The Long‐Term Progression of Aneurysmal Disease in Common Iliac Arteries After Standard EVAR and Its Clinical Implications.

Introduction: The progression of aneurysmal disease in the common iliac arteries (CIAs) after EVAR remains an insufficiently investigated field. The purpose of this study is to investigate the long‐term outcomes of standard elective EVAR with a variety of last‐generation bifurcated aortic endografts in relation with the progression of aneurysmal disease in the CIAs. Methods: This is a prospective cohort study of 168 patients, who were treated with six different endografts between 2013 and 2018 and completed the 5‐year computed tomography aortoangiography (CTA) follow‐up. Postoperative CTA analysis included CIA measurements at four diameters' points and two length levels in three postoperative time spots: first, 24th, and 60th months. All EVAR‐related adverse events were recorded, including migrations, endoleaks, limb occlusions, reinterventions, ruptures, and mortality. Results: At both time intervals, a significant and nearly linear dilatation and elongation of CIAs was evident. The mean percent increase, among all diameter points measured, was 11.7% at 24 months and 22.8% at 60 months (p < 0.001) with a nearly constant mean increase rate by 0.07 mm per month. The corresponding monthly elongation rate of total CIA length was 0.26 mm at 24 months and 0.34 mm at 5 years (p < 0.001). The respective monthly lengthening of CIAs' uncovered (from stent graft) segment was 0.10 and 0.15 mm, and the overall increase rate at 60 months was up to 53.9% (p < 0.001). A total of 20 EVAR‐related events were recorded, and multivariate analysis revealed that CIA dilatation served as a significant and independent predictor of long‐term EVAR failures, increasing the likelihood of adverse events by 2.8‐fold. Conclusions: Analysis of long‐term geometric CIA remodeling after a standard EVAR revealed a significant progression of aneurysmal disease in CIAs, which was associated with worsening EVAR outcomes and emphasizes the importance of a rigorous and extensive follow‐up protocol to maintain the long‐term EVAR effectiveness. [ABSTRACT FROM AUTHOR]