Predictive Factors Analysis Of Pelvic Ischemic Symptoms After Iliac Artery Occlusion In EVAR And Application Of Physician Modified Iliac Branch Devices

Section I:Predictive factors analysis of pelvic ischemic symptoms after internal iliac artery occlusion in EVARObjective:To summarize single center clinical information of abdominal aorta aneurysm(AAA)nearly 5 years and analyze risk factors for pelvic ischemic complications after embolization of the internal iliac artery in EVAR.Methods:The clinical history,preoperative CTA measurement and follow-up results of 82 patients with unilateral embolization of internal iliac artery were analyzed statistically.Patients with pelvic ischemic symptoms were performed as the study group and the remaining patients were included in the control group.Results:Of the 82 patients with internal iliac artery occlusion,20 had pelvic ischemic symptoms,the incidence rate was 24%,13 patients symptoms disappeared,5 patients were relieved after treatment,and 2 patients symptoms persist.There were significant differences between the two groups in the number of branches of the contralateral iliac artery and the rate of stenosis in the ipsilateral deep femoral artery(P<0.05).In the multivariate logistic regression analysis,the risk of pelvic ischemic symptoms was significantly increased when the number of contralateral iliac artery branches was ?3(OR value was 8.383,95%confidence interval was 1.469-47.841,P=0.017).The deep stenosis rate of the deep femoral artery was 0.084,which was not statistically significant.Conclusion:Number of branches of the contralateral iliac artery on preoperative CTA?3 is an independent risk factor for pelvic ischemia complications after EVAR surgery.Section ?:Anatomic suitability of abdominal-iliac aortic aneurysm patients in chinese for iliac branched devicePurpose:Preservation of internal iliac flow is the key to prevent ischemic complications during endovascular aneurysm repair.This article aim to determine the morphological features of abdominal aortic aneurysms(AAA)in Chinese in order to identify unique features for iliac branched systems currently in clinical trial.Methods:Patients who had common iliac aneurysms suitable for imaging review from 2014 to 2017 at 1 institution in China were reviewed.Three-dimensional workstations were used to measure Centerline diameters and lengths of aortoiliac morphology and compared with exclusion criteria for both Cook and Gore iliac branch devices.Results:102 lesions of common iliac aneurysms suitable for imaging review.Anatomic standards compliant were shown as 13.7%(14/102)and 9.8%(10/102)by the Gore IBE criteria and by the Cook IBD criteria respectively,three of them were suitable for both devices.The most common reason causing failure in the Cook IBD(78.4%)and Gore IBE(48.03%)was the same which was constraints in the diameter of the target internal iliac artery.It was determined that of the 92 lesions excluded from the Cook IBD trial,11(10.9%)would be eligible for the Gore IBE trial.Likewise7.95%(7/88)of the lesions excluded from the Gore IBE trial would have been eligible for the Cook IBD graft.In a practice able to offer patients entry into both trials,a total of 20.6%(21/102)would be eligible for treatment based on anatomic criteria.Conclusions:The incidence of iliac artery involvement in abdominal aortic aneurysms will make the EVAR more complicated.The Cook IBD and Gore IBE can only apply to a total of 20.6%patients in Chinese for treatment based on anatomic criteria.Constraints in the diameter of the target internal iliac artery is the most common reason causing failure on both device.Design modifications for future generation iliac branch technology should focus on diameter accommodations for the hypogastric branch stent to reach a wider group of patients with aortoiliac aneurysmal disease.Section?:Physician modified iliac branch devices for the endovascular treatment of aorta-iliac aneurysmsObjective:To summarize experience and short-term efficacy of preservation of internal iliac artery(?A)in endovascular aorta-iliac artery repair with physician modified iliac branch devices(IBD).Methods:Thirteen patients' internal iliac arteries were reconstructed in endovascular aorta-iliac artery repair with physician modified iliac branch devices,two bilateral contractions and eleven unilateral contractions.Regular follow-up were reviewed as well.Results:Success rate of the surgeries was 100%.Two Type ? endoleaks and one type ? endoleak occurred without the other complications.The average follow-up time was 9 months(4-12months)and no sack enlargement,stent thrombus and death occurred.Two type ? endoleaks disappeared,one type ? endoleak still exist but no enlargement of aneurysm.IBD and internal iliac artery were well patency(100%).One case of buttock claudication got better after 3 months,no erectile and defecation dysfunction occurred.Conclusion:The physician modified iliac branch devices are safe and effective.The short-term efficacy is favorable and long-term lumen patency rate remains to be further followed up.