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• W2758574536 abstract "Before the availability of iliac branch devices (IBDs), hypogastric artery embolization (HAE) was routinely performed to prevent type Ib endoleak in endovascular repair of abdominal aortic aneurysms with associated common iliac aneurysms. This, however, can result in poor pelvic perfusion leading to ischemic colitis, buttock claudication, and sexual dysfunction. This study investigated whether IBD is superior to HAE in 30-day outcomes of patients with elective endovascular aneurysm repair (EVAR) using the multicenter prospectively collected American College of Surgeons National Surgical Quality Improvement Program database. We used the Targeted Vascular module in the American College of Surgeons National Surgical Quality Improvement Program database to identify patients undergoing elective EVAR for infrarenal abdominal aortic aneurysm repair with and without HAE or IBD from 2012 to 2015. The χ2 test, Fisher exact test, and multivariate regression models were used for data analysis. There were 6311 patients identified; 5114 patients had routine EVAR without either HAE or IBD, 310 with HAE only, 796 with IBD only, and 91 with both HAE and IBD. Subgroup analyses were performed to compare the outcomes of HAE or IBD against routine EVAR and each other (Table). Compared with routine EVAR, prolonged operative time of >5 hours was more common in HAE (6% vs 2%; P < .01) and IBD (4.0% vs 2%; P = .01). Patients also had longer intensive care unit and hospital stays after HAE and IBD compared with routine EVAR (Table). Patients with HAE had higher 30-day mortality than those with routine EVAR (3% vs 1.0%; P = .02), whereas those with IBD had higher rate of ischemic colitis than those with routine EVAR (1% vs 0.4%; P = .01). After multivariate analysis, IBD was associated with higher incidence of ischemic colitis compared with routine EVAR (odds ratio, 3.13 [1.41-6.95]; P = .005). There was no difference in 30-day outcomes between HAE and IBD, including ischemic colitis (0.7% vs 1.0%; P = .74). The increased complexity of HAE and IBD in EVAR is associated with worse outcomes compared with routine EVAR. IBD appears to make no difference in 30-day outcomes, including ischemic colitis, compared with HAE. Future research to examine other benefits of IBD in preserving pelvic perfusion, such as preventing buttock claudication and sexual dysfunction, is warranted.TableThirty-day outcomes of hypogastric artery embolization (HAE), iliac branch device (IBD), and routine endovascular aneurysm repair (EVAR)Groups, No. (%)P valuesHAE (n = 310)IBD (n = 796)Routine EVAR (n = 5114)HAE vs routine EVARIBD vs routine EVARHAE vs IBDOperative time >5 hours18 (6)32 (4)127 (2)<.01.01.20Mortality8 (3)8 (1)53 (1).02.94.09Cardiac events4 (1)9 (1)71 (1).99.56.76Ischemic colitis2 (0.7)9 (1)19 (0.4).34.01.74Composite outcome29 (9)67 (8)401 (8).34.58.62ICU LOS >2 days19 (6)49 (6)176 (3).01<.01.99Hospital LOS >2 days105 (34)268 (34)1261 (25)<.01<.01.95ICU, Intensive care unit; LOS, length of stay. Open table in a new tab" @default.
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• W2758574536 date "2017-10-01" @default.
• W2758574536 modified "2023-09-27" @default.
• W2758574536 title "Iliac Branch Devices Do Not Decrease Ischemic Colitis Compared With Hypogastric Artery Embolization in Endovascular Abdominal Aneurysm Repair" @default.
• W2758574536 doi "https://doi.org/10.1016/j.jvs.2017.07.079" @default.
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