German Aortic Centre Hamburg, Department of Vascular Medicine, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
German Aortic Centre Hamburg, Department of Vascular Medicine, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
Eur J Vasc Endovasc Surg. 2024 Jun;67(6):895-902. doi: 10.1016/j.ejvs.2024.01.087. Epub 2024 Feb 4.
Iliac branch devices (IBDs) have shown good results but there is little evidence for the risk of internal iliac artery (IIA) endoleak, so there are no clear recommendations on the maximum diameter it should be. Based on limited evidence, it was hypothesised that an IIA of ≥ 11 mm in diameter presents an increased risk of type Ic endoleak.
This was a single centre, retrospective case control study. Patients undergoing an IBD with the main trunk of the IIA as the target vessel, between 2015 and 2021, were identified. Two groups were created: those with a main trunk diameter of < 11 mm; and those with a diameter of ≥ 11 mm. Technical success, freedom from type Ic endoleak, and re-intervention rates were compared. A receiver operating characteristic (ROC) curve was performed to show a cutoff IIA diameter value for risk of type Ic endoleak. Multivariate analysis was performed to assess the risk of type Ic endoleak and the presence of calcification, stenosis, and landing zone length in the IIA.
There were 182 IBDs identified. The dilated IIA group (54 IBDs) had significantly lower technical success (91% vs. 98.4%; p = .002), lower freedom from type Ic endoleak (77% vs. 97.1% at 24 months; p = .001), and lower freedom from re-interventions (70% vs. 92.4% at 24 months; p = .002). The ROC curve showed that 10.5 mm was the cutoff diameter for type Ic endoleak. Moderate or severe calcification as well as landing zone length < 5 mm also correlated with type Ic endoleak.
IBDs have a statistically significantly higher rate of technical failure, lower freedom from type Ic endoleak, and lower freedom from re-intervention when the IIA is ≥ 11 mm in diameter.
髂分支装置（IBD）已显示出良好的效果，但关于髂内动脉（IIA）内漏的风险证据较少，因此对于其最大直径没有明确的建议。基于有限的证据，假设 IIA 直径≥11mm 会增加 Ic 型内漏的风险。
这是一项单中心、回顾性病例对照研究。确定了 2015 年至 2021 年间接受 IBD 治疗且 IIA 主干为靶血管的患者。创建了两组：一组 IIA 主干直径<11mm；另一组 IIA 主干直径≥11mm。比较了技术成功率、无 Ic 型内漏率和再介入率。进行了受试者工作特征（ROC）曲线分析，以显示 IIA 直径值的临界值与 Ic 型内漏风险的关系。进行了多变量分析，以评估 Ic 型内漏的风险以及 IIA 中的钙化、狭窄和着陆区长度的存在。
共确定了 182 个 IBD。扩张的 IIA 组（54 个 IBD）的技术成功率显著较低（91%比 98.4%；p=0.002），无 Ic 型内漏的比例较低（24 个月时为 77%比 97.1%；p=0.001），无再介入的比例较低（24 个月时为 70%比 92.4%；p=0.002）。ROC 曲线显示，10.5mm 是 Ic 型内漏的临界直径。中度或重度钙化以及着陆区长度<5mm 也与 Ic 型内漏相关。
当 IIA 直径≥11mm 时，IBD 的技术失败率、无 Ic 型内漏率和无再介入率均有统计学显著升高。
