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Iliac Branch Devices Do Not Decrease Ischemic Colitis Compared to Hypogastric Artery Embolization in Endovascular Abdominal Aneurysm Repair
Jinny Lu, MD, Sara Zettervall, MD, Kyongjune B. Lee, MD, Richard Amdur, PhD, Robyn Macsata, MD, Anton Sidawy, MD, Bao-Ngoc Nguyen.
George Washington University, Washington, DC, USA.

Introduction: Prior to the availability of iliac branch devices (IBD), hypogastric artery embolization (HAE) was routinely performed to prevent type IB endoleak in endovascular repair of abdominal aortic aneurysms with associated common iliac aneurysms. This, however, can result in poor pelvic perfusion leading to ischemic colitis, buttock claudication and sexual dysfunction. This study investigates whether IBD is superior to HAE in 30-day outcomes of patients with elective EVAR using the multicenter prospectively collected ACS-NSQIP database.
Methods: We utilized the Targeted Vascular Module in the ACS-NSQIP database to identify patients undergoing elective EVAR for infrarenal AAA repair with and without HAE or IBD from 2012 to 2015. Chi-square, Fisher Exact Test, and multivariate regression models were used for data analysis.
Results: 6311 patients were identified: 5114 patients had routine EVAR without either HAE or IBD, 310 with HAE only, 796 with IBD only and 91 had both HAE and IBD. Subgroup analyses were performed to compare the outcomes of HAE or IBD against routine EVAR and each other (Table 1).  Compared to routine EVAR, prolonged operative time of greater 5 hours was more common in HAE (6% vs 2%, p=<0.01) and IBD (4.0% vs 2%, p=0.01). Patients also had longer ICU and hospital stays following HAE and IBD compared to routine EVAR (Table 1).   Patients with HAE had higher 30-day mortality than those with routine EVAR (3% vs 1.0%, p=0.02) whereas those with IBD had higher rate of ischemic colitis than routine EVAR (1% vs. 0.4%, p=0.01). Following multivariate analysis, IBD was associated with higher incidence of ischemic colitis compared with routine EVAR (OR 3.13 [1.41-6.95], p=0.005). There was no difference in 30-day outcomes between HAE and IBD, including ischemic colitis (0.7% vs 1.0%, p=0.74).
Conclusions: The increased complexity of HAE and IBD in EVAR is associated with worse outcomes compared to routine EVAR. IBD appears to make no difference in 30-day outcomes, including ischemic colitis, compared to HAE.  Future research to examine other benefits of IBD in preserving pelvic perfusion, such as preventing buttock claudication and sexual dysfunction, is warranted.


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