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Long-term Results of IBD-EVAR: 10 Year Experience from Leipzig
Daniela Branzan, MD,
Department of Vascular Surgery
University Hospital Leipzig
Disclosure
I do not have any potential conflict of interest.
Rationale
3
Common iliac artery aneurysm
- Isolated: rare
- Unilateral: 43% of pts. with AAA1
- Bilateral: 11% of pts. with AAA1
Endovascular Repair of CIA Aneurysms
• requires distal extension into the EIA, covering the
origin of the IIA
• sacrifice of the HA is associated with wide range of
complications:
– Persisting Buttock Claudication (50%)
– Sexual dysfunction (10-20%)
Hinclilieffe et al.. J Vasc Surg 2003;38(1):88-92
Kouvelos et al. Eur J Vasc Endovasc Surg 2016
Farivar et al. J Vasc Surg 2017
Chitragari et al. J Vasc Surg 2015
Farahmand et al. Eur J Vasc Endovasc Surg 2008
4
Solution = Iliac Branch Device (IBD)
extends conventional EVAR
stent-graft into the external iliac
artery
preserves flow into the
ipsilateral internal iliac artery
using a side branch
Leipzig Experience 2007-2017
5
0
5
10
15
20
25
30
35
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
2 2
5
10
1718
22
14
17
2324
2 2
5
11
21
19
26
17
22
24
33
Pat Nr.=154
IBD Nr.=182
Move to University
Hospital Leipzig
Patients‘ Characteristics
6
N %
Total 154
Obesity 89 58
Hypertension 151 98
Smoking 127 82
Diabetes 50 32
CHD 81 53
Hyperlipidämie 110 71
PAOD 45 29
Renal Insufficinecy 88 57
Dialysis 2 1
Patients‘ Profile
Age (year) Mean, (SD) 72±9.3
Gender Male 149
Indications for Treatment
7
Indication for Treatment N %
Total 154
AAA+CIAA 66 42.9
unilat 55
bilat 11
ø AAA, Mean, (SD) (mm) 62±12.3
CIAA 81 52.6
unilat 66
bilat 15
øCIA, Mean, (SD) (mm) 35±10
HAA isolated 7 4.5
unilat 6
bilat 1
ø HA, Mean, (SD) (mm) 30±11
Perioperative Details
8
Parameter N %
182
ZBIS Cook 172 95
IBD Gore 8 4
IBD Jotec 2 1
Aortic component different that IBD 12 7
Suprarenal 6 3
Previous EVAR 23 13
Isolated IBD 12 7
General anesthesia 163 98
Percutaneous access 117 70
Upper extremity access 26 15
Contralateral hypogastric embolization 15 8
Visceral branch embolization and distal
landing in the gluteal branch 33 18
Early Results
9
N %
154
30 Day-mortality 0 0
Cardio-vascular complications 7 4,5
Technical failure 2 1,3
Puncture site complications 5 3,2
Graft related endoleak 8 5,2
Type 2 endoleak 23 14,9
EIA Occlusion 1 0,6
Technical Failure # 1
10
Technical Failure # 2
11
Early EIA Occlusion
12
Late Results
154 %
Mean follow-up (months) 34±29
Late mortality (all causes) 21 13,6
AAA-related mortality 0 0,0
Buttock claudication 7 4,5
External iliac occlusion 3 1,9
13
Long-Term Results: Mean follow-up 34 Mo
Survival: 133/154
14
Patients at risk%
154 106 84 61 46 32 18 10 4 1 1
94 92 92 89 82 73 68 59 39 39 39
73%
39%
• No date on 9 Pts.
• No aneurysm related
death
• No aneurysm rupture
Long-Term Results: Mean follow-up 34 Mo
Freedom from IBD Reintervention: 169/182
15
182 120 96 66 48 33 17 8 4 1 1
96 94 93 88 88 85 85 85 85 85 85
Devices at risk%
88%85%
• 6 Pts: IBD Occlusion• Surgical Tx
• Endo Tx
• 7 Pts: Type 1c, 3 Endoleak• Endo Tx
EL 1
16
Long-Term Results: Mean follow-up 34 Mo
HA Patency: 175/182
17
182 123 99 68 49 33 18 10 5 1 1
98 97 96 93 90 90 90 90 90 90 90
Devices at risk%
90%• 3 Pts: asymptomatic
• 4 Pts: buttock claud.• 2 Pt: Endo Tx
• 2 Pt: conservative Tx
HA Occlusion
18
Long-Term Results: Mean follow-up 34 Mo
Freedom from Reinterventions: 145/182
• 29 Pts: reintervention
for Endoleak causing
aneurysm progression
• EL 1:13
• EL 2:11
• EL 3: 5
• 8 Pts :
• 2 HA Occlusion
• 4 IBD Occlusion
• 1 Access site
occl.
• 1 limb occl.
Contralat.
19
182 105 81 56 39 26 15 8 4 1 1
85 79 77 72 72 66 66 66 66 66 66
Devices at risk%
66%
El 1a
20
EL 2
21
Lessons learned
Circumferential thrombus, calcifications of the arterial
implantation sites
Hypogastric aneurysm/large landing zone in HA
Upper extremity access for short CIA/Re-do procedures
22
Results of EVAR with IBD
Author (Year) n IBD Mortality
Technical
success
Mean FU
(mo)
Branch
occlusion
Haulon (2006) 52 53 0 94 14 11
Dias (2008) 22 23 0 91 20 13
Ferreira (2010) 37 54 0 97 22 11
Parlani (2012) 100 100 0 95 17 7
Wong (2013) 130 138 0 94 20 15
Bisdas (2014) 18 22 0 100 - 0
Pratesi (2014) 81 85 0 99 20 2
Torsello (2015) 178 188 0.3 99 20 8
GORE 12-04 (2017) 96 100 0 98 6 5
Cook PRESERVE (2016) 52 52 0 100 7 0
Simonte(2017) 149 157 0 97,5 44,2 11
Branzan (2018) 154 182 0 98,7 34 7
23
Conclusion
Endovascular treatment of aorto-iliac aneurysms with
the IBD
• is feasible and associated with high technical
success even in the “off the label” cases
• offers acceptable rates of iliac branch occlusion and
reinterventions
• is associated with a low risk of pelvic ischemia
periprocedural as well as in the follow-up period
24
Long-term Results of IBD-EVAR: 10 Year Experience from Leipzig
Daniela Branzan, MD,
Department of Vascular Surgery
University Hospital Leipzig
