Vascular Annual Meeting

Provided by the
Society for Vascular Surgery

Is it Necessary to Cover the Entire Length of the Common Iliac Artery During EVAR?

Jagajan Karmacharya1, Jeffrey P. Carpenter.2
1Cedar Sinai Medical Center, Los Angeles, Calif.;2University of Pennsylvania, Philadelphia, Pa.

OBJECTIVES: Complete common iliac artery coverage has been advocated as a hedge against aneurysmal degeneration of this segment which might threaten the distal seal after EVAR. However, there is little evidence to support this rationale. We desired to learn the natural history of the covered and uncovered portions of the iliac artery after EVAR.

METHODS: Using data from the multicenter pivotal trial of the Powerlink device, CTA’s of patients before and after EVAR (352 iliacs, mean f/u 50 months) were reviewed.

RESULTS: The complete length of iliac artery was not fully covered in 279 iliac arteries (79%). The mean length of the uncovered segments of the iliac artery was 23.25 mm (range 0-82.7 mm). While regression of the iliac artery diameter was the rule, expansion of the iliac artery diameter was noted in 75 (21%) arteries. Aneurysmal dilatation of the iliac artery (≥25 mm) did not occur in any patient. No patients developed distal attachment endoleaks. Significant regression of the iliac artery diameter over time was observed for both the covered and uncovered segments. Regression rates for the covered vs. the uncovered portions of the artery were 0.09 mm/month and 0.13 mm/month respectively.

CONCLUSIONS: The iliac artery lengthens and its diameter regresses after EVAR. Both the covered and the uncovered portions show diameter regression. Later aneurysmal dilatation of initially non-aneurysmal iliac segments and failure of iliac seal are rare in this setting. Routine coverage of non-aneurysmal iliac arteries during EVAR is unnecessary as a prophylactic measure to prevent later aneurysmal degeneration.

AUTHOR DISCLOSURES: J. Karmacharya, Endologix; J.P. Carpenter, Endologix.

 

The uncovered portion of the iliac artery lengthened over time at an average rate of 0.13 mm/month.

 


 

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