Comparison Study of Iliac Branch Endoprosthesis when Used on and off Label

Limael E Rodriguez; John C Eun; Ryan T Calkins; Adam M Carroll; Emily A Malgor; Max V Wohlauer; Mark R Nehler; Donald L Jacobs; Rafael D Malgor

doi:10.1016/j.avsg.2022.03.015

Comparison Study of Iliac Branch Endoprosthesis when Used on and off Label

Ann Vasc Surg. 2023 Feb:89:28-35. doi: 10.1016/j.avsg.2022.03.015. Epub 2022 Mar 24.

Authors

Limael E Rodriguez¹, John C Eun², Ryan T Calkins³, Adam M Carroll², Emily A Malgor², Max V Wohlauer², Mark R Nehler², Donald L Jacobs², Rafael D Malgor²

Affiliations

¹ Division of Vascular Surgery, Department of Surgery, University of Colorado Anschutz School of Medicine at Denver, Aurora, CO. Electronic address: Limael.Rodriguez@cuanschutz.edu.
² Division of Vascular Surgery, Department of Surgery, University of Colorado Anschutz School of Medicine at Denver, Aurora, CO.
³ University of Colorado Anschutz School of Medicine at Denver, Aurora, CO.

PMID: 35339599
DOI: 10.1016/j.avsg.2022.03.015

Abstract

Background: The aim of this study is to compare how instructions for use (IFU) affected perioperative and intermediate term outcomes for common iliac artery aneurysms (CIAA) treated with the Gore Excluder iliac branch endoprosthesis (IBE).

Methods: A retrospective analysis was performed of all patients treated at two affiliated academic centers from September 2016 to May 2020. Outcomes were compared between IFU and nonIFU IBE cases. Criteria for nonIFU included: (1) use with a nonGore aortic endoprosthesis (n = 10), (2) isolated IBE (n = 3), and (3) requiring nondedicated covered stents for additional extension into a more suitable landing zone in the ipsilateral internal iliac artery or one of its branches (n = 11). Perioperative and intermediate term data were collected for both groups. The primary end points were free from the major adverse event (MAE) at 30 days and primary effectiveness at 1 year.

Results: A total of 51 CIAA (39 patients) were treated with an IBE. Overall, 15 patients were treated under IFU and 24 under nonIFU. The IFU group mean age was older (72 vs. 67 years, P = 0.03), and males (97%) were primarily treated. Comorbidities were similar except nonIFU had more patients with previous endovascular abdominal aortic aneurysm repair on presentation (0 vs. 4 cases, P = 0.04). Procedure (178 vs. 264 min, P = 0.02) and fluoroscopy (52 vs. 74 min, P = 0.04) times were longer in the nonIFU group. Technical success was 100% for both groups, and there was no difference in device related reintervention at 30 days (0 vs. 1, P = 0.44). There was no MAE in either group at 30 days. Intervention for any endoleak was similar between the groups (2 vs. 3, P = 0.94). Percent CIAA sac regression was similar between the groups (19% vs. 18%, P = 0.21). There was no difference for primary effectiveness at 1 year (93% vs. 92%, P = 0.85). There was one death per group at one year not related to an aortic or iliac cause.

Conclusions: In properly selected patients with complex anatomy, IBE can be used with nondedicated aortic and internal iliac components with good early term outcomes.

MeSH terms

Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation* / adverse effects
Endovascular Procedures* / adverse effects
Humans
Iliac Aneurysm* / diagnostic imaging
Iliac Aneurysm* / etiology
Iliac Aneurysm* / surgery
Male
Off-Label Use
Prosthesis Design
Retrospective Studies
Stents
Time Factors
Treatment Outcome