Surgery, Perugia, Italy.
 
OBJECTIVES: To analyze early and mid-term outcome of endovascular treatment in patients with iliac aneurysms.

METHODS: Consecutive patients with iliac aneurysm receiving side branched endograft (Group 1) and those receiving endograft with hypogastric exclusion (Group 2) during 2000-2007 interval were compared. Procedural details and outcome at one year, to avoid mismatch in follow-up length, were analyzed.

RESULTS: A total of 65 patients (mean age 75.8year, 94% males) were treated: 25 in Group 1 and 40 in Group 2. No difference in baseline risk factors and aneurysm diameter (39.3mm, IQR 33-43 in Group1 vs. 38.2mm, IQR 29-46 in Group 2) were found. Concurrent treatment of aortic aneurysm was performed in 16/25 (64%) of Group 1 and 32/40 (80%) of Group 2. A total of eight patients, equally distributed in the 2 Groups presented bilateral iliac involvement. In all but one patient at least one hypogastric artery was saved or revascularized. Fluoro time was 48 minutes (IQR 31-57) in Group 1 vs. 31minutes (IQR 23-38) in Group 2 (p=0.04). The amount of contrast was similar in both Groups: 184 ml ( IQR 155-210) in Group 1 vs. 183 mL (IQR 155-200) in Group 2. No intestinal ischemia or deaths occurred. There were no significant differences in failures of hypogastric side branch deployment (2/25) compared to hypogastric coiling (3/40). Limb occlusions all occurring in the external iliac artery side were 2/25 in Group 1 vs. 3/40 in Group 2. Reintervention rates were similar (4/25 vs. 4/40) at 1 year. Shrinkage of 5 mm or more was detected in 7/25 (28%) of Group 1, and 13/40 (32%) of Group 2. In Group 1 no hypogastric endoleak (Group 2: 8/40, 20%; p=0.015) and no buttock claudication or impotence (Group 2: 7/40, 18%, p= 0.04) were recorded.

CONCLUSIONS: Endoleak and buttock claudication occurred frequently in patients with iliac aneurysm treated with hypogastric exclusion and never in those with side branch endograft. Limb occlusion rate occurring in the external iliac side at 1 year may occur with both treatments, however, patients with preserved hypogatsric flow through the side branch present fewer clinical symptoms or have a more likely successful reintervention than patients with hypogastric exclusion. Side branched endografting for iliac aneurysm may be considered a primary choice , but larger studies are needed.

AUTHOR DISCLOSURES: F. Verzini, None; L. Romano, None; P. De Rango, None; G. Parlani, None; G. Iacono, None; P. Cao, None.