Iliac branch device (IBD) technology has become a more accepted endovascular option to preserve internal iliac artery flow for aneurysms involving the iliac bifurcation. Because several studies reported inferior outcomes in women compared with men after endovascular aortic aneurysm repair with standard EVAR devices,1 the aim of this work was to evaluate the impact of sex differences on the post-operative outcome for patients treated with an IBD. A retrospective review was performed using the pELVIS registry, in which nine high volume European centres are participating. An IBD was indicated as the preferable first line endovascular treatment for a >24 mm diameter aneurysm involving the iliac bifurcation as suggested by Verzini et al.2 All patients were deemed to be high risk for an open surgical procedure, defined by the presence of three or more serious predetermined cardiovascular comorbidities. Details regarding other inclusion criteria, data collection, and follow up imaging have been published previously.3 This registry provided longitudinal post-operative outcomes for up to 60 months. This project was approved by the local ethics committee. Between 2005 and 2017, 804 (mean age 72.1 ± 8.6 years) consecutives patients were treated with 910 IBDs. There were 36 women (4.5%) and 768 men (95.5%) and no differences were found between the two groups when comparing for age, aneurysm morphology, and pre-operative risk factors. On completion angiography, 21 (2.6%) patients had a type 1 endoleak, and they were all men. No intra-operative conversion or deaths occurred. No difference in 30 day mortality between women and men (2.8% vs. 0.4%, p = .17) was found. The deaths were secondary to myocardial infarction in two cases, respiratory failure combined with stroke in one case, and acute renal failure in the last case. Median hospital length of stay was 7 (range 5–9) days with no sex differences. Moreover, there was no significant difference between women and men in the rates of 30 day complication, myocardial infarction, stroke, pneumonia, peripheral embolisation, early graft thrombosis, colonic ischaemia, and 30 day re-intervention (Table 1). Acute renal failure requiring dialysis appeared to be higher in the women cohort (5.6% vs. 0.7%, p = .036).
Iliac Branch Devices in Women: Results From the pELVIS Registry / Soler R.; Charbonneau P.; Sobocinski J.; Mougin J.; Donas K.P.; Torsello G.; Fabre D.; Haulon S.; Austermann M.; Inchingolo M.; Bisdas T.; Pratesi G.; Barbante M.; Cao P.; Ferrer C.; Verzini F.; Parlani G.; Simonte G.; Pratesi C.; Fargion A.; Masciello F.; Kolbel T.; Tsilimparis N.; Haulon S.; Branzan D.; Schmidt A.; Scheinert D.. - In: EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY. - ISSN 1078-5884. - ELETTRONICO. - 59:(2020), pp. 490-491. [10.1016/j.ejvs.2019.12.038]
Iliac Branch Devices in Women: Results From the pELVIS Registry
Pratesi C.;Fargion A.;Masciello F.;
2020
Abstract
Iliac branch device (IBD) technology has become a more accepted endovascular option to preserve internal iliac artery flow for aneurysms involving the iliac bifurcation. Because several studies reported inferior outcomes in women compared with men after endovascular aortic aneurysm repair with standard EVAR devices,1 the aim of this work was to evaluate the impact of sex differences on the post-operative outcome for patients treated with an IBD. A retrospective review was performed using the pELVIS registry, in which nine high volume European centres are participating. An IBD was indicated as the preferable first line endovascular treatment for a >24 mm diameter aneurysm involving the iliac bifurcation as suggested by Verzini et al.2 All patients were deemed to be high risk for an open surgical procedure, defined by the presence of three or more serious predetermined cardiovascular comorbidities. Details regarding other inclusion criteria, data collection, and follow up imaging have been published previously.3 This registry provided longitudinal post-operative outcomes for up to 60 months. This project was approved by the local ethics committee. Between 2005 and 2017, 804 (mean age 72.1 ± 8.6 years) consecutives patients were treated with 910 IBDs. There were 36 women (4.5%) and 768 men (95.5%) and no differences were found between the two groups when comparing for age, aneurysm morphology, and pre-operative risk factors. On completion angiography, 21 (2.6%) patients had a type 1 endoleak, and they were all men. No intra-operative conversion or deaths occurred. No difference in 30 day mortality between women and men (2.8% vs. 0.4%, p = .17) was found. The deaths were secondary to myocardial infarction in two cases, respiratory failure combined with stroke in one case, and acute renal failure in the last case. Median hospital length of stay was 7 (range 5–9) days with no sex differences. Moreover, there was no significant difference between women and men in the rates of 30 day complication, myocardial infarction, stroke, pneumonia, peripheral embolisation, early graft thrombosis, colonic ischaemia, and 30 day re-intervention (Table 1). Acute renal failure requiring dialysis appeared to be higher in the women cohort (5.6% vs. 0.7%, p = .036).
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