Use of the Reversed Zenith Iliac Limb Extension in the Treatment of Iliac Artery Aneurysms and Various Aortoiliac Pathologies: Outcome in Midterm Follow-up

Purpose: To report the midterm follow-up after treatment of various aortoiliac pathologies in an acute setting using reversed Zenith iliac limb extensions when appropriately sized stent-grafts were not available. Methods: From 2005 to 2007, 12 patients (10 men; mean age 71.5 +/- 7.3 years) were treated with reversed Zenith iliac limb extensions for solitary iliac artery aneurysms (n=8), an abdominal aortic aneurysm (AAA) in a small caliber aorta (n=1), an anastomotic pseudoaneurysm in an aortobi-iliac graft (n=1), a hypogastric artery aneurysm (n=1), and a ruptured AAA secondary to a late type Ib endoleak after Talent stent-graft implantation (n=1). The Zenith iliac limb extensions were deployed on the back table and reloaded in a reversed manner to treat aneurysms and other lesions with a broad range of different diameter necks and landing zones. Results: The technical success rate was 100%, and no endoleaks were present at the end of the procedures. The endoleak patient with the ruptured AAA died owing to respiratory insufficiency. The other 11 patients have a mean follow-up of 29 +/- 9 months. In this period, 2 patients received a femorofemoral crossover bypass because of an occluded iliac limb extension. One patient had a type II endoleak without growth of the iliac aneurysm. Two patients died of a ruptured 4.4-cm AAA at 16 months and of respiratory insufficiency due to metastases at 47 months, respectively. Conclusion: When necessary, it is feasible to use a revered Zenith limb extension to treat solitary iliac aneurysms and other aortoiliac pathologies, achieving satisfactory midterm outcomes. J Endovasc Ther. 2011;18:762-767