Risk factors for iliac limb migration after endovascular infrarenal aortic repair

This study investigated anatomical and procedural factors influencing iliac limb migration and its correlation with late type 1b and type 3 endoleaks. We analyzed data of 141 iliac limbs from 91 patients who underwent endovascular aneurysm repair for infrarenal abdominal aortic aneurysm between 2005 and 2017. Iliac limb migration was measured using initial and follow-up computed tomography angiography scans conducted at least three years post-procedure, with significant migration defined as a change of ≥ 5 mm. The iliac limbs were classified into Group 1 (G1; n = 34 limbs, 26 patients) with significant migration and Group 2 (G2; n = 107 limbs, 65 patients) without significant migration. The median follow-up periods were 70.5 months (interquartile range 49.7-91.8 months) for G1 and 57.6 months (interquartile range 44.2-73.2 months) for G2. Multivariable analysis confirmed that significant migration correlated with larger common iliac artery (CIA) diameters and lower iliac limb oversizing. Significant iliac limb migration was associated with a higher risk of type 1b endoleak development. Our findings suggest that careful iliac limb oversizing is essential for patients with a CIA diameter > 20 mm, and vigilant monitoring of the iliac landing zone is crucial during postoperative surveillance.