Durability of iliac artery preservation associated with endovascular repair of infrarenal aortoiliac aneurysms.

OBJECTIVE: This study evaluated and compared the long-term clinical outcomes of endovascular repair of infrarenal aortoiliac aneurysms (EVAR) vs EVAR with preservation of antegrade internal iliac artery (IIA) perfusion using iliac branched devices (EVAR-IBDs). METHODS: From October 1998 to August 2015, patients with infrarenal aortoiliac aneurysmal (AIA) disease at high risk for conventional open surgery were enrolled in a prospective physician-sponsored investigational device exemption trial. Clinical data of 75 patients treated with EVAR-IBD and 255 with standard EVAR were analyzed. Technical success, perioperative outcomes, mortality, device patency, endoleak rates, and reinterventions during a follow-up of 10 years were analyzed. RESULTS: There were 87 IBDs deployed in 75 patients. Technical success rate was 97%. Mortality at 30 days was 1.3%. Freedom from aneurysm-related mortality at 3, 5, and 10 years was 99%. Freedom from a type I or III endoleak at 3, 5, and 10 years was 99%. Freedom from secondary reinterventions at 3, 5, and 10 years was 86%, 81%, and 81%, respectively. Primary patency of the IBDs at 3, 5, and 10 years was 94%, 94%, and 77%, respectively. Twenty-four percent of patients underwent EVAR for concomitant AIA disease (EVAR-AIA), and 78% were managed by staged IIA embolization before EVAR. No statistically significant difference in freedom from aneurysm-related mortality, limb occlusions, or endoleak rates was identified in patients with EVAR-AIA vs EVAR-IBD (P > .05). There were significantly more secondary reinterventions in the EVAR-AIA group compared with the EVAR-IBD group (hazard ratio, 0.476, 95% confidence interval, 0.226-1.001; P = .045). CONCLUSIONS: EVAR of infrarenal AIAs with preservation of antegrade flow to the IIA using IBDs is feasible with long-term sustained durability. Serious considerations should be given to the use of IBDs in patients with infrarenal AIAs meeting appropriate anatomic criteria.

Technical considerations, outcomes, and durability of inferior vena cava stenting.

OBJECTIVE: Inferior vena cava (IVC) thrombosis is an uncommon condition but can cause devastating complications to those affected. Historically, this has been treated with an open surgical approach (with high morbidity) and with angioplasty in more recent years. Herein we describe technical aspects of stenting of the IVC in patients with recalcitrant chronic occlusive disease and evaluate its outcomes. METHODS: We reviewed all the patients treated in an endovascular fashion for venous disease at our institution from 2005 to 2014 to identify and to include those with IVC stent placement in this study. Clinical characteristics, treatment details, and outcomes data were collected from medical records. Primary end points were technical success, symptom resolution, freedom from reintervention, and patency rate at follow-up. RESULTS: Twenty-eight patients (15 men) with a mean age of 48 ± 2.7 years underwent IVC stent placement for 16 occlusions (4 congenital) and 12 high-grade stenoses. Hypercoagulable state was noted in 14 patients, 7 of whom had malignant disease. A previously placed IVC filter was present in 13 patients. Median time from onset of symptoms to presentation was 81 months (3-480 months). Lytic therapy with tissue plasminogen activator (Alteplase) was performed in 12 patients for a median of 2 days (range, 1-3 days). Self-expanding stents (Wallstent; Boston Scientific, Natick, Mass) were used most commonly in the IVC (n = 22) with or without adjunctive use of balloon-expandable stents (Palmaz stent; Cordis, New Brunswick, NJ). Technical success was 100%. At median follow-up of 10 months (range, 0-56 months), thrombotic complications requiring reintervention occurred in four patients at 1, 4, 8, and 37 months. One patient died at 2 weeks secondary to underlying malignant disease. Freedom from reintervention, patency rate, and symptom-free survival rate at 2 years were 84%, 90%, and 80%. CONCLUSIONS: Endovascular stenting for chronic occlusive disease of the IVC is safe and effective in the midterm follow-up, with minimal morbidity. Reintervention rate is low, with excellent functional outcomes.