Abstract
ObjectiveThe aim of study is to investigate the safety and efficacy of preserving bilateral internal iliac arteries (IIAs) in patients with aortoiliac aneurysms using iliac branch stent grafts (IBSG).MethodsFrom June 2019 to February 2024, a total of 265 patients with aortoiliac aneurysm from four tertiary hospitals in China were included. They were divided into 110 patients with bilateral iliac artery aneurysms and 155 patients with unilateral aneurysm. Based on whether the IIA were occluded, the patients with bilateral aneurysms were further divided into Group BB (bilateral aneurysms with bilateral IBSG) and Group BU (bilateral aneurysms with unilateral IBSG and contralateral IIA embolization), and the patients with unilateral aneurysm into Group UB (unilateral aneurysm and preserve bilateral IIA) and Group UU (unilateral aneurysm and preserve unilateral IIA). Group BB and Group BU, as well as Group UB and Group UU, were compared after propensity score matching. The primary endpoint was major adverse events, and the secondary endpoint was pelvic ischemia.ResultsAfter matching, there were 76 patients in the Group BB (38 patients) and the Group BU (38 patients), with an average follow-up of 24.0 ± 7.0 months. Among these patients, 3 patients (7.9%) in the Group BB and 2 patients (5.3%) in the Group BU experienced IBSG occlusion. In the Group BB, 1 patient (2.6%) had type IB endoleak, 1 patient (2.6%) had type III endoleak due to IBSG migration, and 1 patient (2.6%) in the Group BU had type I endoleak. The rate of IBSG-related interventions was similar between the two groups (13.2% vs. 7.9%, p > 0.05). Compared with the Group BB, patients with buttock claudication (1 vs. 10, p < 0.05) and decreased erection function (2 vs. 12, p < 0.05) were more common in the Group BU, and the Group BU also reported more new cases of erectile dysfunction (1 vs. 6, p < 0.05). After matching, there were 55 patients in the Group UB and 55 patients in the Group UU, with an average follow-up of 23.0 ± 6.0 months. One patient (1.8%) in the Group UB and 1 patient (1.8%) in the Group UU experienced type I endoleak. Four patients (7.3%) in the Group UB and 1 patient (1.8%) in the Group UU underwent reintervention (p > 0.05). One patient (1.8%) in the Group UB and 13 patients (23.6%) in the Group UU complained of buttock claudication, and more patients in the Group UU had decreased erection function (2 vs. 14, p < 0.05). Among these, 9 patients (16.4%) had newly developed erectile dysfunction (p < 0.05). During the study period, no patients experienced aneurysm-related mortality.ConclusionThe complete preservation of bilateral IIAs using IBSG has shown satisfactory midterm results, which are associated with lower rates of occlusion and reintervention. Additionally, the strategy may effectively preserve the ambulation and sexual function of patients.