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PVSS11. Managing Iliac Artery Occlusive Disease During Endovascular Aneurysm Repair: The Use Of Conduits

Daniel Silverberg, Sharif H. Ellozy, Donald T. Baril, Alfio Carroccio, Saber Ghiassi, Tikva S. Jacobs, Ulka Sachdev, Victoria J. Teodorecu, Michael L. Marin, James J. Peter.
VA Medical Center, Bronx, N.Y., Mount Sinai School of Medicine; New York, N.Y.

OBJECTIVES: Challenging iliac artery anatomy may prevent success of endovascular repairs of thoracic and abdominal aortic aneurysms (EVAR). An endoluminal or extra anatomic iliac artery conduit may expand the use of endovascular stent-grafts. We report a single institutions experience using conduits to manage complex iliac artery anatomy.

METHODS: A retrospective review was performed of all patients who underwent EVAR of thoracic (TAA) or abdominal aortic aneurysms (AAA) between 2001 and 2006. Patients requiring an iliac conduit were identified. Patients charts and imaging were reviewed for type of conduit, Iliac artery anatomy, EVAR technical success rate and outcome. Iliac anatomy was evaluated for diameter, calcifications, tortuosity, angulation and pelvic circulation.

RESULTS:  Of 857 patients who underwent EVAR, 45 patients (5.3%) required 49 conduits. Thirty (61%) were endoluminal conduits and 19 (39%) were extra- anatomical. Fourteen (28%) were performed for TAA and 35 (72%) for AAA. Ten conduits (20%) were applied for emergency aneurysm repairs. EVAR technical success was achieved in 90% (44/49) of the procedures. Intraoperative complications occurred in 4 patients, all related to ruptures of iliac arteries. Two post-operative deaths occurred, one related to the conduit. Late morbidity related to the conduits occurred in 2 patients, both with endoluminal conduits. One developed stenosis of the conduit and the other developed graft occlusion. Both underwent successful revision.

CONCLUSIONS: Iliac artery conduits can safely facilitate endovascular stent graft delivery in EVAR with coexistent complex iliac anatomy. They must be used with caution due to a significant risk of morbidity in this complex patient population.