ORIGINAL ARTICLE  VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2022 August;63(4):464-70

DOI: 10.23736/S0021-9509.22.12040-9

Copyright © 2022 EDIZIONI MINERVA MEDICA

lingua: Inglese

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

BACKGROUND: The aim of this study was 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 1, 2005, and April 30, 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: Iliac artery; Endoleak; Endovascular procedures