Iliac Artery Endoconduits Should Be the Preferred Adjunctive Access Procedure to Facilitate Endovascular Complex Aortic Aneurysm Repair

Abstract

Anatomic factors of the iliac arteries, including vessel calcification, luminal diameter, and tortuosity can have a dramatic impact on the success complex endovascular aortic procedures. The aim of this study was to evaluate the outcomes of open and endovascular iliac conduits performed to facilitate complex aortic aneurysm endovascular repair. All patients who underwent complex endovascular aortic aneurysm repair through an iliac conduit to treat thoracoabdominal, juxtarenal or suprarenal aneurysms at the University of Colorado Hospital from September 2013 through June 2019 were included. Primary outcomes were endovascular and open iliac conduits morbidity and mortality. A total of 27 patients with 43 conduits were included in the study. The majority of the patients were female (n = 15, 56%). Hypertension (n = 16, 59%) and diabetes (n = 4, 20%) were the most prevalent risk factors. Twenty-two (51%) endoconduits and 21 (49%) open conduits were performed. Patients undergoing endo conduits had significant less complications than those undergoing open conduits (1, 4% vs 10, 48%; P = .02). The most common complications of open conduits were infection (n = 5, 24%) and postoperative hemorrhage (n = 4, 19%). The only complication noted for endoconduits was one access site hematoma requiring surgical evacuation. Overall mortality rate was similar and not related to type of conduit (endoconduits 1, 4% vs open 0; P = NS). Overall complication rate associated with open iliac artery conduits is not negligible. Endoconduits, however, carry less morbidity than open conduits and are thus preferred as a first line adjunctive access to facilitate complex endovascular aneurysm repair whenever feasible.