Comparative Study Of Internal Iliac Artery Preservation In EVAR

Objective:To compare and analyze the safety,feasibility,and effectiveness of iliac artery bifurcation device(IBD)and sandwich technique in preserving the internal iliac artery,providing a certain clinical reference for patients with abdominal aortic aneurysm involving the iliac artery or isolated common iliac artery aneurysm.Methods:A retrospective study was conducted to collect clinical data of patients with abdominal aortic aneurysms associated with iliac aneurysms and isolated common iliac aneurysms who underwent endovascular repair of the internal iliac artery during the period from January 2019 to January 2022 in the cardiovascular surgery department of our center,based on the inclusion and exclusion criteria,All patients underwent computed tomography angiography(CTA)before surgery to diagnose a renal inferior abdominal aortic aneurysm with common or internal iliac aneurysms,and isolated common iliac aneurysms.After surgery,CTA reexamination was performed in the outpatient department.According to the different surgical methods for preserving the internal iliac artery,they were divided into IBD group and sandwich group.Data of the two groups of patients before,during,after,and during follow-up were collected.According to the type of data and the distribution characteristics of data,appropriate statistical methods were selected for analysis to evaluate the safety,feasibility,and effectiveness of the two techniques in preserving the internal iliac artery.Results:A total of 31 patients were included,including 26 males and 5 females,aged52-85 years,with an average age of 69.4 ± 9.9 years.Among them,there were 21 patients with hypertension,7 with diabetes,11 with coronary heart disease,9 with hyperlipidemia,2 with stroke history,4 with renal insufficiency,and 18 with smoking history.The two groups of patients had similar preoperative conditions in terms of age distribution,gender composition,and comorbidities(P>0.05),but the difference was not statistically significant.The two groups were similar in terms of technical success rate,bleeding volume,imaging dose,operation time,postoperative hospital stay,and perioperative complications(P>0.05),with no statistically significant difference.The technical success rate of IBD group and sandwich group was 94.7%(one patient failed to implant IBD due to failure of superselective internal iliac artery)and 100%,respectively,The incidence of perioperative complications was 10.5%(1 case had poor healing of the groin incision,1 case had limping of the gluteus muscle)and 8.3%(1 case had hematoma at the puncture point of the brachial artery),respectively.In terms of hospitalization expenses,the IBD group was significantly higher than the sandwich group(239914.04 ± 10525.30 yuan and 223966.56+-10944.07 yuan,P<0.01),with statistically significant differences.The follow-up period was from March to December,with an average follow-up time of 9.97 months.The two groups had similar postoperative internal leakage rates,iliac branch occlusion rates,reduction in diameter of common iliac artery aneurysm,and 1-year mortality rate(P>0.05),with no statistically significant differences.The IBD group and sandwich group had postoperative internal leakage rates of 0% and 8.3%,respectively(with 1 case of type III internal leakage)The rate of iliac branch occlusion was 5.3%(1 case of internal iliac artery occlusion)and 25%(1 case of internal iliac artery occlusion and 2 cases of external iliac artery occlusion)respectively,and the 1-year mortality rate after operation was 5.3%(1 case died of pulmonary infection)and 0% respectively.In terms of secondary intervention rate,the IBD group was significantly better than the sandwich group(0% and 25%,P<0.05),and the difference was statistically significant.Conclusion:Both IBD and sandwich techniques for preserving the internal iliac artery exhibit high technical success rates and low mortality,indicating the similar feasibility and safety of the two techniques.Although there was no statistically significant difference between the two groups in terms of perioperative complications and stent related complications during the follow-up period,IBD has significant advantages in terms of secondary intervention rates and may have more ideal effectiveness.IBD technology is the best choice for patients with appropriate anatomical conditions of the iliac artery that require the preservation of the internal iliac artery.Sandwich technology has obvious advantages in terms of hospitalization costs,which can reduce the financial burden of patients to a certain extent.Moreover,this technology has low requirements for the anatomical conditions of the patient’s iliac artery,and is suitable for patients whose anatomical conditions do not match the IBD requirements.