Preservation of the Internal Iliac Arteries with Branched Iliac Stent Grafts (Zenith Bifurcated Iliac Side): 5 Years of Experience

Background: The extension of the aneurysmal disease to the iliac bifurcations is one of the limits of the endovascular treatment of aortoiliac aneurysms. The Zenith Bifurcated Iliac Side (ZBIS (R)) stent graft (Cook Medical) is a branched stent graft making it possible to preserve the internal iliac arteries (IIAs) using a totally endovascular procedure. Methods: The purpose of this monocentric retrospective study was to analyze the results of the ZBIS stent graft among patients presenting aortoiliac aneurysms extending to the iliac bifurcation treated between January 1st, 2010 and January 1st, 2015 in the department of vascular surgery of the University Hospital of Toulouse. Results: A total of 26 ZBIS stent grafts were implanted in 25 patients. The perioperative mortality was null, and the technical success rate was 96% (24 of 25). The median duration of follow-up was 29 months (1-60). Mortality rate at 30 days was null. The rate of early complications was 4% (1 of 25), with only one early reintervention for acute ischemia. Patency rate at 30 days was 96.1% (25 of 26) with 1 type 1 a endoleak observed with 1 aortobi-iliac stent graft. The midterm patency rate without endoleak was 94.7% (18 of 19), with 2 patients presenting a persistent buttock claudication due to the embolization of the IIA. Conclusions: The ZBIS stent graft makes it possible to exclude aortoiliac aneurysms by endovascular route, whereas preserving the IIA with satisfactory results in the short and medium term. The careful study of the preoperative quality of the IIAs and the respect of the Instructions for Use made it possible to obtain a very satisfactory patency rate.