Comparison Study of Iliac Branch Endoprosthesis when Used on and off Label

• Published in: Annals of vascular surgery Vol. 89; pp. 28 - 35
• Main Authors: Rodriguez, Limael E., Eun, John C., Calkins, Ryan T., Carroll, Adam M., Malgor, Emily A., Wohlauer, Max V., Nehler, Mark R., Jacobs, Donald L., Malgor, Rafael D.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-02-2023
• Subjects: Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Endovascular Procedures - adverse effects; Humans; Iliac Aneurysm - diagnostic imaging; Iliac Aneurysm - etiology; Iliac Aneurysm - surgery; Male; Off-Label Use; Prosthesis Design; Retrospective Studies; Stents; Time Factors; Treatment Outcome
• ISSN: 0890-5096; 1615-5947
• DOI: 10.1016/j.avsg.2022.03.015

The aim of this study is to compare how instructions for use (IFU) affected perioperative and intermediate term outcomes for common iliac artery aneurysms (CIAA) treated with the Gore Excluder iliac branch endoprosthesis (IBE).
A retrospective analysis was performed of all patients treated at two affiliated academic centers from September 2016 to May 2020. Outcomes were compared between IFU and nonIFU IBE cases. Criteria for nonIFU included: (1) use with a nonGore aortic endoprosthesis (n = 10), (2) isolated IBE (n = 3), and (3) requiring nondedicated covered stents for additional extension into a more suitable landing zone in the ipsilateral internal iliac artery or one of its branches (n = 11). Perioperative and intermediate term data were collected for both groups. The primary end points were free from the major adverse event (MAE) at 30 days and primary effectiveness at 1 year.
A total of 51 CIAA (39 patients) were treated with an IBE. Overall, 15 patients were treated under IFU and 24 under nonIFU. The IFU group mean age was older (72 vs. 67 years, P = 0.03), and males (97%) were primarily treated. Comorbidities were similar except nonIFU had more patients with previous endovascular abdominal aortic aneurysm repair on presentation (0 vs. 4 cases, P = 0.04). Procedure (178 vs. 264 min, P = 0.02) and fluoroscopy (52 vs. 74 min, P = 0.04) times were longer in the nonIFU group. Technical success was 100% for both groups, and there was no difference in device related reintervention at 30 days (0 vs. 1, P = 0.44). There was no MAE in either group at 30 days. Intervention for any endoleak was similar between the groups (2 vs. 3, P = 0.94). Percent CIAA sac regression was similar between the groups (19% vs. 18%, P = 0.21). There was no difference for primary effectiveness at 1 year (93% vs. 92%, P = 0.85). There was one death per group at one year not related to an aortic or iliac cause.
In properly selected patients with complex anatomy, IBE can be used with nondedicated aortic and internal iliac components with good early term outcomes.
•Endoleaks occurred at similar rates between the IFU and nonIFU groups.•NonIFU IBE with a nonGORE aortic component and/or covered stent extensions to complete a repair is safe and feasible with similar outcomes at short and intermediate term follow-up.•Regardless of IFU status, IBE is associated with high procedural success and low reintervention rates.