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Endovascular Iliac Branch Devices for Iliac Aneurysms
Endovascular aneurysm repair (EVAR) offers significant benefits to many patients, yet the applicability of EVAR has been challenged in patients with unfavorable proximal necks or aneurysmal involvement of the iliac arteries. The latter situation occurs in 12% to 40% of patients. Standard therapy involves embolization or coverage of the internal iliac artery, which often results in buttock and thigh claudication and on rare occasion spinal cord ischemia, mesenteric ischemia, and pelvic necrosis. The need and desire to incorporate iliac branches into an aortic repair has led to development of extra-anatomic reconstructions, chimney-type stent grafts, modifications of commercially available stent grafts, and the use of specifically designed iliac branch devices (IBDs).
Rationale
Complications of not preserving internal iliac artery blood flow during EVAR, such as claudication or sexual dysfunction, are not well studied or reported in most series. Nevertheless, these problems affect up to 50% of patients treated with unilateral internal iliac artery occlusion and up to 80% of those having occlusion of both iliac arteries. The risk of serious complications is greater in patients with thoracoabdominal aneurysms, where compromise of the internal iliac artery circulation has been shown to increase the risk of paraplegia in experimental models and clinical reports. Thus the ability to maintain antegrade perfusion of the pelvic circulation using IBD is potentially useful in patients with limited disease, but it is critical in patients with more extensive disease.
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