Aneurysmal Extension to the Iliac Bifurcation Increases the Risk of Complications and Secondary Procedures After Endovascular Repair of Abdominal Aortic Aneurysms

BackgroundTo compare the outcome of endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) in patients with and without associated common iliac artery aneurysm (CIAA) extending to the iliac bifurcation.MethodsReview of 157 patients who underwent endovascular aneurysm repair between 1999 and 2007. Group 1 included 133 patients with and without CIAA and suitable distal common iliac neck (type A, B, C, or D). Group 2 included 24 patients with associated CIAA extending to the iliac bifurcation (type E). Stent-grafts were Powerlink (Endologix, Irvine, CA) in 42, Zenith (Cook, Bjaeverskov, Danemark) in 55, and Talent (Medtronic, Sunnyvale, CA) in 60 patients. Forty patients had aorto-uni-iliac stent-grafts.ResultsNo difference in overall mortality and AAA rupture was observed. AAA-related complication-free survival at 5 year was 72 ± 5% and 41 ± 14% in group 1 and 2, respectively (p = 0.006). Secondary intervention-free survival was 84 ± 5% and 55 ± 12% in group 1 and 2, respectively (p = 0.0008). Incidence of distal type 1 endoleak and stent-graft thrombosis was 17 and 8 % in group 2, 3.8 and 0.8 % in group 1, respectively (p = 0.07 and p = 0.01, respectively).ConclusionAAA-related complications and secondary interventions occur more frequently in patients with type E AAA. Distal type 1 endoleak and stent-graft thrombosis are more frequent in these patients. These results warrant further development of technologies that are better adapted for treatment of CIAAs, such as branched and flexible stent-grafts.