Autor:innen:
Prof. Dr. med. Johannes N. Hoffmann | CONTILIA Heart and Vascular Center - Elisabeth Hospital Essen | Germany
Dr. med. Ahmed Soliman | CONTILIA Heart and Vascular Center - Elisabeth Hospital Essen | Germany
Dr. med. Johannes Bernheim | CONTILIA Heart and Vascular Center - Elisabeth Hospital Essen | Germany
Dr Ahmed Moussa | CONTILIA Heart and Vascular Center - Elisabeth Hospital Essen | Germany
PD Dr. Benjamin Juntermanns | HELIOS Group | Germany
Dr. med. Mikolaj Walensi | CONTILIA Heart and Vascular Center - Elisabeth Hospital Essen | Germany
Objective: The Gore® Excluder® - side branch endoprosthesis for iliac arteries (iliac branch endoprosthesis, IBE) is a device for the treatment of solitary or combined (aorto-)(bi-)iliac arterial aneurysms, mainly to prevent major complications occurring from an occluded internal iliac artery (IIA), i.e. buttock claudication (approx. 16-55%) and erectile dysfunction (approx. 10-17%). The objective of our study is to evaluate the safety, feasibility, and efficacy of this IBE in the treatment of (aorto-)(bi-)iliac aneurysms.
Patients and methods: All consecutive patients, who underwent iliac aneurysm repair (solitary or combined with an endovascular aortic repair) using the Gore® Excluder® - IBE device in our clinic since 2016 were included. Indication, localization, operation time, blood loss, hospitalization time, as well as complications, reinterventions, and patency rates were evaluated. All values are given as median (range). Statistical analysis was performed by non-parametric paired tests.
Results: Between 02/2016 and 10/2020, 53 aneurysms (16 solitary, 31 combined; 6 double-sided) were treated in 47 consecutive patients (age 71 (53-89)), BMI 28 (22-45), 4 female, 4 symptomatic) using the Gore® Excluder® - IBE. The implantation was successful in 52/53 cases (98%), in one case complete implantation failed due to distinctive atherosclerosis of the IIA landing zone. Hospitalization time was 7 (4-21) days, operation time 169 (80-541) min, blood loss 500 (100-3000) ml. Hemoglobin concentration (g/dl) was 14 (11-16) preoperatively and 12 (9-14) directly postoperatively (p=0.0001), transfusion of 2 (2 patients) and 4, respectively, red cell concentrates was necessary in 3 patients. Creatinine concentration (mg/dl) was 1.0 (0.5-1.65) preoperatively and 0.85 (0.39-1.51) directly postoperatively (p=0.25). Perioperative mortality and IBE-related 30-days-reintervention rate was 0%. Main surgery associated perioperative complications were the following cases: one patient required thrombectomy of the right leg due to postoperative occlusion during the hospital stay. Furthermore, one dissection of the external iliac artery, not requiring any further intervention, one occlusion of the side branch due to inappropriate dual platelet aggregation inhibition (incompliance), one case of acute kidney failure one month after surgery, not requiring dialysis and one wound healing disorder, were observed. The median follow-up time was 6 months (4 days - 2.6 years) with an overall patency rate of 98% of the IBEs (52/53 devices).
Conclusion: The treatment of (aorto-)(bi-)iliac arterial aneurysms using the Gore® Excluder® - IBE is safe and feasible and shows excellent short-term patency rates and low perioperative complication rates. To validate long-term results, further follow-ups of the treated patients are required, ideally using contrast enhanced sonography (e.g. SonoVue®) or CT angiography.