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

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