Network meta-analysis compares iliac bifurcation strategies during EVAR

A systematic review and Bayesian network meta-analysis of 21 studies (6291 patients, 7008 iliac bifurcations) compared endovascular strategies for managing the iliac bifurcation during endovascular aneurysm repair, including iliac branch devices (IBD), bell bottom technique, coil and cover, internal iliac artery coverage with external iliac artery extension, and the sandwich technique. The analysis reported that IBD was the only strategy associated with fewer reinterventions compared with internal iliac artery coverage with external iliac artery extension, had fewer type Ib/Ic endoleaks than bell bottom, and was linked to less buttock claudication than coil and cover, with certainty of evidence ranging from low to high across comparisons. The authors concluded IBD showed the most consistently favourable outcome profile among strategies evaluated when anatomically suitable.

Most relevant for: Patients undergoing endovascular aneurysm repair who require management of the iliac bifurcation, particularly when anatomy allows consideration of iliac branch devices.

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