Mid-Term Outcomes of PTFE-Based Contralateral Iliac Limbs in Polyester-Based Fenestrated Bifurcated Endografts

Abstract

Purpose:

The aim of this study was to evaluate the feasibility and mid-term results of combining polytetrafluoroethylene (PTFE)-based iliac limbs, having a short dilator tip, with a polyester (Dacron)-based bifurcated component during a fenestrated endovascular aortic repair (FEVAR).

Materials and Methods:

All patients who underwent a FEVAR procedure in a single tertiary center were screened for inclusion in the study. Data were collected retrospectively and all imaging was reviewed for the study. The criterion for inclusion in the study was the implantation of a PTFE-based iliac limb endoprosthesis at the contralateral side of the polyester-based bifurcated component during a FEVAR procedure landing in a native common iliac artery. The primary study endpoints were technical success, adverse events, and reinterventions related to limbs, migration between contralateral iliac limbs and bifurcated components, type Ib and IIIa endoleaks, and iliac limb patency.

Results:

A total of 30 patients with a median age of 77 (70, 79) years, who underwent FEVAR procedures from June 2020 to July 2023, were included in the study. The total number of target vessels was 116, and the majority (N = 24) of patients received 4 fenestrations. Technical success was achieved for the iliac limb in all patients, and for the FEVAR, it was obtained in 29 cases (97%). Median follow-up was 24 (12, 30) months. There were no clinical limb-related adverse events or reinterventions. At the end of the follow-up period, all limbs remained patent. The median absolute and percentual change in overlap between the limb and the cuff of the bifurcated endograft was of −0.1 mm (−0.8, 1.1) and −0.4% (−2.7, 4), respectively. The estimated primary, secondary clinical success of the FEVAR, and survival rates (± standard error) at 2 years were 86 ±7%, 90±6, and 83±7%, respectively.

Conclusions:

The present study demonstrated promising mid-term outcomes, with the absence of limb-related adverse events, reinterventions, and any significant change in the overlap of PTFE iliac limbs combined with polyester bifurcated device during FEVAR. Further validation in a larger cohort as well as comparative analysis between different component combinations are needed to confirm the findings of the present study.

Clinical Impact

This study underscores the feasibility and excellent mid-term clinical outcomes of combining PTFE-based iliac limbs with a short dilator tip and a polyester-based bifurcated component during fenestrated endovascular aortic repair. The absence of significant migration and adverse effects related to the iliac limbs, along with the lack of target vessel occlusions, suggests a potential advantage of using a delivery system that avoids crossing the fenestrations, thereby enhancing technical success and ensuring stable and durable results over time.