Special iliac artery considerations during aneurysm endografting.
BACKGROUND
The feasibility of endograft exclusion of abdominal aortic aneurysms (AAA) has been established. However, the technical challenges of graft delivery through tortuous or diseased iliac arteries and the treatment of associated iliac aneurysmal disease have received little attention.


METHODS
Over 19 months, 74 patients underwent endoluminal repair of AAA and/or iliac artery aneurysms. Iliac anatomy that required special consideration during endografting was reviewed.


RESULTS
Of the 74 patients, 35 (47%) had iliac anatomy that required special attention. Thirteen patients (18%) had aneurysmal involvement of a common iliac artery. Eleven of these patients required endograft extension into the external iliac artery (EIA) and hypogastric coil embolization due to the proximity of the aneurysm to the hypogastric origin. Eleven patients with ectatic, nonaneurysmal iliac arteries required aortic cuffs to achieve a distal seal in these oversized vessels. Iliac artery tortuosity or stenosis were complicating factors in 27 of the 74 patients (36%), requiring the use of brachial guidewire tension in 2 patients to facilitate tracking of the delivery device. Five patients with severely splayed aortic bifurcations required crossed placement of the iliac limbs to prevent kinking of the endograft. Occlusive atherosclerotic disease of the EIA mandated preprocedural dilatation and stenting in 3 patients and postprocedural surgical EIA reconstruction in another 5 patients. Three patients who underwent successful endograft placement required subsequent endovascular repair of traumatized EIAs.


CONCLUSIONS
Iliac artery anatomy plays a significant role in the endoluminal treatment of infrarenal abdominal aortic aneurysms, complicating the procedure in up to 47% of patients with otherwise suitable anatomy. A variety of supplemental procedures, both surgical and endovascular, may be required to facilitate endograft placement. A special understanding of these constraints and proper planning is required for optimal therapy.
Henretta
J P
JP
Department of Surgery, Southern Illinois University School of Medicine, Springfield, USA.
Karch
L A
LA
Hodgson
K J
KJ
Mattos
M A
MA
Ramsey
D E
DE
McLafferty
R
R
Sumner
D S
DS
D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D004621:Embolization, Therapeutic; D006801:Humans; D017543:Iliac Aneurysm / Q000601:surgery*; D007083:Iliac Artery / Q000473:pathology*; D011446:Prospective Studies; D011474:Prosthesis Design; D015607:Stents