Branched grafting for aortoiliac aneurysms

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Aneurysm Repair

Background:

• Common iliac artery aneurysms pose a risk for rupture and can complicate endovascular aneurysm repair (EVAR).
• Preserving pelvic perfusion, particularly to the internal iliac arteries, is crucial to avoid complications like buttock claudication and ischemic colitis.
• Traditional EVAR techniques may require sacrificing internal iliac artery flow, necessitating alternative strategies.

Purpose of the Study:

• To evaluate a novel branched endograft for maintaining pelvic perfusion during endovascular repair of abdominal aortic aneurysms (AAA) with common iliac artery extension.
• To assess the safety and efficacy of this approach in high-risk patients unsuitable for open surgery.

Main Methods:

• A multicenter prospective study involving patients with common iliac artery aneurysms (>20mm) amenable to branched device implantation.
• Implantation of a branched endograft designed to perfuse the internal iliac artery.
• Preoperative and serial follow-up CT scans and radiographs were obtained up to 24 months.

Main Results:

• 52 patients (53 internal iliac arteries) received the investigational device between 2003-2006.
• Technical success was achieved in 94% of cases; 11% of branches occluded within the first month, with no further occlusions.
• Common iliac aneurysm shrinkage was observed in 42% at 6 months and 81% at 12 months. No aneurysm-related deaths or conversions occurred.

Conclusions:

• Endovascular repair using branched prostheses to maintain antegrade perfusion of internal iliac arteries is feasible.
• Early results suggest this technique is safe and effective for managing complex aneurysms.
• This approach offers a promising solution for preserving pelvic circulation in EVAR procedures.