定制髂动脉分支装置腔内重建髂内动脉的临床分析

据文献统计43％的腹主动脉瘤(abdominal aortic aneurysm,AAA)患者病变累及一侧髂总动脉,累及双侧髂总动脉者为11％ [1-2],而髂内动脉受累是孤立性髂动脉瘤和AAA合并髂总动脉瘤(CIAA)病变中常见的现象.在栓塞一侧髂内动脉的患者中有超过45％的人会出现臀肌跛行,髂内动脉闭塞后所出现的症状严重程度依赖于闭塞前髂内动脉的通畅性和闭塞后侧支循环代偿情况,这种代偿通常来自于与对侧髂内动脉以及同侧和对侧股深动脉分支血管的沟通情况[3-4].只要条件允许,力争保留或重建髂内动脉是最合理的,这样才更能保证患者的生活质量.虽然已有多种技术被应用于腹主动脉瘤腔内修复术时重建髂内动脉,但完全腔内技术且比较合理的解决方案目前似乎只有髂动脉分支装置(iliac branched device,IBD),我们中心使用定制的IBD完成数例患者的腔内重建髂内动脉手术,现将我们的使用经验介绍如下.     

髂动脉分支支架拓展应用保留单侧髂内动脉的可行性与安全性

背景与目的 对于主-髂动脉瘤合并双侧髂内动脉瘤（IIAA）的患者,髂动脉分支支架（IBD）是目前保留单侧髂内动脉（IIA）首选治疗方式,但商业化的IBD因个体化解剖差异而应用受限,难以满足所有患者情况,因此,本研究探讨IBD拓展应用保留单侧IIA的可行性与安全性。方法 回顾性分析2021年4月—2021年6月复旦大学附属中山医院厦门医院行腹主动脉瘤腔内修复（EVAR）中采用不同方法拓展应用G-iliac^TM IBD保留单侧IIA的3例主-髂动脉瘤合并双侧IIAA患者临床资料。结果 3例患者均为男性,年龄66~70岁;腹主动脉瘤（AAA）最大直径29~56 mm,保留侧IIA主干有效腔管径及扩张处最大直径分别为10~11 mm和17~20 mm。保留侧髂总动脉（CIA）及髂外动脉（EIA）直径分别为15~28 mm和13~18 mm,栓塞侧IIA主干扩张处最大直径25~37 mm。3例患者均接受EVAR,采用G-iliac^TM IBD保留IIAA相对较小的一侧,弹簧圈栓塞IIAA较大一侧,技术成功率100%。保留单侧IIA拓展策略包括：将IIA桥接支架锚定于其主干相对健康管腔处,以及利用球扩式覆膜支架远端后扩放大特性,加强支架与扩张IIA远端密封性。围手术期无心梗、脑梗、出血及死亡等重大并发症发生。1例发生保留侧IIA来源Ib型内漏,球囊扩张后内漏消失;1例出现肠系膜下动脉来源II型内漏,出院前及术后3个月随访无明显改变;1例术后随访期间出现栓塞侧IIA分支来源II型内漏,术后3个月内漏消失。均未出现臀肌跛行症状,无支架断裂、移位、血栓等支架相关并发症。结论 对于合并双侧髂内动脉瘤样扩张的主-髂动脉瘤患者,采用不同策略,拓展IBD应用以保留单侧IIA短期内可行、安全,其中远期效果需进一步随访。     

腔内重建髂内动脉治疗破裂性腹主动脉瘤一例

患者 男,64岁,主因突发右下腹、腰部剧烈疼痛13 h于2007年10月23日人院.入院时血压80/45 mm Hg(1 mm Hg=0.133 kPa),腹部膨隆,右下腹压痛明显.腹部CT血管造影(CTA)检查:腹主动脉瘤(AAA)累及双髂内动脉,腹膜后血肿,动静脉瘘(图1).诊断:破裂性A从.急诊动脉造影:右侧髂总动脉大量造影剂漏出,并进入左侧髂总静脉,并迅速回流入下腔静脉.鉴于病变特点,拟行AAA腔内修复术和右髂内动脉腔内重建术.     

