%0 Journal Article
%T Anatomical Predictors of Flared Limb Complications in Endovascular Aneurysm Repair
%A Andrea Stella
%A Chiara Mascoli
%A Enrico Gallitto
%A Gianluca Faggioli
%A Giuseppe Indelicato
%A Mauro Gargiulo
%A Mohammad Abualhin
%A Rodolfo Pini
%J Journal of Endovascular Therapy
%@ 1545-1550
%D 2019
%R 10.1177/1526602819851251
%X Purpose: To evaluate possible predictors of complications with flared iliac stent-graft limbs for ectatic common iliac arteries (CIAs) associated with abdominal aortic aneurysms treated with endovascular aneurysm repair (EVAR). Materials and Methods: A retrospective comparative analysis was conducted of 533 EVAR patients (mean age 75 years; 442 men) treated between 2012 and 2017 who had complications associated with the stent-graft limbs (n=1066). Complications, including type Ib endoleak, type IIIa endoleak, and limb occlusion, were compared between patients with nondilated (<16 mm) CIAs treated with standard iliac limbs (SLs, n=808) vs patients with ectatic CIAs treated with flared limbs (FLs, n=258). Follow-up included a duplex scan at 3, 6, and 12 months and yearly thereafter; computed tomography angiography was performed in case of iliac complications. Risk factors for iliac complications in FLs were investigated using Cox regression and Kaplan-Meier analyses; results of the regression analysis are presented as the hazard ratio (HR) and 95% confidence interval (CI). Results: Overall, no iliac complications occurred at 30 days, but over a mean follow-up of 38¡À8 months, there were 10 (1%) events (4 limb occlusions, 6 type Ib endoleaks): 7 (3%) in FLs and 3 (0.4%) in SLs (p=0.20). Kaplan-Meier analysis found no differences at 5 years in SLs vs FLs for freedom from limb occlusion (99%¡À1% vs 98%¡À1%, respectively; p=0.30) or type Ib endoleak (96%¡À3% vs 97%¡À1%, respectively; p=0.44). Similarly, the overall 5-year iliac complication rates were similar in SLs vs FLs (96%¡À3% vs 95%¡À2%, p=0.21). Regression analysis found CIA length ¡Ü30 mm (HR 4.7, 95% CI 1.02 to 21.6, p=0.04) and a diameter ¡Ý20 mm (HR 7.8, 95% CI 1.05 to 64.8, p=0.03) to be independent predictors of iliac complications in FLs. Kaplan-Meier estimates of iliac complication¨Cfree survival in FLs were significantly worse when the CIA length was ¡Ü30 mm (79%¡À9% vs 98%¡À1%, p=0.003) or the diameter was ¡Ý20 mm (85%¡À7% vs 99%¡À1%, p=0.02). The combination of both risk factors produced significantly poorer iliac complication¨Cfree survival compared with cases in which there was one or no risk factor (67%¡À19% vs 96%¡À2% vs 99%¡À1%, respectively; p<0.001). Conclusion: Iliac limb complications are infrequent in EVAR, regardless of the type of iliac limb chosen; however, CIAs ¡Ü30 mm in length or ¡Ý20 mm in diameter significantly increased the risk of late iliac complications in FLs. If both characteristics were present, this risk was further elevated
%K common iliac artery
%K complication
%K endovascular aneurysm repair
%K endoleak
%K flared limb
%K limb occlusion
%K type Ib endoleak
%U https://journals.sagepub.com/doi/full/10.1177/1526602819851251