LAUSR

Objectives: To evaluate long-term results of self-expanding versus balloon-expandable hypogastric stent grafts in conjunction with iliac branch devices (IBD) for aortoiliac aneurysm (AAIA) repair, in a multicenter experience (pELVIS Registry). Methods: All patients electively treated for AAIA with the Cook IBD in 9 European Centers were reviewed. Clinical and imaging data were prospectively collected locally and a multicenter database was created and interrogated. Primary outcomes were incidence of graft occlusions and reinterventions. For the purpose of this investigation, three subgroups were identified: patients receiving hypogastric balloon-expandable (BE) stent grafts; those with self-expanding (SE) grafts; and those with any stent graft plus relining with a bare metal stent (RE). Results: Between 2005 and 2017, 783 patients underwent 897 elective endovascular repair of AAIA (n 1⁄4 671, 74.8%) or isolated iliac aneurysms (n 1⁄4 226, 25.2%), with 897 Cook IBDs (n 1⁄4 114 bilateral) in nine European centers. Mean age was 71.4 years (range 45-93); and 749 (95.7%) patients were men. In 420 procedures (46.8%) BE was used, in 139 SE (15.5%), in 90 BE plus SE or undefined stent, and in 248 (27.6%) RE. At 30 days there were 4 perioperative deaths (0.5%), 10 (1.1%) technical failures, 11 (1.2%) graft thromboses, 41 (4.5%) reinterventions, and 1 (0.1%) conversion to open repair. After a mean follow-up of 32 months (range, 0-128 months), 55 IBD occlusions (6.2%) occurred. Overall primary patency, at KaplanMeier analysis, was 99.3 6 0.3 at 1 month, 97.2 6 0.6 at 12 months, 92.9 6 1.2 at 60 months, and 91.2 6 1.7 at 72 months. Primary patency was not significantly different in the BE vs SE or RE cohorts (P 1⁄4 .4; Fig 1). During follow-up, there were 149 (16.8%) reinterventions, 116 (13.1%) of which were IBD-related, including 12 (1.4%) conversions. Overall, freedom from reinterventions and conversion, estimated by Kaplan-Meier analysis, was 94.7 6 0.8 at 1 month, 86.8 6 1.2 at 12 months, 70.7 6 2.2 at 60 months, and 65.7 6 2.8 at 72 months. Reinterventions during follow-up in the 3 cohorts (Fig 2) were not significantly different (P 1⁄4 .4). Overall survival, estimated by Kaplan-Meier analysis, was 99.5 6 0.3 at 1 month, 94.8 6 0.9 at 12 months, 76.0 6 2.3 at 60 months, and 72 6 2.7 at 72 months.