杂交技术治疗累及髂外动脉的股总动脉闭塞性病变

目的探讨杂交技术治疗累及髂外动脉的股总动脉闭塞性病变的临床疗效。方法对2008年5月至2013年4月收治的47例累及髂外动脉的股总动脉病变患者的临床资料进行回顾性分析。均实施了股动脉内膜剥脱及髂动脉球囊扩张及支架植入术,观察围手术期结果及动脉再通情况。结果患者均成功完成手术。每例患者平均植入支架(1.51±0.75)枚,术后踝肱指数(ABI)较术前增加0.54,患者下肢缺血症状均明显改善。围手术期并发症发生率为17.0%(8/47),无死亡病例。平均随访时间为(673.6±384.4)天。随访中有4例患者出现支架内闭塞。应用Kaplan-Meier生存率分析,术后12个月一期通畅率为(97.8±2.2)%,术后24个月一期通畅率为(86.3±6.7)%。结论杂交技术治疗累及髂外动脉的股总动脉闭塞性病变围手术期结果及早期随访效果理想。     

腹主动脉瘤腔内隔绝术中髂动脉的处理

目的:总结腹主动脉瘤(AAA)行腔内隔绝术时髂动脉的处理方式。方法:2004年7月至2010年11月共对43例瘤体累及单侧或双侧髂动脉分叉的AAA行腔内隔绝术,其中单侧髂动脉分叉受累27例,双侧髂动脉分叉受累16例。根据髂动脉病变情况,分别采取髂内动脉单纯覆盖、髂内动脉栓塞后覆盖、髂动脉外环结扎、一侧髂内动脉重建等不同的处理方法。结果:所有病例均操作成功,手术结束时无Ⅰ型内漏存在。术后出现臀部间歇性跛行6例(14.0%),便血1例(2.3%),无病例发生臀部或会阴部皮肤坏死、肠坏死及死亡。结论:术中避免同时封闭双侧髂内动脉,尽量保留一侧髂内动脉是很重要的。     

腔内治疗腹主动脉瘤合并双髂总动脉瘤的疗效分析

目的总结腹主动脉瘤合并双髂总动脉瘤的腔内治疗经验。方法总结2016年4月至2018年11月新疆维吾尔自治区人民医院18例接受腹主动脉腔内修复术(EVAR)的腹主动脉瘤合并双髂总动脉瘤患者。其中6例双侧髂总动脉直径18～25 mm,选择合适口径的髂动脉分支支架完成传统EVAR;9例双侧髂总动脉直径≥25 mm,选择双侧髂外动脉作为锚定区完成EVAR,并行髂总动脉直径较大侧或合并髂内动脉瘤样变侧进行髂内动脉弹簧圈栓塞术;3例双侧髂总动脉直径≥25 mm,选择双侧髂外动脉作为锚定区完成EVAR,并行三明治技术单侧髂内动重建。结果腔内手术均获得成功,手术时间(120±35)min,出血量(100±40)ml。术中无即刻Ⅰ型内漏出现。1例双侧髂外动脉作为锚定区治疗患者术后发生臀肌缺血症状;3例三明治技术单侧髂内动重建患者中,1例髂内动脉Ⅱ型内漏发生,1例髂内动脉闭塞。术后随访3～32个月,平均10.3个月,无动脉瘤破裂,髂动脉直径无明显扩张。结论腹主动脉瘤合并双髂总动脉瘤患者根据髂总动脉直径选择合适的腔内治疗方法可达到理想的治疗效果,重建髂内动脉与否术后生活质量无明显差异。     

腹主动脉瘤腔内修复术后急性髂动脉血栓形成致多器官功能衰竭一例北大核心CSCD

患者男,81岁,“体检发现腹主动脉瘤1周”2014年5月21日入院.既往高血压病史.入院查体：血压152/87 mmHg,心肺腹未见异常.双侧胫后动脉、足背动脉搏动可扪及.CTA示：肾动脉下型腹主动脉瘤,累及右侧髂总动脉和双侧髂内动脉;右侧髂总起始部明显扭曲,横断面CT可见双影征（图1）.完善术前检查后,局麻下行腹主动脉瘤腔内隔绝术（endovascular aneurysm repair,EVAR）,术中见：瘤颈直径28 mm,瘤颈长22.5 mm,瘤体最大直径80 mm,右侧髂总动脉最大直径40 mm,累及右侧髂总动脉分叉部,左侧髂总动脉直径15 mm,右侧髂内动脉最大直径35 mm,左侧髂内动脉最大直径19 mm.术中切开双侧股动脉行支架植入,封闭右侧髂内动脉,保留左侧髂内动脉（图2）.     

