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The Journal of Cardiovascular Surgery 2022 Mar 03

DOI: 10.23736/S0021-9509.22.12040-9

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Long-term outcomes of endovascular aortic repair with flared iliac limb endografts in patients with abdominal aortic aneurysm and aneurysmal common iliac arteries

Stefano BONARDELLI 1, Fabio VERZINI 2, Nicola RIVOLTA 3, Gabriele PAGLIARICCIO 4, Camilla ZANOTTI 1, Michele BOERO 2, Marco FRANCHIN 3, Luciano CARBONARI 4, Paolo BAGGI 1, Lorenzo GIBELLO 2, Gianbattista PARLANI 5, Raffaella CAVI 3, 6, Gabriele PIFFARETTI 3

1 Vascular Surgery, Department of Surgical and Clinical Sciences, Spedali Civili Hospital, University of Brescia School of Medicine, Varese, Italy; 2 Vascular Surgery, Department of Surgical Sciences, City of Health and Sciences Hospital, University of Turin School of Medicine, Turin, Italy; 3 Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy; 4 Vascular Surgery, Ospedali Riuniti, Ancona, Italy; 5 Vascular and Endovascular Surgery Unit, Santa Maria della Misericordia Hospital, Perugia, Italy; 6 ASST Settelaghi, Varese, Italy


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BACKGROUND: To evaluate the long-term outcomes of endovascular aneurysm repair with flared iliac limb grafts in patients with abdominal aortic aneurysm (AAA) and aneurysmal common iliac arteries (CIAs).
METHODS: This is a multicenter, retrospective, observational cohort study that involves four tertiary referral hospitals between May 1st 2005 and April 30th 2019. Primary outcomes were freedom from aneurysm-related mortality (ARM), and freedom from iliac-related reintervention.
RESULTS: We studied 995 aneurysmal iliac limbs in 795 (85.2%) patients who met the inclusion criteria. Median AAA diameter was 55mm (IQR, 51-60). Early mortality occurred in 3 (0.4%) patients. The median of follow-up time was 52 months (IQR, 26-88). Estimated freedom from ARM was 99% ± 0.002 (95%CI: 99-99.9) at 1 year, and 99% ± 0.004 (95%CI: 97.9-99.6) at 5-years. Chronic obstructive pulmonary disease (HR: 6.4, 95%CI: 1.7-24.0, p = 0.006), chronic kidney disease (HR: 5.5, 95%CI: 1.4-21.9, p = 0.016), and the presence of an aneurysmal left CIA (HR: 5.3, 95%CI: 1.0.5-27.4, p = 0.044) was associated with ARM. There were 42 (7.3%) late iliac-related events (limb occlusion, n = 5; iliac-related endoleaks, n = 37). Estimated freedom from iliac-related reintervention was 98% ± 0.003 (95%CI: 97-99) at 1 year, and 95% ± 0.01 (95%CI: 92.7-96.7) at 5-years, which was associated with an aneurysmal right CIA (HR: 2.2, 95%CI: 1.3-3.9; p = 0.005), and age ≥ 78 years (HR: 1.9, 95%CI: 1.01-1.3; p = 0.039).
CONCLUSIONS: EVAR flared iliac limb grafts showed a high rate of freedom from ARM and a low reintervention rate. Owing to these results, it can be a durable and stable alternative for patients aged >78 years.


KEY WORDS: Aneurysmal common iliac artery; Aneurysmal iliac arteries; Type 1b endoleak; Endovascular aortic repair; Bell-bottom

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