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Outcomes of Unilateral Versus Bilateral Use of the Iliac Branch Endoprosthesis for Elective Endovascular Treatment of Aorto-iliac Aneurysms

CardioVascular and Interventional Radiology volume 45, pages 939–949 (2022)Cite this article

Abstract

Purpose

The aim of the study was to evaluate outcomes after bilateral implantation of the Gore Excluder Iliac Branch Endoprosthesis (IBE) versus those achieved after unilateral implantation.

Methods

All consecutive patients electively treated in a single center for aorto-iliac aneurysm using the IBE device between January 1, 2014, and December 31, 2018, were reviewed. Early outcome measures were technical success, 30 days or in-hospital mortality, and major adverse events (MAE). Late outcome measures were survival, internal iliac artery (IIA) patency, and freedom from IIA branch instability.

Results

A total of 74 patients (97% males, mean age 74 ± 7 years) were included. Thirteen patients (17%) received bilateral IBE implantation for a total of 85 vessels evaluated. The technical success rate was 97% and was not significantly different between the two groups (p = .32). Two patients died within 30 days, both in the unilateral group (p = 1). No significant differences were seen in the rates of 30 days MAE (p = .10). At one year, the overall survival rate was 95 ± 2% vs 90 ± 3% in the unilateral and bilateral group, respectively (Log-rank = .05). There were no differences in 1-year primary and secondary patency rates between groups (Log-rank = .75 and Log-rank = .34, respectively). Freedom from IIA branch instability at one year was also not significantly different (unilateral: 94 ± 3% vs. bilateral: 82 ± 9%, Log-rank = .22)..

Conclusions

Bilateral IBE use for elective endovascular treatment of aorto-iliac aneurysms appears safe and feasible and may achieve satisfactory short-term and mid-term outcomes. Bilateral IBE use should be employed judiciously in the context of a comprehensive risk/benefit evaluation.

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Author notes

  1. Mario D’Oria and Emanuel R. Tenorio contributed equally to this work and should co-share the 1st authorship.

Authors and Affiliations

  1. Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA

    Mario D’Oria, Emanuel R. Tenorio, Gustavo S. Oderich, Randall R. DeMartino, Manju Kalra, Fahad Shuja, Jill J. Colglazier & Bernardo C. Mendes

  2. Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, 34149, Trieste, TS, Italy

    Mario D’Oria

  3. Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Centre at Houston, McGovern Medical School, Houston, TX, USA

    Emanuel R. Tenorio & Gustavo S. Oderich

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  1. Mario D’Oria
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Correspondence to Mario D’Oria.

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G.S.O. has received consulting fees and grants from W.L. Gore (all paid to Mayo Clinic with no personal income).

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D’Oria, M., Tenorio, E.R., Oderich, G.S. et al. Outcomes of Unilateral Versus Bilateral Use of the Iliac Branch Endoprosthesis for Elective Endovascular Treatment of Aorto-iliac Aneurysms. Cardiovasc Intervent Radiol 45, 939–949 (2022). https://doi.org/10.1007/s00270-022-03166-3

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Keywords

  • Endovascular repair
  • Stent-graft
  • Iliac Branch Endoprosthesis
  • Hypogastric artery
  • Aortic disease
  • Aorto-iliac aneurysms