Document Detail


Aneurysmal iliac arteries do not portend future iliac aneurysmal enlargement after endovascular aneurysm repair for abdominal aortic aneurysm.
MedLine Citation:
PMID:  21030200     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The purpose of this study was to examine the fate of aneurysmal iliac arteries managed during endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA).
METHODS: We analyzed data from the Cook Zenith trial. Follow-up was at 1 month, 6 months, 12 months, and then annually for 5 years. Patients were evaluated according to the largest iliac artery diameter: group A (≥ 20 mm) and group B (< 20 mm). These groups were further subdivided based on iliac artery growth ≥ 5 mm during follow-up. The Fisher exact test and χ(2) test were used.
RESULTS: Of 736 patients treated, 671 had a follow-up examination (group A = 274). In group A, 220 (80%) were treated with flared limbs in the common iliac artery. Group A did not demonstrate increased iliac growth as compared to group B. Furthermore, both groups had a similar percentage of patients that experienced iliac artery expansion of 32.1% and 31.5%, respectively. Extension to the external iliac artery did not affect growth (P = .4). No difference was noted in the need for secondary interventions between groups. However, group A patients that did not experience growth were more likely to develop a distal type I endoleak than group B patients who did not develop growth (P = .03). There was no difference in serious adverse events (SAEs) between groups (P = .51). However, patients that developed iliac artery growth in either group were less likely to have an SAE compared to patients who did not experience growth (P = .035). There was no difference in the mean percent oversizing of the iliac limbs between groups A and B. However, the mean percent oversizing in groups A and B that had iliac artery growth was significantly higher than in those that demonstrated no growth (P < .01).
CONCLUSION: Aneurysmal iliac arteries managed by flared limbs or external iliac extensions at the time of EVAR for AAA do not demonstrate future iliac growth, increased rate of secondary interventions, or SAEs compared to patients with normal iliac arteries. This suggests that aneurysmal iliac arteries can be safely treated with appropriately sized limbs landed in the common or external iliac artery.
Authors:
Melissa L Kirkwood; Alan Saunders; Benjamin M Jackson; Grace J Wang; Ronald M Fairman; Edward Y Woo
Publication Detail:
Type:  Journal Article     Date:  2010-10-27
Journal Detail:
Title:  Journal of vascular surgery     Volume:  53     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-01-31     Completed Date:  2011-03-10     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  269-73     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Division of Vascular Surgery and Endovascular Therapy, University of Pennsylvania Health System, Philadelphia, PA, USA. Melissa.kirkwood@uphs.upenn.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal / complications,  radiography,  surgery*
Aortography / methods
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation* / adverse effects,  instrumentation
Chi-Square Distribution
Controlled Clinical Trials as Topic
Endoleak / etiology,  surgery
Endovascular Procedures* / adverse effects,  instrumentation
Female
Humans
Iliac Aneurysm / complications,  radiography,  surgery*
Male
Middle Aged
Multicenter Studies as Topic
Prosthesis Design
Reoperation
Risk Assessment
Risk Factors
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
United States
Comments/Corrections
Comment In:
J Vasc Surg. 2011 Nov;54(5):1552; author reply 1552   [PMID:  22027441 ]
J Vasc Surg. 2011 Jul;54(1):285; author reply 285   [PMID:  21722838 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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