The use of iliac branched devices in the acute endovascular repair of ruptured aortoiliac aneurysms.

Abstract Objectives To evaluate the feasibility and midterm outcomes of iliac branch devices (IBDs) to preserve the internal iliac artery (IIA) perfusion in emergent endovascular repair of ruptured aorto-iliac aneurysms. Methods Between December 2012 and July 2017, a total of 8 IBDs were implanted in 6 patients (median age 65 years; all men) in a single tertiary referral center. The indication for IBD implantation was a ruptured abdominal aortic aneurysm with a concomitant common iliac artery (CIA) aneurysm (n=4) or an isolated CIA aneurysms (n=2). The main outcome measures were technical and clinical success. Secondary outcomes were primary and primary assisted patency, occurrence of types I/III endoleaks and re-interventions. Results All patients were hemodynamically stable during the procedures, which were performed under local anesthesia. Technical success was achieved in all cases (median total procedure time 188 min, median IBD procedure time 28 min). Median follow-up was 34 months (IQR 19 -78). There were no deaths during follow up and no major complications unrelated to the IBD. Two (25%) secondary interventions were performed for IBD-occlusion in patients with bilateral IBDs. The other re-intervention was a type II endoleak embolization in one of these 2 patients. The freedom from re-intervention estimate was 75% through 2 year. The overall primary assisted patency was 100% through 3 years. Conclusion The use of iliac branched devices in the acute setting is feasible to exclude ruptured aorto-iliac aneurysms while maintaining pelvic circulation. The secondary intervention rate is considerable, however the midterm assisted primary patency rates are promising. Further studies are needed to guide patient selection and to evaluate longer term outcomes.