Aim: Iliac limb occlusion following endovascular repair (EVAR) may result in limb threatening acute ischemia. The incidence is reported at up to 10% and is known to be influenced by iliac angulation and kinking of the stent graft. The aim of this study was to evaluate the performance of the AorfixTM graft in tortuous iliac anatomy and examine the impact of the graft on the rate of iliac limb thrombosis following EVAR in a single UK centre
Methods: We performed a retrospective review of all EVAR performed from May 1998 to May 2010. From November 2007, patients with highly angulated iliac anatomy were treated with the AorfixTM(Lombard) stent graft, or when a ZenithTM(Cook) main body was chosen, the AorfixTM iliac limbs were used with the ZenithTM(Cook) device. We compared the rate of iliac limb occlusions before (group 1) and after (group 2) the adoption of this policy.
Results: Two hundred and sixty seven patients underwent EVAR (group 1 n=129; group 2 n=138). In group 1, eight patients had a unilateral iliac limb occlusion (6.2%). Six of the patients had >90 degrees iliac angulation, one had an unrecognised limb stenosis, and one patient had the stent landed in the external iliac. In group 2 there were no limb occlusions. Of the 138 patients, 25 had iliac angulation of >90 degrees . Of these 25, eighteen were treated with the AorfixTM stent graft system because of iliac angulation, and 7 were treated with AorfixTM legs and ZenithTM bodies.
Conclusion: The rate of early iliac limb occlusion following EVAR in patients with angulated iliac anatomy can be substantially reduced by using the flexible Aorfix stent graft system.