倒装Gore Excluder对侧喇叭腿支架治疗孤立性髂动脉瘤1例

<正>患者,男性,77岁。因"突发胸背部疼痛1天"于2017年3月8日入住我院心血管内科,入院后行全主动脉CT血管造影(computed tomography angiography,CTA)显示:胸主动脉弓降部小弯侧溃疡;左髂总动脉瘤(瘤体最大直径40 mm,近端髂总动脉瘤颈直径16 mm、长度15 mm,远端髂外动脉直径12 mm)(图1)。于2017年3月14日,气管插管全麻下行胸主动脉溃疡腔内隔绝+左锁骨下动脉烟囱支架植入+左髂内动脉栓塞+左髂动脉腔内隔绝(倒装Gore Excluder对侧喇叭腿支架)术。手     

保髂内动脉技术在腹主动脉瘤合并髂动脉瘤腔内修复中的应用北大核心CSCD

回顾性分析2018年1月—2021年12月在苏州大学附属张家港医院和南京鼓楼医院行腔内修复(endovascular aneurysm repair,EVAR)治疗的17例腹主动脉瘤(abdominal aortic aneurysm,AAA)合并总髂动脉瘤(common iliac artery aneurysms,CIAs)患者的临床资料,分别采用了髂动脉分支支架技术(iliac branch device,IBD,n=3)、喇叭形支架技术(bell-bottom technique,BBT,n=10)和髂外、髂内动脉搭桥技术(n=4)。三种方法均取得较好的技术成功率和近期效果。本研究显示根据腹主、髂总和髂内动脉具体情况,选择IBD、BBT和自体血管移植等技术,均可达到预期的治疗效果,降低术后臀肌跛行、内漏、内脏缺血等并发症的发生率。     

股-股深动脉人工血管旁路术治疗单侧长段髂股动脉硬化闭塞症

目的 评价股-股深动脉人工血管移植旁路术治疗单侧髂股动脉长段硬化闭塞症的长期疗效.方法 回顾性分析1995年7月至2010年12月收治的40例单侧长段髂股动脉硬化闭塞症患者的临床资料,其中男28例,女12例;年龄66 ～ 90岁,平均(73±6)岁.所有患者的诊断经CT动脉造影证实,单侧髂总动脉,髂外动脉,股总动脉和股浅动脉硬化闭塞.均采用股-股深动脉人工血管旁路术治疗,术前、后检测血管流速,踝/肱指数.使用Kaplan-Meier方法分析5、7、10年累积通畅率和5、7、10年保肢率.结果 本组患者在围手术期无死亡和截肢.35例(87.5％)随访1 ～13年,平均(5.7±2.8)年.ABI由术前平均0.23±0.10升至术后0.55±0.11,差异有统计学意义(t=15.91,P=0.000).术前彩超检测腘动脉及胫动脉平均血流速度分别为(14±6)cm/s和(10±4) cm/s,术后分别升至(34±10)cm/s和(22±7)cm/s.术后5、7、10年一二期累计通畅率分别为:60.1％,44.3％,25.3％和93.5％,86.8％,57.9％.术后5,7,10年保肢率分别为:97.5％,95％和90％.结论 治疗单侧髂股动脉长段闭塞症,股-股深人工血管旁路术安全有效,本术式可用于不适合腔内治疗和开腹手术的患者.     

A propensity score-matched comparison of two commercially available iliac branch devices in patients with similar clinical and anatomic preoperative features

ObjectiveThe objective of this study was to compare the perioperative and midterm results of Zenith Bifurcated Iliac Side (ZBIS; Cook Medical, Bloomington, Ind) and Gore Iliac Branch Endoprosthesis (IBE; W. L. Gore & Associates, Flagstaff, Ariz) iliac branch devices (IBDs) in treatment of dilated iliac bifurcations in patients with similar anatomic and clinical preoperative features.MethodsBetween July 2007 and May 2018, 190 IBDs were implanted at two high-volume Italian vascular and endovascular centers. Among the series, preoperative propensity score matching based on preoperative anatomic and clinical factors was performed, and two homogeneous groups were created: group 1, 35 Cook ZBIS IBD implants; and group 2, 35 Gore IBE devices. Early results were analyzed in terms of technical success, death, conversion to open surgery, and occurrence of major local and systemic complications. Follow-up results were analyzed in terms of patency of the IBD, freedom from type I and type III endoleaks, aneurysm-related reintervention, and aneurysm-related death.ResultsTechnical success was achieved in all implants from both groups. Perioperative IBD-related complications and major complications occurred in one case from group 1 (P = .49). No perioperative mortality was recorded in the two groups. Mean postoperative follow-up was 46.7 months in group 1 (standard deviation, ± 36.3) and 20.8 months in group 2 (standard deviation, ± 15.9; P < .0001). None of the IBDs or target hypogastric arteries occluded during follow-up in this series. Estimated 36-month freedom from type I and type III endoleaks was 97% (standard error [SE], 0.03) in group 1 and 87% (SE, 0.09) in group 2 (P = .34; log-rank, 0.9). Estimated freedom from IBD-related reintervention was 97% (SE, 0.03) in group 1 and 93% (SE, 0.06) in group 2 (P = .81; log-rank, 0.05). The estimated rates of overall survival at 36 months from the IBD implantation were 95% (SE, 0.04) in group 1 and 88% (SE, 0.08) in group 2 (P = .03; log-rank, 4.7); freedom from aneurysm-related death was 100% in group 1 and 93% (SE, 0.06) in group 2 (P = .19; log-rank, 1.7).ConclusionsThe propensity score-matched comparison between the Cook ZBIS and Gore IBE devices showed similar, satisfying perioperative and midterm results in the experience of two high-volume Italian vascular centers.     

