Introduction and objective:

iliac limb thrombosis in endovascular aorto-iliac aneurysm repair (EVAR) has an incidence rate of 6 % to 7 %, leading in these cases to a high reintervention rate. Aortic bifurcation diameter has been studied as a risk factor. The aim of this study was to analyze the impact of aortic bifurcation anatomy in aorto-iliac aneurysm treated with EVAR.

Methods:

we conducted a single-center retrospective study in patients treated with bifurcated EVAR (2011-2020). We analyzed the demographic, anatomical, surgical and clinical variables. Narrow aortic bifurcation (NAB) was defined as diameters < 20 mm and regular aortic bifurcation (RAB) ≥ 20 mm. Primary endpoint: iliac limb primary patency during follow-up. Secondary endpoints: EVAR limb stenosis or kinking requiring further intraoperative treatment (percutaneous transluminal angioplasty (PTA) and/or stenting) and freedom from device-related reintervention.

Results:

205 patients (410 iliac limbs) were included; 47 patients with NAB (18.1 ± 1.24 mm) and 94 iliac limbs (23 %) and 158 RAB with 316 iliac limbs (77 %) were included. During follow-up (mean follow-up of 40.5 months) occlusion rate was 1.6 % in RAB and 0 % in NAB (p = 0.593). The NAB group showed a 3.2 % rate of limb stenosis which required further intraoperative treatment vs a 1.3 % rate from the control group (p = 0.2). The rates of freedom from device-related reintervention at 1 month, 1, 5 and 10 years were 98.1 %, 92.9 %, 83.4 %, and 79.1 % in RAB, and 100 %, 100 %, 94.7 %, and 94.7 % in NAB, respectively (p = 0.013).

Conclusions:

EVAR seems to be feasible, safe and effective in the managemenf of narrow aortic bifurcations with current devices, achieving high patency rates, without requiring additional intraoperative measures.

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