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Page 4 of 9 Ghoneim et al. Vessel Plus 2020;4:38 I http://dx.doi.org/10.20517/2574-1209.2020.35

Table 2. Procedural and anatomical features
IIA salvage group (n = 32) (Mean ± SD) IIA sacrifice group (n = 33) (Mean ± SD) P value
Operative time (h) 2.20 ± 0.44 3.43 ± 1.54 0.001*
Aneurysm size (cm) 5.40 ± 1.65 5.70 ± 2.50 0.569
Right CIA diameter (mm) 15.40 ± 9.24 32.90 ± 20.98 0.001*
Left CIA diameter (mm) 18.95 ± 4.77 16.82 ± 6.52 0.137
Right IIA diameter (mm) 9.00 ± 2.30 16.40 ± 9.40 0.001*
Left IIA diameter (mm) 9.10 ± 2.80 11.48 ± 6.80 0.071
HDU stay (days) 0.16 ± 0.57 0.75 ± 1.49 0.040*
Total hospital stay (days) 2.91 ± 2.67 5.56 ± 4.88 0.005*
*Statistically significant. IIA: internal iliac artery; SD: standard deviation; CIA: common iliac artery; HDU: high density unit

Table 3. Postoperative complications
Complications IIA salvage group (n = 32) IIA sacrifice group (n = 33) P-value
Thirty-day mortality 0 0 -
Hematoma 1 3 0.613
Infection 1 1 1
Cardiac complications 1 4 0.355
Respiratory complications 0 2 0.492
Renal complications 0 1 1
Type Ib endoleak 0 3 0.238
Lower limb macro-embolization 0 2 0.492
Buttock claudication 0 1 1
Erectile dysfunction 0 1 1
Stroke 0 0 -
Bowel ischemia 0 0 -
Spinal cord ischemia 0 0 -
Deep vein thrombosis 0 0 -
Pulmonary embolism 0 0 -
IIA: internal iliac artery

The IIA sacrifice group compared to the IIA salvage group had significantly higher procedure time (3.43 ±
1.54 h vs. 2.20 ± 0.44 h, P = 0.001), mean hospital stay (5.56 ± 4.88 days vs. 2.91 ± 2.67 days, P = 0.005) and
high dependency unit (HDU) stay (0.75 ± 1.49 days vs. 0.16 ± 0.57 days, P = 0.040).

Technical success was 100%, and there was no 30-day mortality in either group. The IIA sacrifice group
had more postoperative complications in general when compared to the IIA salvage group, but they
were not significant (P < 0.05) [Table 3]. As such, there were higher numbers of hematoma (3 vs. 1, P =
0.613), cardiac complications (4 vs. 1, P = 0.355), respiratory complications (2 vs. 0, P = 0.492) and renal
complications (1 vs. 0, P = 1.000) in the IIA sacrifice group. Similarly, IIA sacrifice group had two cases
of lower limb microembolization (P = 0.492), one erectile dysfunction (P = 1.000), and one buttock
claudication (P = 1.000), while they were not seen in IIA salvage group. The buttock claudication occurred
in a patient with bilateral IIA coverage. There was no ruptured iliac access, device-related malfunction,
spinal cord ischemia or bowel ischemia in either group.

The mean follow-up was 3.28 years. At three-years, there were no statistically significant difference in the
freedom from reintervention (85% vs. 93.75%, P = 0.253) [Figure 1], aneurysm-related survival (97% vs.
97%, P = 0.982) [Figure 2] and overall survival (67% vs. 72%, P = 0.963) [Figure 3] between the IIA sacrifice
and IIA sparing groups.

DISCUSSION
EVAR is progressively being adopted in AAA repair. Many reports focus on the proximal landing zones;
however, there could be a need to extend EVAR to EIA due to either short CIA or aneurysmal CIAs. Recent