Study Evaluates Long-Term Outcomes of EVAR for Infrarenal Aortoiliac Aneurysms

September 27, 2017—Findings from a study evaluating and comparing the long-term clinical outcomes of endovascular aneurysm repair (EVAR) of infrarenal aortoiliac aneurysms (AIAs) versus EVAR with preservation of antegrade internal iliac artery (IIA) perfusion using iliac branched devices (IBDs) were published by Behzad S. Farivar, MD, et al in Journal of Vascular Surgery (JVS; 2017;66:1028–1036).

The investigators concluded that EVAR of infrarenal AIAs with preservation of antegrade flow to the IIA using IBDs is feasible with long-term sustained durability. They advised that serious considerations should be given to the use of IBDs in patients with infrarenal AIAs that meet appropriate anatomic criteria.

As summarized in JVS, patients with infrarenal AIA disease at high risk for conventional open surgery were enrolled in a prospective, physician-sponsored, investigational device exemption trial from October 1998 to August 2015. The investigators evaluated the clinical data of 75 patients treated with IBD EVAR and 255 patients with standard EVAR. Technical success, perioperative outcomes, mortality, device patency, endoleak rates, and reinterventions during a follow-up of 10 years were analyzed.

There were 87 IBDs deployed in 75 patients. The 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, 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 who underwent AIA EVAR versus IBD EVAR (P > .05). There were significantly more secondary reinterventions in the AIA EVAR group compared with the IBD EVAR group (hazard ratio, 0.476; 95% confidence interval, 0.226–1.001; P = .045), reported the investigators in JVS.