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8-Year Long-Term Outcome Comparison: Two Ways to Exclude the Internal Iliac Artery during Endovascular Aorta Repair (EVAR) Surgery.

Luo H, Huang B, Yuan D, Yang Y, Xiong F, Zeng G, Wu Z, Chen X, Du X, Wen X, Liu C, Yang H, Zhao J - PLoS ONE (2015)

Bottom Line: There were no significant differences in the early outcomes of intraoperative blood loss (87.23±14.07 ml; A: 86.53±9.57 ml vs.However, there were significant differences in contrast consumption (65.18±9.85 ml; A: 61.89±7.95 ml vs.In the follow-up analysis, no significant differences were identified in the incidence of endoleak (22 subjects; type I: A: 2 vs.

View Article: PubMed Central - PubMed

Affiliation: West China Medical School of Sichuan University, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China.

ABSTRACT

Purpose: To evaluate the 8-year long-term outcome after internal iliac artery (IIA) coverage with or without embolization in EVAR.

Patients and methods: From January 2006 to December 2013, abdominal aortic aneurysm (AAA) subjects that underwent EVAR and IIA exclusion were recruited and analyzed retrospectively. All the subjects were divided into group A or B based on the presence or absence of intraoperative IIA embolization before coverage (group A: without embolization; group B: with embolization). The 30-day mortality, stent patency, and the incidences of endoleaks and ischemia of the buttocks and lower limbs were compared. The follow-up period was 96 months.

Result: There were 137 subjects (A: 74 vs. B: 63), 124 male (91.1%) and 13 female (9.5%), with a mean age of 71.6 years. There were no significant differences in the early outcomes of intraoperative blood loss (87.23±14.07 ml; A: 86.53±9.57 ml vs. B: 88.06±18.04 ml, p = .545) and surgery time (87.13±9.25 min; A: 85.99±7.07 min vs. B: 88.48±11.19 min, p = .130). However, there were significant differences in contrast consumption (65.18±9.85 ml; A: 61.89±7.95 ml vs. B: 69.05±10.50 ml, p<.001) and intraoperative X-ray time (5.9±0.86 min; A: 5.63±0.49 min vs. B: 6.22±1.07 min, P<.001). The 30-day mortality was approximately 0.73%. In the follow-up analysis, no significant differences were identified in the incidence of endoleak (22 subjects; type I: A: 2 vs. B: 2, p = 1.000; type II: A: 8 vs. B: 4, p = .666; type III: A: 4 vs. B: 3, p = 1.000), occlusion (5 subjects; 4.35%; A: 1 vs. B: 4, p = .180), or ischemia (9 subjects; 7.83%; A: 3 vs. B: 6, p = .301). In the analysis of group B, although there were no significant differences between subjects with unilateral and bilateral IIA embolization, but longer hospital stays were required (P<.001), and a more severe complication (skin and gluteus necrosis) occurred in 1 subject with bilateral IIA embolization.

Conclusion: IIA could be excluded during EVAR. IIA coverage without embolization had a good surgical and prognostic outcome, and this procedure was not different significantly from coverage with embolization in terms of endoleaks, patency and ischemia.

No MeSH data available.


Related in: MedlinePlus

*Indications for group A (a, b, c, d, e, f, g): a: Standard abdominal aortic aneurysm (AAA; not coupled with common iliac artery aneurysm, CIAA), but the landing zone in the common iliac artery (CIA) was too short to anchor.b, c, d: Standard AAA coupled with internal iliac artery aneurysm (IIAA). e, f, g: AAA coupled with CIAA (unilateral or bilateral), and CIAA did not invade the original IIA, and the distance (L) from the distal end of the CIAA to the original IIA was less than 10–15 mm without stenosis or ectasia. *Indications for group B (h, I, j): AAA coupled with CIAA (unilateral or bilateral), and the CIAA invaded the original internal iliac artery (IIA). *Stents were supplied by Medtronic Inc (TALENT and ENDURANT series). Coils were supplied by Johnson & Johnson Company (Amplatzer).
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pone.0130586.g001: *Indications for group A (a, b, c, d, e, f, g): a: Standard abdominal aortic aneurysm (AAA; not coupled with common iliac artery aneurysm, CIAA), but the landing zone in the common iliac artery (CIA) was too short to anchor.b, c, d: Standard AAA coupled with internal iliac artery aneurysm (IIAA). e, f, g: AAA coupled with CIAA (unilateral or bilateral), and CIAA did not invade the original IIA, and the distance (L) from the distal end of the CIAA to the original IIA was less than 10–15 mm without stenosis or ectasia. *Indications for group B (h, I, j): AAA coupled with CIAA (unilateral or bilateral), and the CIAA invaded the original internal iliac artery (IIA). *Stents were supplied by Medtronic Inc (TALENT and ENDURANT series). Coils were supplied by Johnson & Johnson Company (Amplatzer).

Mentions: 3) AAA coupled with CIAA (unilateral or bilateral), CIAA did not invade the original IIA, and L (shown in Fig 1, the distance from the distal end of the CIAA to the original IIA) was less than 10–15 mm without stenosis or ectasia (a, b, c, d, e, f, g).


