Natural History of the Iliac Arteries after Endovascular Abdominal Aortic Aneurysm Repair and Suitability of Ectatic Iliac Arteries as a Distal Sealing Zone

Abstract

Purpose:

To investigate the natural history of dilated common iliac arteries (CIA) exposed to pulsatile blood flow after endovascular abdominal aortic aneurysm repair (EVAR) and the suitability of ectatic iliac arteries as sealing zones using flared iliac limbs.

Methods:

Follow-up computed tomograms of 102 CIAs in 60 EVAR patients were investigated. Diameter changes in CIAs ≤16 mm (group 1) were compared with changes in vessels where a dilated segment >16 mm in diameter continued to be exposed to pulsatile blood flow (group 2). Within group 2, cases in which the stent terminated proximal to the dilated artery segment (2a) were compared with those that had been treated with a flared limb (2b).

Results:

The mean CIA diameter increased by 1.0±1.0 mm in group 1 (p<0.001 versus immediately after EVAR) and by 1.5±1.7 mm in group 2 (p<0.001 versus immediately after EVAR) within an average follow-up of 43.6±18.0 months. Diameter increase was more pronounced in dilated CIAs (p=0.048), and it was not significantly different between groups 2a and 2b (p=0.188). No late distal type I endoleak or stent-graft migration associated with CIA ectasia was observed.

Conclusion:

Dilatation of the CIA is significant after EVAR, and it is more pronounced in ectatic iliac arteries. Although ectatic iliac arteries appear to be suitable sealing zones in the short term, continued follow-up is mandatory.

Keywords

endovascular aneurysm repair common iliac artery dilatation ectatic artery stent-graft flared graft limb

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References

Drury

Michaels

Jones

. Systematic review of recent evidence for the safety and efficacy of elective endovascular repair in the management of infrarenal abdominal aortic aneurysm. Br J Surg. 2005; 92: 937–946.

Longo

Eskandari

. Overview of success of EVAR: Progress to date. Semin Vasc Surg. 2004; 17: 307–313.

Karch

Hodgson

Mattos

. Adverse consequences of internal iliac artery occlusion during endovascular repair of abdominal aortic aneurysms. J Vasc Surg. 2000; 32: 676–683.

Karch

Hodgson

Mattos

. Management of ectatic, nonaneurysmal iliac arteries during endoluminal aortic aneurysm repair. J Vasc Surg. 2001; 33: S33–38.

Kritpracha

Pigott

Russell

. Bell-bottom aortoiliac endografts: An alternative that preserves pelvic blood flow. J Vasc Surg. 2002; 35: 874–881.

Brown

Sanchez

Hovsepian

. Use of aortic cuffs to exclude iliac artery aneurysms during AneuRx stent-graft placement: Initial experience. J Vasc Interv Radiol. 2001; 12: 1383–1387.

Timaran

Lipsitz

Veith

. Endovascular aortic aneurysm repair with the Zenith endograft in patients with ectatic iliac arteries. Ann Vasc Surg. 2005; 19: 161–166.

Hakaim

Lau

Neuhauser

. A comparison of AneuRx aortic cuff and Zenith distal flare exclusion of common iliac artery ectasia for endovascular aneurysm repair. Vasc Endovascular Surg. 2004; 38: 51–56.

Greenberg

Chuter

Sternbergh

. Zenith AAA endovascular graft: Intermediate-term results of the US multicenter trial. J Vasc Surg. 2004; 39: 1209–1218.

10.

Buth

van Marrewijk

Harris

. Outcome of endovascular abdominal aortic aneurysm repair in patients with conditions considered unfit for an open procedure: A report on the EUROSTAR experience. J Vasc Surg. 2002; 35: 211–221.

11.

Armon

Yusuf

Whitaker

. The anatomy of abdominal aortic aneurysms: Implications for sizing of endovascular grafts. Eur J Vasc Endovasc Surg. 1997; 13: 398–402.

12.

Henretta

Karch

Hodgson

. Special iliac artery considerations during aneurysm endografting. Am J Surg. 1999; 178: 212–218.

13.

Mehta

Veith

Ohki

. Unilateral and bilateral hypogastric artery interruption during aortoiliac aneurysm repair in 154 patients: A relatively innocuous procedure. J Vasc Surg. 2001; 33: S27–32.

14.

Criado

Wilson

Velazquez

. Safety of coil embolization of the internal iliac artery in endovascular grafting of abdominal aortic aneurysms. J Vasc Surg. 2000; 32: 684–688.

15.

Mehta

Veith

Darling

. Effects of bilateral hypogastric artery interruption during endovascular and open aortoiliac aneurysm repair. J Vasc Surg. 2004; 40: 698–702.

16.

Razavi

DeGroot

Olcott

. Internal iliac artery embolization in stent-graft treatment of aortoiliac aneurysms: Analysis of outcomes and complications. J Vasc Interv Radiol. 2000; 11: 561–566.

17.

Parodi

Ferreira

. Relocation of the iliac artery bifurcation to facilitate endoluminal treatment of abdominal aortic aneurysms. J Endovasc Surg. 1999; 6: 342–347.

18.

Brener

Faries

Connelly

. An in situ adjustable endovascular graft for the treatment of abdominal aortic aneurysms. J Vasc Surg. 2002; 35: 114–119.

19.

Abraham

Reilly

Schneider

. A modular multi-branched system for endovascular repair of bilateral common iliac artery aneurysms. J Endovasc Ther. 2003; 10: 203–207.

20.

Chuter

. Branched stent-grafts for endovascular repair of aortic and iliac aneurysms. Tech Vasc Interv Radiol. 2005; 8: 56–60.

21.

Santilli

Wernsing

Lee

. Expansion rates and outcomes for iliac artery aneurysms. Vasc Surg. 2000; 31: 114–121.

22.

Dillavou

Muluk

Makaroun

. Is neck dilatation after endovascular aneurysm repair graft dependent? Results of 4 US Phase II trials. Vasc Endovasc Surg. 2005; 39: 47–54.