Balloon-Expandable Versus Self-Expandable Stent Grafts for Endovascular Repair of Aorto-Iliac Aneurysms with Iliac Branch Devices: A Systematic Review and Meta-Analysis

Abstract

Background: To compare the results of internal iliac artery (IIA) incorporation using balloon-expandable stent grafts (BESGs) versus self-expandable stent grafts (SESGs) while using iliac branch devices (IBDs) for endovascular repair of aorto-iliac artery aneurysms.

Methods: A systematic review and meta-analysis was conducted. PubMed, Embase, and Cochrane databases were searched for studies up to December 2024 that compared BESG and SESG for IBD during endovascular repair of aorto-iliac aneurysms. A total of 1,107 articles were screened following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. End points included a composite of all endoleaks, types 1b, 1c, and 3 endoleaks, buttock claudication, IIA occlusion, and IBD-related reinterventions during follow-up.

Results: Four cohort studies met the eligibility criteria with 684 patients treated with 711 IBDs. 460 (64.7%) BESGs and 251 (35.3%) SESGs were used in the target IIAs. Both groups had similar demographics and cardiovascular risk factors. The median age of patients was 71.1 years and 88.7% were male. A composite of all endoleaks (odds ratio [OR]: 5.53; 95% confidence interval [CI]: 1.15 to 26.63; P = 0.03; I² = 0) was significantly less common in patients treated with SESG compared to BESG. Type 1b (OR: 4.62; 95% CI: 0.18-116.16; P = 0.35), type 1c (OR: 1.52; 95% CI: 0.09-25.03; P = 0.77), type 3 endoleaks (OR: 5.25; 95% CI: 0.58-47.47; P = 0.14), buttock claudication (OR: 0.38; 95% CI: 0.06-2.58; P = 0.32; I² = 0%), IIA occlusion (OR: 0.40; 95% CI: 0.06-2.57; P = 0.34; I² = 0%), and IBD-related reinterventions (OR: 1.62; 95% CI: 0.84-3.11; P = 0.15; I² = 0%) were not significantly different between groups.

Conclusion: SESG for IIA was associated with a lower incidence of all types of endoleaks when compared to BESG during endovascular repair of aorto-iliac aneurysms using IBD. However, types 1b, 1c, and 3 endoleaks; buttock claudication; IIA occlusion; and IBD-related reinterventions were similar among SESG and BESG. BESG is more versatile to adjust to challenging anatomical conditions.