Division of Vascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Department of Vascular Surgery, Heidelberg University Hospital, Heidelberg, Germany.
Ann Vasc Surg. 2024 Nov;108:484-497. doi: 10.1016/j.avsg.2024.05.022. Epub 2024 Jul 14.
The Global Iliac Branch Study (NCT05607277) is an international, multicenter, retrospective cohort study of anatomic predictors of adverse iliac events (AIEs) in aortoiliac aneurysms treated with iliac branch devices (IBDs).
Patients with pre-IBD and post-IBD computed tomography imaging were included. We measured arterial diameters, stenosis, calcification, bifurcation angles, and tortuosity indices using a standardized, validated protocol. A composite of ipsilateral AIE was defined, a priori, as occlusion, type I or III endoleak, device constriction, or clinical event requiring reintervention. Paired t-test compared tortuosity indices and splay angles pretreatment and post-treatment for all IBDs and by device material (stainless steel and nitinol). Two-sample t-test compared anatomical changes from pretreatment to post-treatment by device material. Logistic regression assessed associations between AIE and anatomic measurements. Analysis was performed by IBD.
We analyzed 297 patients (286 males, 11 females) with 331 IBDs (227 stainless steel, 104 nitinol). Median clinical follow-up was 3.8 years. Iliac anatomy was significantly straightened with all IBD treatment, though stainless steel IBDs had a greater reduction in total iliac artery tortuosity index and aortic splay angle compared to nitinol IBDs (absolute reduction -0.20 [-0.22 to -0.18] vs. -0.09 [-0.12 to -0.06], P < 0.0001 and -19.6° [-22.4° to -16.9°] vs. -11.2° [-15.3° to -7.0°], P = 0.001, respectively). There were 54 AIEs in 44 IBDs in 42 patients (AIE in 13.3% of IBD systems), requiring 35 reinterventions (median time to event 41 days; median time to reintervention 153 days). There were 18 endoleaks, 29 occlusions, and 5 device constrictions. There were no strong associations between anatomic measurements and AIE overall, though internal iliac diameter was inversely associated with AIE in nitinol devices (n = 8).
Purpose-built IBDs effectively treat aortoiliac disease, including that with tortuous anatomy, with a high patency rate (91.5%) and low reintervention rate (9.1%) at 4 years. Anatomic predictors of AIE are limited.
全球髂支研究（NCT05607277）是一项国际性、多中心、回顾性队列研究，旨在探讨解剖学因素与接受髂分支装置（IBD）治疗的腹主动脉瘤髂内分支不良事件（AIE）之间的关系。
纳入了接受 IBD 治疗前和治疗后 CT 影像学检查的患者。使用标准化、经过验证的方案测量动脉直径、狭窄程度、钙化、分叉角度和迂曲指数。预先定义同侧 AIE 的复合事件为闭塞、I 型或 III 型内漏、器械狭窄或需要再次介入治疗的临床事件。对所有 IBD 以及不锈钢和镍钛诺两种材料的治疗前后的迂曲指数和张开角进行配对 t 检验。采用两样本 t 检验比较不同器械材料治疗前后的解剖学变化。Logistic 回归分析评估了 AIE 与解剖学测量之间的相关性。
我们分析了 297 例患者（286 例男性，11 例女性）的 331 个 IBD（227 个不锈钢，104 个镍钛诺）。中位临床随访时间为 3.8 年。所有 IBD 治疗后髂内分支解剖结构均明显拉直，尽管不锈钢 IBD 治疗后总髂动脉迂曲指数和主动脉张开角的降低幅度大于镍钛诺 IBD（绝对值降低 -0.20 [-0.22 至 -0.18] 比 -0.09 [-0.12 至 -0.06]，P < 0.0001 和 -19.6° [-22.4° 至 -16.9°] 比 -11.2° [-15.3° 至 -7.0°]，P = 0.001）。42 例患者的 44 个 IBD 中发生了 54 例 AIE（13.3%的 IBD 系统发生 AIE），需要 35 次再次介入治疗（中位事件时间 41 天；中位再次介入治疗时间 153 天）。发生 18 例内漏、29 例闭塞和 5 例器械狭窄。尽管镍钛诺器械中，髂内动脉直径与 AIE 呈负相关（n=8），但总体上解剖学测量与 AIE 之间无明显相关性。
专为治疗髂内分支疾病而设计的 IBD 可有效治疗腹主动脉瘤，包括迂曲解剖结构的病变，4 年通畅率为 91.5%，再次介入治疗率为 9.1%。AIE 的解剖学预测因素有限。
