Morphological Suitability of Patients with Aortoiliac Aneurysms for Endovascular Preservation of the Internal Iliac Artery Using Commercially Available Iliac Branch Graft Devices

Abstract

Purpose:

To quantify the proportion of patients with morphology suitable for the use of a commercially available iliac branch graft device (IBD), which offers an endovascular alternative to avoid the morbidity of internal iliac artery (IIA) embolization during endovascular aneurysm repair (EVAR) of aortoiliac aneurysms.

Methods:

A retrospective single-center study was conducted of 51 patients (44 men; mean age 75±7 years) undergoing IIA embolization (36 unilateral, 15 bilateral) prior to EVAR between June 2005 and August 2009. Three-dimensional volume-rendered reconstructions of computed tomographic angiography (CTA) scans were compared to criteria published by experienced surgeons and to manufacturer's instructions for use (IFU). Morphological suitability for IBD was graded with a score reflecting 15 variables (morphological score) extracted from the IFU and publications from experienced endovascular centers. The higher the score, the more adverse morphological features were encountered.

Results:

In the 51 patients, 66 target IIAs were studied. Of these, 25 (38%) target IIAs with a mean morphological score 4.44±1.96 were compliant with the manufacturer's IFU. Nineteen (29%) target IIA were compliant with experienced surgeons' criteria, with a mean morphological score of 4.2±2.0. The most common adverse feature was an aneurysmal IIA.

Conclusion:

In a population of patients with aortoiliac aneurysms, morphological applicability of a commercially available IBD was low, with the majority of patients possessing at least 1 adverse anatomical feature. A validated morphological scoring system derived from registry-type data is needed, with quantification of outcomes in IBD deployment that extends the IFU.

Keywords

endovascular aneurysm repair aortoiliac aneurysm internal iliac artery stent-graft morphology iliac branch graft device

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