Han Jesse Y, DiBartolomeo Alexander D, Pyun Alyssa J, Hong Yong H, Paige Jacquelyn F, Magee Gregory A, Weaver Fred A, Han Sukgu M
Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine of the University of Southern California, Los Angeles, CA.
Division of Vascular Surgery and Endovascular Therapy, Keck Medical Center of University of Southern California, Los Angeles, CA.
Ann Vasc Surg. 2025 Feb;111:13-24. doi: 10.1016/j.avsg.2024.09.049. Epub 2024 Oct 10.
Treatment of iliac artery aneurysms (IAAs) with the iliac branch endoprosthesis (IBE) during endovascular repair of infrarenal abdominal aortic aneurysm (endovascular aortic repair (EVAR)) has been well-documented as effective. However, limited data exist evaluating the safety and efficacy of treating complex abdominal (cAAAs) and thoracoabdominal aortic aneurysms (TAAAs) with associated IAA with combined physician-modified fenestrated-branched EVAR (PM-FBEVAR) and IBE. Moreover, limited studies exist assessing the impact of adding IBE on the outcomes following PM-FBEVAR. Therefore, we compared the clinical outcomes of patients who underwent PM-FBEVAR with and without IBE for the treatment of cAAA and TAAA.
A single-institution retrospective review of consecutive patients who underwent PM-FBEVAR between September 2015 and February 2021 was conducted. Patients with both unilateral and bilateral IBE implantation were included. Infected aneurysms and pseudoaneurysms were excluded. Demographics, technical success, and operative factors were analyzed. Primary outcomes were incidence of pelvic ischemia including buttock and thigh claudication, bowel and spinal cord ischemia, patency of internal and external limbs of IBE, and target vessel instability. Secondary outcomes included technical success, 30-day major adverse events, 30-day and all-cause mortality, and endoleaks.
Among 183 patients identified who underwent PM-FBEVAR, 22 patients underwent PM-FBEVAR and IBE with 3 patients treated with bilateral IBEs. There was no pelvic ischemia in the PM-FBEVAR and IBE group. Technical success, fluoroscopy time, and procedure time were comparable between the 2 groups. Contrast usage was higher in the PM-FBEVAR and IBE group (P = 0.01). Thirty-day major adverse event and mortality were not statistically different between the 2 groups. At a mean follow-up of 23 months, all-cause mortality was similar for both groups (21% vs. 27%; P = 0.47). Patency of internal iliac artery limb and external iliac artery limb of the IBE were 96% (24 of 25) and 100%, respectively, during mean follow-up of 23 months. The patient with occlusion of internal iliac limb was asymptomatic and received no reintervention.
Treatment of cAAA and TAAA associated with IAA using combined PM-FBEVAR and IBE is feasible with high efficacy and safety, and without adverse effect on outcomes. Long-term follow-up is planned to assess durability of repair with PM-FBEVAR and IBE.
在肾下腹主动脉瘤腔内修复术（血管腔内主动脉修复术（EVAR））期间，使用髂支血管内支架（IBE）治疗髂动脉瘤（IAA）已被充分证明是有效的。然而，关于联合医生改良开窗分支EVAR（PM-FBEVAR）和IBE治疗复杂腹主动脉瘤（cAAA）和胸腹主动脉瘤（TAAA）合并IAA的安全性和有效性的数据有限。此外，评估添加IBE对PM-FBEVAR术后结局影响的研究也很有限。因此，我们比较了接受PM-FBEVAR联合或不联合IBE治疗cAAA和TAAA患者的临床结局。
对2015年9月至2021年2月期间连续接受PM-FBEVAR治疗的患者进行单中心回顾性研究。纳入单侧和双侧植入IBE的患者。排除感染性动脉瘤和假性动脉瘤。分析人口统计学、技术成功率和手术因素。主要结局包括盆腔缺血的发生率，包括臀部和大腿间歇性跛行、肠道和脊髓缺血、IBE内、外分支的通畅情况以及靶血管稳定性。次要结局包括技术成功率、30天主要不良事件、30天和全因死亡率以及内漏。
在183例接受PM-FBEVAR治疗的患者中，22例接受了PM-FBEVAR联合IBE治疗，其中3例接受双侧IBE治疗。PM-FBEVAR联合IBE组未发生盆腔缺血。两组的技术成功率、透视时间和手术时间相当。PM-FBEVAR联合IBE组的造影剂用量更高（P = 0.01）。两组间30天主要不良事件和死亡率无统计学差异。平均随访23个月时，两组的全因死亡率相似（21%对27%；P = 0.47）。在平均23个月的随访期间，IBE的髂内动脉分支和髂外动脉分支的通畅率分别为96%（25例中的24例）和100%。髂内分支闭塞的患者无症状，未接受再次干预。
联合PM-FBEVAR和IBE治疗合并IAA的cAAA和TAAA是可行的，具有高疗效和安全性，且对结局无不良影响。计划进行长期随访以评估PM-FBEVAR和IBE修复的耐久性。