Five-year outcomes from a prospective,multicenter study of endovascular repair of iliac artery aneurysms using an iliac branch device

ObjectiveWe have reported the 5-year results of a pivotal prospective, multicenter study conducted in the United States of a specifically designed iliac branch endoprosthesis (IBE; W.L. Gore & Associates, Flagstaff, AZ) for endovascular repair of aortoiliac aneurysms and common iliac artery aneurysms.MethodsA total of 63 patients (98.4% male; mean age, 70 years) with aortoiliac or common iliac artery aneurysms had undergone implantation of a single IBE device and a bifurcated aortoiliac stent graft. Patients with bilateral common iliac artery aneurysms (n = 22; 34.9%) had undergone either staged occlusion or surgical revascularization of the contralateral internal iliac artery before study enrollment. At 5 years, 36 of the 63 patients had completed the final study follow-up examinations, including clinical examinations (n = 35) and computed tomography (n = 32), with the results evaluated by an independent core laboratory and adverse events adjudicated by a clinical events committee.ResultsAt 5 years, freedom from all-cause mortality was 85.7% and freedom from aneurysm-related mortality was 100%. The nine deaths that had occurred (range, 132-1898 days) were adjudicated as unrelated to the aneurysm or procedure. Primary patency of the internal and external iliac artery IBE limbs was 95.1% and 100%, respectively. No patients had experienced new-onset buttock claudication on the IBE side or self-reported new-onset erectile dysfunction. The common iliac artery diameter on the IBE side was either unchanged or had decreased by ≥5 mm in 30 of the 31 patients (96.8%) with a baseline (1 month) and 5-year (range, 1641-2006 days) computed tomography scan available. Of the 31 evaluable patients, 9 (29.0%) had had an increase of ≥5 mm in the aortic diameter, 5 of whom had had a concurrent type II endoleak. No type I or type III endoleaks or device migration were identified by the core laboratory. Six patients had undergone eight secondary interventions, including five interventions for a type II endoleak. The freedom from secondary intervention was 90.5%.ConclusionsThe 5-year results of our prospective, multicenter study have confirmed the safety, efficacy, and durability of the IBE device for the treatment of aortoiliac and iliac artery aneurysms. The device effectively prevented common iliac artery aneurysm rupture, maintained the patency of the internal iliac artery, and avoided the complications associated with internal iliac artery sacrifice. Although common iliac artery aneurysm enlargement was rare, abdominal aortic enlargement was more common, suggesting that the outcomes of endovascular aneurysm repair might be different for patients with or without associated common iliac artery aneurysms.     

腹主动脉瘤腔内修复术中髂动脉瘤的处理策略

目的:探讨腹主动脉瘤合并髂动脉瘤的腔内修复术(EVAR)方法。方法:回顾性分析2007年8月—2014年3月35例腹主动脉瘤合并髂动脉瘤行EVAR术患者资料,其中9例合并单侧髂内动脉瘤,1例合并双侧髂内动脉瘤,14例合并单侧髂总动脉瘤(直径18 mm),11例合并双侧髂总动脉瘤,所用腔内技术包括栓塞髂内动脉瘤后覆盖,髂内动脉瘤单纯覆盖,"喇叭口"支架,以及"三明治"技术重建一侧髂内动脉等。结果:所有腔内技术均获得成功,手术时间(125±40)min,出血量(173±65)m L。术中发现内漏8例(22.9%),其中I型内漏4例(近端2例,远端2例)均经球囊扩张后内漏消失,III型内漏1例,经扩张及部分加弹簧圈栓塞后内漏消失,II型内漏2例及IV型内漏1例,均未予处理。35例术后随访6~60个月,无动脉瘤破裂,2例术后6个月发现腹主动脉瘤体增大,造影确诊远端I型内漏,经弹簧圈栓塞后内漏消失,其余33例瘤体直径无增大。结论:对于合并髂动脉瘤的腹主动脉瘤患者,有效处理髂内动脉,然后根据髂总动脉直径选择合适的治疗方法可以达到理想的近期效果。     

