Dottorato in FISIOPATOLOGIA ED IMAGING CARDIO-TORACO-VASCOLARE

Titolo della tesi: STUDIO PROSPETTICO SULL’IMPIEGO DI NUOVI DEVICES PER LA RIVASCOLARIZZAZIONE DELL’ARTERIA IPOGASTRICA NELLA PROCEDURA DI ESCLUSIONE ENDOVASCOLARE DEGLI ANEURISMI DELL’AORTA ADDOMINALE

Background: The use of iliac branch device (IBD) is increasing due to the less invasive character and accumulated experience of physicians in this endovascular technique. Clinical data regarding the Gore Iliac Branch Excluder (IBE) and Jotec E-liac stent graft, however, are scarce. This study shows the mid-term outcomes of the side branch stent-graft from a large single center. Methods: Patients treated with IBD for (aorto-) iliac aneurysms between 2018 and 2024 with follow-up in our center were included. Postoperative (technical and clinical success, reintervention, 30-day mortality) and mid-term outcomes (endoleak, reintervention, hypogastric patency, mortality) were analyzed. Results: 51 patients (46 male, median age 71 years) were treated with Gore IBE and Jotec E-liac stent-grafts for aorto-iliac aneurysms with a median follow-up of 21 months. The primary technical success rate was 96.1%, with an assisted technical success rate of 98%. Ninety-eight percent of the interal iliac arteries remained patent during follow-up. No 30-day mortality was encountered. During follow-up one patient had an endoleak type III and received additional intervention. Two other patients had a type 2 endoleak without sac enlargement (≥5 mm). One (1.9%) IBD-related reintervention was performed with relining of the stent graft. Secondary patency of the interal iliac artery was high and the mortality was 7.8% during follow-up. No statistically significance emerged between patients treated with Gore IBE and Jotec E-Iliac. No statistically significance emerged between patients treated inside the Instruction for Use and off-label (p= ns). Conclusions: This study shows high technical success rates for the side branch stent-grafts, with corresponding good mid-term outcomes. The endovascular treatment of (aorto-)iliac aneurysm is a feasible, safe and effective solution, which could be enlargent also in cases of aneurysms involving the internal iliac artery.