Five-Year Data From the GREAT Registry: A Comparison of Outcomes for Bell Bottom, Iliac Branch Endoprosthesis, and Coil and Cover Approaches

OBJECTIVES:There are a variety of methods used today to treat common iliac aneurysms with endovascular techniques. Of these approaches, little is known about whether a particular limb strategy influences endoleak, reintervention, or aneurysm regression rates. We present the 5 year data comparing endoleak, stent graft migration, fracture, aneurysm sac dynamics, and aortic rupture rates among patients treated with Bell Bottom limbs (BB), Iliac Branch Endoprosthesis (IBE), and Coil & Cover (CC) approaches from the GREAT registry. Secondary endpoints were all-cause mortality, stroke, reintervention, and paraplegia. METHODS:Subjects from the GORE Global Registry for Endovascular Aortic Treatment (GREAT) were enrolled over a 5 year period from October 2017 to August 2022. 924 subjects were included in this specific study. Statistical data was generated on R software and limb groups were compared using the Pearson's Chi-squared test and the Kruskal- Wallis rank sum test. RESULTS:We found no statistical difference in endoleak rates, stent graft migration, fracture, or aortic rupture when stratified by limb strategy. There was no difference between limb approaches in regards to aneurysm sac dynamics among those with abdominal aortic aneurysms and common iliac aneurysms. Similarly, no statistical difference between limb strategies was found in all-cause mortality, stroke, paraplegia, or reintervention rates. Among patients that required an additional graft during reintervention, the highest rates were found within the IBE group 8.6%, compared with BB group 2.2% and CC group 1.3% (P= 0.006). CONCLUSIONS:Overall, there was no difference among limb strategies in endoleak rates, stent graft migration, aneurysm sac dynamics, aortic rupture rates, or our secondary endpoints. Increased rates of reintervention requiring an additional graft within the IBE group is noteworthy and must be weighed against the adverse effects of hypogastric sacrifice with the CC approach or potentially less advantageous seal zones in the BB approach. This suggests that all limb approaches have equivalent effectiveness in managing the aneurysmal common iliac artery and thus the choice of limb strategy should be individualized and remain physician discretion. Future research should include a more robust sample size to reproduce these findings.