Universität zu Köln

Gray, D., Shahverdyan, R., Reifferscheid, V., Gawenda, M. and Brunkwall, J. S. (2017). EVAR with Flared Iliac Limbs has a High Risk of Late Type 1b Endoleak. Eur. J. Vasc. Endovasc. Surg., 54 (2). S. 170 - 177. LONDON: W B SAUNDERS CO LTD. ISSN 1532-2165

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Abstract

Introduction: Re-interventions are still the Achilles' heel of endovascular aneurysm repair (EVAR). Ectatic common iliac arteries (CIA) can be treated with flared iliac limbs but a dilated artery used as sealing zone could increase the risk of a late type 1b endoleak. The aim of the present analysis was to evaluate the risk of late type 1b endoleak after EVAR in patients with CIA limbs >= 20 mm compared with those <20 mm. Methods: A retrospective analysis was performed of patients treated by EVAR at the study institution between 2006 and 2012, including patients with available information about the type of iliac stent grafts and a minimum follow-up (FU) of 3 years with contrast enhanced CT, or those that had developed a type 1b endoleak earlier. The cohort was divided into two groups: Group I included iliac limbs with a distal diameter <20 mm, and Group II included all iliac limbs with a distal diameter >= 20 mm. Results: Of 692 limbs (346 patients),239 limbs (34.5%) from 129 patients were included in the analysis. Mean CT FU was 53 months, 178 had an iliac stent graft diameter <20 mm (Group I), and 61 a diameter of >= 20 mm (Group II). Mean oversizing for iliac limbs was 17.2% (IQR 14) and there was no case of immediate type lb endoleak. For the whole group, 18 type 1b endoleaks occurred during FU (7.5%) after a mean of 37.7 months (range 4-96). Eleven of 61 (18%) iliac limbs in Group II developed a type lb endoleak during FU in contrast to 7/178 (3.9%) in Group I (OR 5.3, 95% CI 1.98-14.59, p = 0,001). The ROC curve analysis indicated a limb diameter of 19 mm as a cutoff value for a higher probability of developing a type 1b endoleak. Conclusion: Patients treated with iliac limbs >= 20 mm had a fivefold higher risk of late (mean 37 months) type lb endoleak compared with patients treated with a distal iliac limb diameter <20 mm. (C) 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Gray, D. UNSPECIFIED UNSPECIFIED UNSPECIFIED Shahverdyan, R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Reifferscheid, V. UNSPECIFIED UNSPECIFIED UNSPECIFIED Gawenda, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Brunkwall, J. S. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-224030
DOI:	10.1016/j.ejvs.2017.05.008
Journal or Publication Title:	Eur. J. Vasc. Endovasc. Surg.
Volume:	54
Number:	2
Page Range:	S. 170 - 177
Date:	2017
Publisher:	W B SAUNDERS CO LTD
Place of Publication:	LONDON
ISSN:	1532-2165
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ABDOMINAL-AORTIC-ANEURYSM; BELL-BOTTOM TECHNIQUE; ENDOVASCULAR REPAIR; ARTERY ANEURYSMS; EXPERIENCE; OUTCOMES; ENLARGEMENT; PREDICTORS; ENDOGRAFT; OCCLUSION Multiple languages Surgery; Peripheral Vascular Disease Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/22403