Background
During endovascular aneurysm repair (EVAR), commercial iliac branch devices (IBDs)
have become an inescapable alternative for preserving antegrade internal iliac artery
(IIA) blood flow. Due to the different morphological features of aneurysms, commercial
IBDs may not be suitable for all patients. Reported experience with the implantation
of the new surgeon-modified IBD (sm IBD) is limited. This investigation describes
the indications, efficacy, and safety of the sm IBD.
Methods
Data from consecutive elective implantations of IBDs in patients between March 2011
and May 2021 in a single center were incorporated. The sm IBDs were indicated in patients
with common iliac artery aneurysms (CIAAs) and with a challenging anatomy and in those
patients with or without abdominal aortic aneurysm (AAA).
Results
Fifteen patients (15 male, mean age 67.6 ± 7.9 years) were included. Fifteen sm IBDs
were implanted in 1 procedure (100%). Fourteen (93.3%) patients had simultaneous endovascular
aneurysm repair (EVAR) and 1 (6.7%) patient previously had a bilateral CIAAs repair
by EVAR. The mean common iliac artery (CIA) diameter was 36.6 ± 12.5 mm. Technical
success was obtained in all patients (100%). The median operation time was 189.7 ± 78.6 min,
with a median fluoroscopy time of 45.3 ± 15.9 min. Axillary artery access was used
in 11 (73.3%) procedures. The mean total hospital stay was 5.6 ± 2.8 days, and the
postoperative follow-up was 35.4 months (range 2–120). The estimated IIA bridge stent
patency at 1 year after operation was 100% and 85.7% ± 13.2% 5 years postoperatively.
One (6.7%) IIA branch was occluded, and this patient remained asymptomatic. One patient
(6.7%) needed reintervention, and another (6.7%) patient had type II leakage, which
is currently under close surveillance.
Conclusions
Using an IBD to maintain the pelvic blood flow is an effective and feasible intravascular
technique, especially for patients with an abnormal iliac artery anatomy. This novel
technique has similar midterm procedural success rate compared to the use of commercial
IBDs. Therefore, these devices are more suitable for patients with certain anatomic
challenges and can be used as an alternative treatment.
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Article info
Publication history
Published online: December 07, 2022
Accepted:
November 6,
2022
Received:
October 12,
2022
Footnotes
Chaonan Wang and Yan Zhou contributed equally to this article as first authors.
Conflict of interest: There is no conflict of interest involved in the article.
Funding sources: This work was supported by the funding from National Key Research and Development Program of China under Grant 2019YFB1311700, National Natural Science Foundation of China (NO. 82070498), CAMS Innovation Fund for Medical Sciences (CIFMS) (no. 2018-I2M-AI-004), Nonprofit Central Research Institute Fund of Chinese Academy of Medical Science (no. 2019XK320004), Fundamental Research Funds for the Central Universities (no. 3332020009), National High Level Hospital Clinical Research Funding (2022-PUMCH-A-078,2022-PUMCH-A-189).
Author contributions: All authors contributed significantly to this work; all authors revised the manuscript and gave final approval of the manuscript to be submitted. CW, YZ, and BL designed the study; JS, ZL, XY, JW, XL and JY analyzed and interpreted the data; KL, ZZ, JC, XY collected the data; CW, YZ and BL drafted the article.
Ethics Statement: Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.
Copyright: The drawings in the manuscript are all original and do not involve copyright issues.
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© 2022 Published by Elsevier Inc.
