Effect of Bridging Stent Graft Selection on the Outcomes of Endovascular Aneurysm Repair using an Iliac Branch Device.

Abstract

This study aimed to assess the effect of bridging stent graft (BSG) selection on the outcomes of endovascular aneurysm repair using an iliac branch device (IBD) and to compare the performance of the Advanta V12 and BeGraft Plus stent grafts for this purpose. This was a retrospective, single centre cohort study including all patients undergoing elective implantation of a Cook Zenith IBD between January 2010 and May 2024. Primary endpoints were technical success, primary BSG patency, and IBD related endoleaks, re-interventions, and target vessel instability (TVI). Secondary endpoints were aneurysm related death and procedure related complications. During the study period, 212 IBDs were implanted in 156 patients (148 men [94.9%]; mean age 68 ± 8 years). Fifty-six patients (35.9%) received bilateral IBDs. The BSGs implanted were Advanta V12 in 114 IBDs (53.8%), BeGraft Plus in 88 IBDs (41.5%), and other BSG types in ten IBDs (4.7%). Primary technical success was achieved in 211 of 212 implanted devices (99.5%), with no early deaths. During a median follow up of 31 months (interquartile range 12, 66), 18 (8.5%) internal iliac artery (IIA) branches occluded in 14 patients. Estimated IIA branch patency at 1, 2, and 4 years was 99.5 ± 0.5%, 91 ± 2.6%, and 84 ± 3.6%, respectively, with no statistically significant differences regarding the BSG used (log rank p = .55). There were 17 (8.0%) IBD related endoleaks during follow up, and 25 patients (16.0%) required a late re-intervention, most of them due to endoleaks or in stent stenosis. Estimated freedom from TVI at 1, 2, and 4 years was 94 ± 1.9%, 84 ± 3.3%, and 76 ± 4%, respectively, with no statistically significant differences regarding the BSG used (log rank p = .35). Advanta V12 and BeGraft Plus performed well as BSGs in combination with the Cook Zenith IBD for endovascular aorto-iliac aneurysm repair and they both showed similar outcomes in terms of primary patency and freedom from IBD related endoleaks, re-interventions, and TVI.