Risk factors and management for iliac branch occlusion after endovascular abdominal aortic aneurysm repair
Objective To analyze the risk factors of iliac branch occlusion after endovascular aneurysm repair(EVAR)for abdominal aortic aneurysm and the countermeasures.Methods Clinical data of 191 patients with abdominal aortic aneurysm undergoing EVAR admitted to Renji Hospital,Shanghai Jiaotong University School of Medicine between Jan-uary 2021 and May 2023 were collected.Using a case-control matched design,the cases with and without iliac branch occlusion were matched in a 1:2 ratio according to gender,age and commercial type of stent used,as the case group(n=26)and control group(n=52).Univariate and conditional Logistic regression analysis was conducted to analyze the risk factors of iliac branch occlusion in the case group compared with the control group.Iliac branch occlusion was treated with thrombolysis,balloon dilatation or stent implantation.Results Iliac branch occlusion occurred in 13.61％(26/191)of the patients after EVAR,and the corresponding treatment was carried out.Among them,1 patient had another limb occlusion in the contralateral side after 1 month,and 2 patients were given continuation of thrombolysis after thrombus aspiration for 1 day and then balloon dilatation was performed.All patients recovered blood flow from ili-ac artery after operation.Conditional Logistic regression analysis showed that abdominal aortic bifurcation diameter＜20 mm(OR=4.544,95％CI:1.397-14.779),preoperative severe distortion of iliac artery before operation(OR=5.971,95％CI:1.528-23.336)and calcification of common iliac artery＞50％(OR=4.165,95％CI:1.189-14.587)were associated with iliac branch occlusion.Conclusion Abdominal aorta diameter＜20 mm,severe preoperative dis-tortion of common iliac artery,and calcification of common iliac artery＞50％may be independent risk factors for iliac branch occlusion after EVAR.It can be improved obviously after embolectomy,balloon dilatation or stent implantation.
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