Endovascular repair of a common iliac artery aneurysm using the Cook Zenith abdominal aortic aneurysm Endovascular Graft Converter

Isolated common iliac artery aneurysm is a rare condition that is treated aggressively because of its high risk of rupture. Endovascular abdominal aortic aneurysm (AAA) repair has recently been extended to the clinical management of the iliac artery aneurysm. Stent grafts have been used successfully to exclude iliac artery aneurysms. Successful graft deployment and aneurysm exclusion require adequate seal and fixation at the proximal and distal attachment sites. This article presents a high-risk surgical patient whose 6.8-cm-diameter iliac artery aneurysm was repaired with a Zenith AAA Endovascular Graft Converter (Cook, Bloomington, Indiana). This device is normally used to convert an aortobiiliac endograft to an aortouniiliac endograft during AAA repair. The tapered 80-mm-long graft has diameters of 24 mm proximally and 12 mm distally. Completion arteriogram demonstrated exclusion of the iliac artery aneurysm with no evidence of endoleak. No postoperative complications occurred. No endoleak was seen on the follow-up abdominal computed tomography scan.     

Long-term results of iliac aneurysm repair with iliac branched endograft: a 5-year experience on 100 consecutive cases

BackgroundIliac branch device (IBD) technique has been introduced as an appealing and effective solution to avoid complications occurring during repair of aorto-iliac aneurysm with extensive iliac involvement. Nevertheless, no large series with long-term follow-up of IBD are available. The aim of this study was to analyse safety and long-term efficacy of IBD in a consecutive series of patients.MethodsBetween 2006 and 2011, 100 consecutive patients were enrolled in a prospective database on IBD. Indications included unilateral or bilateral common iliac artery aneurysms combined or not with abdominal aneurysms. Patients were routinely followed up with computed tomography. Data were reported according to the Kaplan–Meier method.ResultsThere were 96 males, mean age 74.1 years. Preoperative median common iliac aneurysm diameter was 40 mm (interquartile range (IQR): 35–44 mm). Sixty-seven patients had abdominal aortic aneurysm >35 mm (IQR: 40–57 mm) associated with iliac aneurysm. Eleven patients presented hypogastric aneurysm. Twelve patients underwent isolated iliac repair with IBD and 88 patients received associated endovascular aortic repair. Periprocedural technical success rate was 95%, with no mortality. Two patients experienced external iliac occlusion in the first month. At a median follow-up of 21 months (range 1–60) aneurysm growth >3 mm was detected in four iliac (4%) arteries. Iliac endoleak (one type III and two distal type I) developed in three patients and buttock claudication in four patients. Estimated patency rate of internal iliac branch was 91.4% at 1 and 5 years. Freedom from any reintervention rate was 90% at 1 year and 81.4% at 5 years. No late ruptures occurred.ConclusionsLong-term results show that IBD use can ensure persistent iliac aneurysm exclusion at 5 years, with low risk of reintervention. This technique can be considered as a first endovascular option in patients with extensive iliac aneurysm disease and favourable anatomy.     

Does the presence of an iliac aneurysm affect outcome of endoluminal AAA repair? An analysis of 336 cases.

