PS64 Iliac Injury During Abdominal and Thoracic Aortic Endovascular Intervention

Abstract

Iliac injury is a devastating and potentially avoidable complication of endovascular aortic intervention. To our knowledge, this study is the first investigation of demographic, anatomic, and device factors related to iliac injury in vascular surgery patients. We retrospectively examined 1859 endovascular aortic interventions and found 42 iliac injuries, including 21 ruptures. Demographic, anatomic, and device data were extracted from these patients and a cohort of 200 case-matched control patients derived from the group of uninjured patients. Anatomic data includes centerline and straight distance measurement of the iliac system from the aortic bifurcation to the inguinal ligament. The ratio of the two (“tortuosity index”) was calculated. Additional data includes midpoint and narrowest diameters in the iliac system along with the most acute angle. Each measurement was taken for the side through which the main body was introduced (“device side”) and the contralateral side. Demographic factors associated with injury were female gender (P < .001) and non-Caucasian race (P = .028). None of the examined comorbidities were associated with iliac injury. Increasing sheath size was associated with injury (P < .001). Device-side anatomic factors associated with injury were decreasing iliac midpoint (P = .002) and narrowest diameters (P < .001). Contralateral-side anatomic variables associated with injury were iliac centerline distance (P = .030), decreasing midpoint (P < .001), narrowest diameters (P < .001), and angularity (P = .036). Injury is associated with inpatient death (P < .001), with iliac rupture conferring an odds ratio of 15.3 (P < .001). Iliac injury is associated with death on the index admission. Female gender, non-Caucasian race, large sheath sizes, and iliac occlusive disease and angularity are associated with iliac injury. These findings should be prospectively evaluated along with interventions to reduce injury.