Perioperative Outcomes After Use of Iliac Branch Devices Compared With Hypogastric Occlusion or Open Surgery for Elective Treatment of Aortoiliac Aneurysms in the NSQIP Database

Background: Iliac branch devices (IBDs) can treat iliac and aortoiliac aneurysms (AIAs) less invasively than open surgery (OS) and preserve pelvic perfusion. Our hypothesis was that the rates of perioperative complications after treatment for AIAs are similar between IBDs and hypogastric occlusion with coil and cover (C&C), and lower than OS. Methods: We identified patients undergoing elective AIA repair by IBD, C&C, and OS (all with infrarenal clamps) within the National Surgical Quality Improvement Program (NSQIP) vascular aneurysm specific Participant User Files (2012-2016). Baseline characteristics, procedural variables, and 30-day outcomes were compared. The primary outcomes were any major complication or death. Secondary outcomes included minor complications, total operative time, total and intensive care unit length of stay (LOS), and reinterventions. Multivariable logistic regression assessed differences in major complications between IBD and C&C/OS after adjusting for patient and procedural variables. Results: We identified 593 patients (83% men, mean age 71.6 +/- 9 years) undergoing elective AIA repair (IBD = 283, C&C = 118, and OS = 192). Patient age and American Society of Anesthesiology (ASA) classification varied significantly between groups. Mean aneurysm diameter was higher for OS and similar between IBD and C&C (5.9 cm vs. 5.5 cm and 5.2 cm, respectively, P < 0.001). OS was associated with higher rate of major complications (65.5% vs. IBD: 8.8% and C&C: 13.6%, P=<0.001) and higher mortality (3.6% vs. IBD: 0.7% and C&C: 0%, P = 0.017). Minor complications and reinterventions were similar. IBD patients had significantly shorter total operative time and total and intensive care unit LOS. After adjustment, OS was associated with higher major complications compared with IBD (Odds ratio [OR]: 11.3, 95% confidence interval [CI]: 5.8-21.9, P < 0.001), primarily because of the use of transfusions (major complications excluding transfusions OR: 1.3, 95% CI: 0.6-2.8, P = 0.52). Major complications between IBD and C&C were similar (OR: 1.6, 95% CI: 0.8-3.4, P = 0.23). Conclusions: The use of IBDs for elective treatment of AIAs is associated with favorable perioperative outcomes and a lower rate of major complications compared with OS, primarily because of fewer transfusions. IBDs use has perioperative outcomes similar to C&C with the associated benefit of preserving pelvic perfusion. Pending long-term durability results for this technique, IBDs appear to be associated with several perioperative advantages in patients with AIAs compared with OS and C&C.