Bare Metal Stent Application To Prevent Limb Graft Occlusion During Endovascular Aneurysm Repair

Objective:There are many risk factors for iliac limb occlusion after endovascular aneurysm repair(endovascular aneurysm repair,EVAR),such as distortion of iliac artery,location of the end of the iliac branch in the external iliac artery,and large diameter of the iliac branch,among which severe curvature of the iliac artery will increase the incidence of limb graft occlusion(LGO).Our study This single-center retrospective study hypothesizes that bare-metal scaffolds(BMS)provide protection against LGO.Methods:All patients undergoing elective EVAR with a bifurcated stent-graft between January 2012-June 2022 were included in this cohort study.Patients with severe tortuosity with the iliac angle were included in this investigation and grouped into two categories:group A included individuals who received BMS and group B included those who did not receive BMS.The principal outcomes were the occurrence of limb occlusion and technical success during follow-up,however,secondary outcomes included perioperative mortality,external iliac angioplasty,and crossed-limb techniques.Results:A total of 157 patients(mean age=71.6±8 years)with infrarenal abdominal aortic aneurysms were enrolled,50 individuals were included in group A while 107 were in group B.Overall technical success was 100%,and only one(2%)patient from group A and 17(15%)from group B suffered from limbs occlusion during follow-up(P<0.05).At a mean follow-up imaging of 28.7 ±23.6 months(range 1-124),the estimated primary limb patency at 2 years was 98%for BMS and 84%for the nonBMS group(P<0.05).No differences in the perioperative mortality or crossed-limb techniques between BMS and the non-BMS groups were observed,however,external iliac angioplasty presented differences between the two cohorts during follow-up(P<0.05).Conclusion:Based on the imaging data of preoperative CTA,intraoperative DSA,postoperative CTA,secondary operation DSA and CTA of IAAA patients who were admitted to the Department of Vascular Surgery of the Second Affiliated Hospital of Nanchang University from January 1,2012 to June 30,2022 and successfully implemented EVAR,Collect,classify,classify,summarize,and conduct a retrospective analysis of a large number of cases in a single center.The conclusion is as follows:1.Iliac artery occlusion after endovascular therapy for abdominal aortic aneurysm is a common complication after EVAR surgery,second only to internal leakage2.The use of bare-metal stents to prevent or treat limb occlusion in severely curved iliac arteries is a safe and effective method with significant long-term results in patency and reintervention.3.Postoperative occlusion usually occurs within six months after surgery.Once this complication occurs,it will bring additional economic burden to patients and their families and increase the pain of patients,so regular review and active intervention should be conducted.