The JOTEC iliac branch device for exclusion of hypogastric artery aneurysms: ABRAHAM study

Philip Dueppers; Mansur Duran; Nikolaos Floros; Hubert Schelzig; Markus U Wagenhäuser; Alexander Oberhuber

doi:10.1016/j.jvs.2018.10.124

The JOTEC iliac branch device for exclusion of hypogastric artery aneurysms: ABRAHAM study

J Vasc Surg. 2019 Sep;70(3):748-755. doi: 10.1016/j.jvs.2018.10.124. Epub 2019 Mar 6.

Authors

Philip Dueppers¹, Mansur Duran², Nikolaos Floros², Hubert Schelzig², Markus U Wagenhäuser², Alexander Oberhuber²

Affiliations

¹ Department of Vascular and Endovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany. Electronic address: philip.dueppers@med.uni-duesseldorf.de.
² Department of Vascular and Endovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany.

PMID: 30850288
DOI: 10.1016/j.jvs.2018.10.124

Abstract

Objective: Hypogastric artery aneurysms (HAAs) are rare but life-threatening in cases of rupture. Open or endovascular techniques traditionally aimed at occluding the hypogastric artery (HA) have considerable risk of pelvic ischemia. Iliac branch devices (IBDs) are indicated for aortoiliac aneurysms; however, they have also been used lately for HAAs. Currently, there are no reports about patient outcomes focusing on HAA therapy using IBDs. We retrospectively analyzed early and midterm outcomes using IBDs for HAAs.

Methods: Patients who received IBDs for HAAs at our department from January 1, 2012, through March 1, 2018, were included. Exclusion criteria were as follows: no HA involvement, emergency procedures, and HA stent grafting without IBD. Perioperative and follow-up data were collected from medical records.

Results: There were 18 IBDs (only IBD, n = 4; IBD + endovascular aneurysm repair [EVAR], n = 7; IBD ± EVAR + side branch occlusion, n = 7) implanted into 14 male patients (76 ± 4 [70-83] years). There were no intraoperative complications, and the technical success rate was 100%. After 19 ± 11 (2-39) months of follow-up, two hybrid (external iliac artery occlusion, n = 1; EVAR graft kinking, n = 1) and four endovascular reinterventions due to two type IB (side branch coiling + stent graft extension) and two type IIIB (stent grafting) endoleaks were required. One IBD-related type II endoleak revealed constant aneurysm diameters during follow-up. One small type IB endoleak was self-limited. Estimated freedom from reintervention was 31% ± 23% at 2.7 years. The clinical success and patency rate was 100%. The IBD-related mortality was 0%.

Conclusions: The IBD for HAA shows good early and midterm results. Adequate sealing of HA landing zones and side branch occlusion are technically challenging but crucial to prevent type IB and type II endoleaks.

Keywords: Aneurysm endoleak; Endovascular procedures; Iliac aneurysm; Iliac artery.

MeSH terms

Aged
Aged, 80 and over
Aneurysm / diagnostic imaging
Aneurysm / physiopathology
Aneurysm / surgery*
Arteries / diagnostic imaging
Arteries / physiopathology
Arteries / surgery*
Blood Vessel Prosthesis Implantation / adverse effects
Blood Vessel Prosthesis Implantation / instrumentation*
Blood Vessel Prosthesis*
Endoleak / etiology
Endoleak / therapy
Endovascular Procedures / adverse effects
Endovascular Procedures / instrumentation*
Female
Graft Occlusion, Vascular / etiology
Graft Occlusion, Vascular / therapy
Humans
Male
Pelvis / blood supply*
Progression-Free Survival
Prosthesis Design
Retrospective Studies
Risk Factors
Time Factors
Vascular Patency