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- W3094187724 abstract "Endovascular treatment of common iliac artery (CIA) and internal iliac artery (IIA) aneurysms using an iliac branch endoprosthesis (IBE) has been safe and effective. Instructions for use require deployment of current IBE technology with the corresponding manufacturer’s modular bifurcated aortic endograft. Concomitant aortoiliac occlusive disease, inadequate renal artery to iliac bifurcation length, and unfavorable aortic anatomy preclude on-label IBE deployment. Herein, we present the technical feasibility and safety outcomes of alternative aortic endograft platforms circumventing aortoiliac anatomy preclusive to current IBE technology. In five consecutive patients with CIA or IIA aneurysms, computed tomography angiography and centerline reconstruction revealed aortoiliac anatomy incompatible with the current IBE instructions for use criteria because of a combination of inadequate renal artery to iliac bifurcation length (n = 5), inadequate proximal CIA landing zone (n = 4), or compromised aortic anatomy (n = 2). To overcome these restrictions and to facilitate IBE deployment, we performed aortoiliac reconstruction using the AFX (Endologix, Irvine, Calif) or Endurant II (Medtronic, Santa Rosa, Calif) platform (Fig, B). All IIA reconstructions and external iliac artery extensions were performed using the Gore VBX stent grafts (W. L. Gore & Associates, Flagstaff, Ariz). Technical success was defined as successful delivery of all endograft components without migration or endoleak. The mean age of the patients was 72 years (range, 61-82 years; four men). Three patients had bilateral CIA aneurysms and two patients had unilateral CIA aneurysms (mean diameter, 4.2 cm; range, 2.2-7 cm). There were 10 IIA VBX stent grafts used for a total of 7 IIAs treated with IBE (bilateral IBE in 2 patients). The mean fluoroscopy time was 37.8 minutes (range, 21.3-64.3 minutes), and the mean contrast material volume was 148.5 mL (range, 122-226 mL). Technical success was 100% with no perioperative complications. Mean hospital stay was 1.75 days (range, 1-3 days). Follow-up ranged from 133 to 685 days (mean, 389 days). At last follow-up, all patients were alive without cardiovascular morbidity; computed tomography angiography revealed stable or decreased aneurysm size, patent endografts, and no evidence of endoleak or migration. Certain aortoiliac anatomic constraints preclusive to current IBE technology can be safely and effectively overcome with alternative aortic endograft platforms. We encourage broader use of these alternative endografts in pertinent anatomic conFigurations." @default.
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- W3094187724 date "2020-11-01" @default.
- W3094187724 modified "2023-09-28" @default.
- W3094187724 title "Alternative Aortic Endografts Overcome Aortoiliac Anatomy Preclusive to Iliac Branch Endoprostheses" @default.
- W3094187724 doi "https://doi.org/10.1016/j.jvs.2020.08.089" @default.
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