Early Outcomes of Physician-Modified Endurant Limbs vs Iliac Branch Devices in Narrow Common Iliac Arteries: A Retrospective Cohort Pilot Study

Objectives: To evaluate the feasibility and short-term outcomes of physician-modified Endurant limbs (PMEGs) for internal iliac artery (IIA) preservation in patients with narrow common iliac artery (CIA) anatomy, with descriptive comparison to commercially available iliac branch devices (IBDs). Methods: This retrospective multicenter pilot study included 20 consecutive patients with a CIA bifurcation diameter ≤18 mm who underwent endovascular aneurysm repair with preservation of at least 1IIA between January 2023 and December 2025. Ten patients were treated with PMEG and 10 with commercially available IBDs. Primary outcomes were technical success and IIA branch patency. Secondary outcomes included operative time, back-table modification time, endoleaks, reinterventions, and perioperative outcomes. Results: Technical success was achieved in all patients. Internal iliac artery branch patency was 100% at 1 and 3 months in both groups and remained 100% in the PMEG group vs 90% in the IBD group at 12 months. No type I/III endoleaks or iliac-related reinterventions occurred. Operative time was similar between groups, while mean PMEG modification time was 61.5 ± 26.4 minutes. No modification-related complications or procedure-related mortality occurred. Conclusions: The PMEG appears to be a feasible option for IIA preservation in patients with narrow iliac anatomy, demonstrating favorable early outcomes. Given the pilot design, small sample size, and limited follow-up, these findings should be interpreted cautiously and require validation in larger prospective studies. Clinical Impact PMEGs may be a feasible option for IIA preservation in patients with narrow CIA anatomy when standard IBDs are limited by profile or availability. This approach may expand endovascular options in selected cases, emphasizing careful planning and technical flexibility. Given the small sample size, these findings warrant cautious interpretation and validation in larger studies.