OBJECTIVE: To determine whether the presence of an iliac aneurysm compromises outcome of endovascular exclusion of AAA and to ascertain the fate of the iliac aneurysmal sac. PATIENTS AND METHODS: Between April 1997 and March 2001, data on 336 consecutive patients undergoing endovascular repair for AAA were entered in a prospective database. Suitability for endovascular repair was assessed by preoperative contrast-enhanced computed tomography. A maximum common iliac artery (CIA) diameter > or = 20 mm was defined as iliac aneurysm. Patients with and without iliac aneurysms were compared to early (immediate conversion or perioperative death) and late failure (increase in aneurysm diameter or persisting graft-related endoleak, or late AAA rupture or conversion). RESULTS: Fifty-nine patients (18%) had iliac aneurysms, 19 were bilateral, for a total of 78 aneurysmal iliac arteries (median diameter 23 mm; range 20-50 mm). A distal seal was achieved by landing in 33 external iliac arteries, in 20 ectatic CIAs, and in 25 normal CIAs. Operating time differed significantly between patients with and without CIA aneurysms (153 +/- 71 vs 123 +/- 55 min, p = 0.0001), whereas no statistically significant differences were found with respect to early and late failure (2% vs 3%, p = 0.5 and 14% vs 8%, p = 0.11, respectively). There were no cases of buttock or colon necrosis. At a median follow-up of 14 months (range 0-46; i.q.r. 7-27 months) common iliac diameter decreased > or = 2 mm in 49 cases, remained stable in 25, and increased > or = 2 mm in 3. CONCLUSION: The presence of iliac aneurysm rendered endoluminal AAA repair more complex but did not affect feasibility and long-term outcome of the procedure. In our experience internal iliac exclusion was never associated with significant morbidity. These data may be useful when considering endovascular repair in high-risk patients with challenging anatomy.     

Safety of coil embolization of the internal iliac artery in endovascular grafting of abdominal aortic aneurysms

PURPOSE: During endovascular grafting of an abdominal aortic aneurysm (AAA), iliac limb extension to the external iliac artery may be indicated when the common iliac artery is ectatic or aneurysmal. Preliminary or concomitant coil embolization of the internal iliac artery (IIA) is thus necessary to prevent potential reflux and endoleak. We sought to determine the safety of hypogastric flow interruption in this setting. METHODS: We retrospectively reviewed 156 patients who underwent stent-graft AAA repair at two institutions between February 1, 1998, and January 31, 1999. Coil embolization of one or both IIAs was undertaken when the diameter of the common iliac artery was more than 20 mm to enable limb endograft extension to the external iliac artery. Bilateral procedures were staged. RESULTS: Thirty-nine (25%) of 156 patients were selected for coil embolization of one (n = 28) or both (n = 11) IIAs. The interventions were performed before (n = 31) or during (n = 8) the stent-graft procedure. Complications included groin hematomas in 3 patients, iliac artery dissection in 1, failure to catheterize the IIA in 2, and transient rise in the serum creatinine level in 3. One patient had erectile dysfunction, and five patients (13%) had buttock claudication after unilateral occlusion. Serious ischemic complications were not observed. CONCLUSION: Coil embolization of one or both IIAs appears to be safe in the setting of endovascular grafting of AAA. Buttock claudication is a relatively significant problem and may limit applicability of this strategy to patients who are unfit for standard open repair.     

Branched iliac bifurcation: 6 years experience with endovascular preservation of internal iliac artery flow

OBJECTIVE: The objective of the current study was to share a 6-year experience with the iliac bifurcation device (IBD) and determine its safety and effectiveness in patients with common iliac artery aneurysms. METHODS: Between 2001 and 2006, 46 patients were prospectively enrolled in a single institution study on the IBD. Indications included unilateral or bilateral common iliac artery aneurysms (CIAA) (combined or not with abdominal aortic aneurysm endovascular repair). The first 26 patients were intended to receive a first generation unibody IBD and the following 20 patients the second generation, modular, IBD. RESULTS: In 33 patients out of 46 attempted (technical success per patient 72%), 35 iliac bifurcated devices (2 patients received bilateral IBD) out of 51 attempted (technical success per vessel 69%), were successfully implanted. The technical success rate (per vessel) was 58% for the first generation device and 85% for the second generation device. Inability to introduce the side branch into the IIA and intraoperative occlusions were the main reasons for technical failure. Among these failures, only two patients required open conversions. The mean +/- SD follow-up (radiological and clinical) of the 33 patients with a total of 35 successful IBD implantations was 26 +/- 17 months (median 24, range 3 to 60). During the follow-up period out of 35 successfully-implanted iliac bifurcation devices, four (11%) hypogastric side branch occlusions occurred, all within the first 12 months. Cumulative IBD side branch patency was 87% at 60 months. Comparing the first with the second generation IBD outcomes, cumulative patency rates at 2 years revealed no statistical difference (P = .774). No endoleak, and particularly no IBD, modular side branch disconnection, no late rupture, or deaths have yet been encountered. CONCLUSIONS: Preservation of pelvic circulation in high risk patients treated for bilateral or unilateral common iliac aneurysms combined or without AAA is feasible and secure exclusively by endovascular repair. New generation iliac bifurcated devices show a favourable intraoperative performance and long-term outcomes.