Surgical versus endovascular repair by iliac branch device of aneurysms involving the iliac bifurcation

Objective: To evaluate early and late results of open (OR) and endovascular aneurysm repair by iliac side branch device (EVRISB) for aneurysms involving the iliac bifurcation (AIB). Methods:Between January 2004 and March 2010, 118 patients were diagnosed with AIBs and underwent OR or EVRISB at two European vascular centers. Particularly, 64 (54.2%) patients were treated by EVRISB and 54 (45.8%) by OR. In one center, 24 consecutive patients were treated by surgery because this was the standard therapeutic approach until January 2005. For the rest of the study period until March 2010,64 consecutive patients with AIB suitable for EVRISB underwent placement of branched devices. In the other center, 30 consecutive patients with AIBs were treated by OR because advanced endovascular imaging was not available during the study period. Results: No significant differences in demographics, anatomical characteristics, or comorbidities of the patients were recorded between the two groups. Early (30-day) mortality was 0% for EVRISB versus 5.5% for the OR group (P < .001). Major morbidity occurred in 4.6% versus 9.3% of the patient subgroups, respectively (P < .001). Buttock claudication and colonic ischemia were recorded in 5.9% and 2% of OR patients compared with 3.1% and 0% of EVRISB cases (P > .05). Primary patency rates were 98.4% for EVRISB and 100% for OR patients. Primary and secondary endoleak rates of the EVRISB group were 12.5% and 6.3%, respectively. Conclusions: Endovascular repair by iliac branch device of aneurysms involving the iliac bifurcation can be accomplished with very low morbidity and mortality rates. Especially for young active patients or in cases of contralateral occlusion, the preservation of hypogastric artery seems to be a strong argument for use of EVRISB as a preferable therapy option. (J Vasc Surg 2011;53:1223-9.)