Lack of Iliac Engagement Correlates With Iliac Limb Complications Following Standard EVAR

Objective: An adequate distal sealing zone is a prerequisite for successful endovascular aneurysm repair (EVAR). Poor engagement of iliac limbs within the common iliac artery potentially increases the risk of limb-related complications. The aim of this study was to investigate the proportion of common iliac artery used for distal sealing as a predictor of iliac limb complications following standard EVAR.Methods: This was a retrospective case controlled study where an iliac complication group was compared to a larger control group from the unit database. Core analysis of postoperative computed tomography scans was used to ascertain the percentage engagement of the iliac limb of the stent graft within the native iliac artery in both groups.Results: There were 240 limbs in the control group and 33 limbs in the complications group. Complications included 10 endoleaks, 1 iliac limb dislocation, 2 insufficient engagement, 4 occlusions, and 16 kinks. The proportion of common iliac artery engagement was significantly higher in the control group compared with the complications group (75.3:68.6%, P = .003).Conclusions: Increased engagement in the common iliac artery following standard EVAR reduces the risks of limb complications. A clinical guide utilization of more than 70% of the total length of common iliac artery could be used as this was associated with a significantly lower rate of iliac limb complications following standard EVAR.