J Vasc Surg. 2022 Mar 9:S0741-5214(22)00421-9. doi: 10.1016/j.jvs.2022.02.053. Online ahead of print.
ABSTRACT
OBJECTIVE: The Gore Excluder iliac branch endoprosthesis (IBE; W.L. Gore & Associates, Flagstaff, AZ) is the only iliac branch device approved in the United States to preserve blood flow to the external and internal iliac arteries (IIAs). Some surgeons have used the Gore Viabahn VBX balloon expandable endoprosthesis (VBX; W.L. Gore & Associates) in the IIA rather than the self-expanding endograft designed for the IBE, the internal iliac component (IIC). The objective of the present study was to examine outcomes in patients treated for aortoiliac artery aneurysms with the IBE using either the IIC or VBX stent.
METHODS: We performed a retrospective, single-center review of patients treated for aortoiliac artery aneurysms using the Gore IBE device, with either the IIC or VBX stent into the internal iliac artery from February 2016 to March 2021. Patient demographics, procedure details, 30-day morbidity and mortality, and 6-month and 1-year outcomes and mortality were analyzed. The categorical factors were summarized using frequencies and percentages. Continuous measures were summarized using mean ± standard deviation. A significance level of P = .05 was assumed for all test results. The analyses were performed using SAS software, version 9.4 (SAS Institute, Cary, NC).
RESULTS: Sixty-four patients underwent elective aortoiliac artery aneurysm repair with IBE. IIC was used exclusively in 35 patients (55%) and VBX in 29 (45%). Patients receiving VBX had higher American Society of Anesthesiologists class (P = .006). Upper extremity access was used for VBX delivery in 24.1% of the procedures. No return to the operating room was required in either group. No differences were found in technical success (97.1% IIC vs 93.1% VBX; P = .59), presence of endoleak upon completion (20.0% vs 6.9%; P = .17), readmission (97.1% vs 93.1%; P = .59), or mortality (1.6% vs 0%; P = .45) at 30 days. No differences were found in the requirement for any IBE reintervention after 30 days. No type Ia, Ib, or III endoleaks occurred in either group at any follow-up point. There was no significant difference in internal iliac limb primary patency (IIC 100% vs VBX 96.3%) between groups. A non-statistically significant trend was found toward fewer trunk-ipsilateral leg type II endoleaks in the VBX group during post-procedure follow-up.
CONCLUSIONS: These data suggest that VBX is a reasonable substitute for IIC and has a comparable safety and efficacy profile. Given its inherent conformability, greater range of diameters, and longer working length, VBX offers expanded internal iliac artery branch options with IBE.
PMID:35278651 | DOI:10.1016/j.jvs.2022.02.053