8-Year Long-Term Outcome Comparison: Two Ways to Exclude the Internal Iliac Artery during Endovascular Aorta Repair (EVAR) Surgery.

Luo H, Huang B, Yuan D, Yang Y, Xiong F, Zeng G, Wu Z, Chen X, Du X, Wen X, Liu C, Yang H, Zhao J - PLoS ONE (2015)

*Indications for group A (a, b, c, d, e, f, g): a: Standard abdominal aortic aneurysm (AAA; not coupled with common iliac artery aneurysm, CIAA), but the landing zone in the common iliac artery (CIA) was too short to anchor.b, c, d: Standard AAA coupled with internal iliac artery aneurysm (IIAA). e, f, g: AAA coupled with CIAA (unilateral or bilateral), and CIAA did not invade the original IIA, and the distance (L) from the distal end of the CIAA to the original IIA was less than 10–15 mm without stenosis or ectasia. *Indications for group B (h, I, j): AAA coupled with CIAA (unilateral or bilateral), and the CIAA invaded the original internal iliac artery (IIA). *Stents were supplied by Medtronic Inc (TALENT and ENDURANT series). Coils were supplied by Johnson & Johnson Company (Amplatzer).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4507853&req=5

pone.0130586.g001: *Indications for group A (a, b, c, d, e, f, g): a: Standard abdominal aortic aneurysm (AAA; not coupled with common iliac artery aneurysm, CIAA), but the landing zone in the common iliac artery (CIA) was too short to anchor.b, c, d: Standard AAA coupled with internal iliac artery aneurysm (IIAA). e, f, g: AAA coupled with CIAA (unilateral or bilateral), and CIAA did not invade the original IIA, and the distance (L) from the distal end of the CIAA to the original IIA was less than 10–15 mm without stenosis or ectasia. *Indications for group B (h, I, j): AAA coupled with CIAA (unilateral or bilateral), and the CIAA invaded the original internal iliac artery (IIA). *Stents were supplied by Medtronic Inc (TALENT and ENDURANT series). Coils were supplied by Johnson & Johnson Company (Amplatzer).
Mentions: 3) AAA coupled with CIAA (unilateral or bilateral), CIAA did not invade the original IIA, and L (shown in Fig 1, the distance from the distal end of the CIAA to the original IIA) was less than 10–15 mm without stenosis or ectasia (a, b, c, d, e, f, g).

Bottom Line: There were no significant differences in the early outcomes of intraoperative blood loss (87.23±14.07 ml; A: 86.53±9.57 ml vs.However, there were significant differences in contrast consumption (65.18±9.85 ml; A: 61.89±7.95 ml vs.In the follow-up analysis, no significant differences were identified in the incidence of endoleak (22 subjects; type I: A: 2 vs.

View Article: PubMed Central - PubMed

Affiliation: West China Medical School of Sichuan University, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China.

ABSTRACT

Purpose: To evaluate the 8-year long-term outcome after internal iliac artery (IIA) coverage with or without embolization in EVAR.

Patients and methods: From January 2006 to December 2013, abdominal aortic aneurysm (AAA) subjects that underwent EVAR and IIA exclusion were recruited and analyzed retrospectively. All the subjects were divided into group A or B based on the presence or absence of intraoperative IIA embolization before coverage (group A: without embolization; group B: with embolization). The 30-day mortality, stent patency, and the incidences of endoleaks and ischemia of the buttocks and lower limbs were compared. The follow-up period was 96 months.

Result: There were 137 subjects (A: 74 vs. B: 63), 124 male (91.1%) and 13 female (9.5%), with a mean age of 71.6 years. There were no significant differences in the early outcomes of intraoperative blood loss (87.23±14.07 ml; A: 86.53±9.57 ml vs. B: 88.06±18.04 ml, p = .545) and surgery time (87.13±9.25 min; A: 85.99±7.07 min vs. B: 88.48±11.19 min, p = .130). However, there were significant differences in contrast consumption (65.18±9.85 ml; A: 61.89±7.95 ml vs. B: 69.05±10.50 ml, p<.001) and intraoperative X-ray time (5.9±0.86 min; A: 5.63±0.49 min vs. B: 6.22±1.07 min, P<.001). The 30-day mortality was approximately 0.73%. In the follow-up analysis, no significant differences were identified in the incidence of endoleak (22 subjects; type I: A: 2 vs. B: 2, p = 1.000; type II: A: 8 vs. B: 4, p = .666; type III: A: 4 vs. B: 3, p = 1.000), occlusion (5 subjects; 4.35%; A: 1 vs. B: 4, p = .180), or ischemia (9 subjects; 7.83%; A: 3 vs. B: 6, p = .301). In the analysis of group B, although there were no significant differences between subjects with unilateral and bilateral IIA embolization, but longer hospital stays were required (P<.001), and a more severe complication (skin and gluteus necrosis) occurred in 1 subject with bilateral IIA embolization.

Conclusion: IIA could be excluded during EVAR. IIA coverage without embolization had a good surgical and prognostic outcome, and this procedure was not different significantly from coverage with embolization in terms of endoleaks, patency and ischemia.

No MeSH data available.


Related in: MedlinePlus