REVIEW  AORTIC DISEASE Editor’s choice • Free access

International Angiology 2019 December;38(6):494-501

DOI: 10.23736/S0392-9590.19.04215-9

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Endovascular treatment of iliac aneurysmal disease with internal iliac artery preservation: a review of two different approaches

José OLIVEIRA-PINTO ✉, Pedro MARTINS, Armando MANSILHA

Department of Surgery and Physiology, Faculty of Medicine of Porto, Porto, Portugal

INTRODUCTION: The feasibility of endovascular aneurysm repair (EVAR) is often challenged by the concurrent presence of common iliac artery aneurysms, which prevent the attainment of a successful distal sealing. The present review aims to portray the safety and efficacy of two internal iliac artery (IIA) preservation strategies in the endovascular treatment of aortoiliac aneurysms: the iliac branch extension device (IBED) and the parallel graft - “sandwich” technique (PG-ST).
EVIDENCE ACQUISITION: A comprehensive literature review was conducted to identify publications on endovascular treatment of iliac aneurysmal disease using IBED or PG-ST. Primary endpoints were freedom from endoleak, IIA branch occlusion and secondary interventions.
EVIDENCE SYNTHESIS: Twenty-eight studies were selected for analysis describing a total of 1316 patients, 1169 in the IBED group and 147 in the PG-ST group. The technical success rates were akin for IBED and PG-ST (83.9-100% versus 81.3-100%). The defined primary endpoints were reported by fourteen articles. Freedom from endoleak, IIA branch occlusion and reintervention, at 6 months, were as follows: 82-100% versus 86%, 90-94% versus 88%, and 90-98% versus 87%, respectively for IBED and PG-ST. Later outcomes were only recorded in the IBED group, and freedom from endoleak, IIA branch occlusion and reintervention, at 9 years, were 83%, 81-90%, and 64-75%, respectively.
CONCLUSIONS: Both IBED and PG-ST have proven to be safe and valid approaches. However, while IBED has established as a durable procedure, mid-term data lacks on PGs performance and further studies are required to attest durability of the latter procedure.

KEY WORDS: Iliac aneurysm; Vascular grafting; Endoleak; Graft occlusion, vascular