Access for endovascular aneurysm repair.
Despite advancement in stent-graft technology, access-related problems continue to occur during endovascular repair of aortic aneurysms. Various techniques have been adopted to overcome difficult access situations, however. To survey these developments in arterial access, we performed a systematic literature review from 1994 through 2005 to identify relevant articles pertaining to endovascular access techniques and complications. Excessive iliac tortuosity, circumferential vessel wall calcification, significant occlusive disease, and small caliber vessels account for the majority of access problems, most of which are readily apparent with adequate baseline imaging. Even with careful preoperative assessment, however, some access problems may not be foreseen; nonetheless, the majority can be overcome using today's array of ancillary procedures, such as an iliac conduit, a brachiofemoral wire, or arterial reconstruction. Alternatively, other approach routes, such as the common carotid artery or direct aortic access, may be used to facilitate endovascular aneurysm repair.
Murray
David
D
Department of Vascular Surgery, Manchester Royal Infirmary, Manchester M13 9WL, UK.
Ghosh
Jonathan
J
Khwaja
Nadeem
N
Murphy
Michael O
MO
Baguneid
Mohammed S
MS
Walker
Michael G
MG
D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods* / Q000639:trends; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000628:therapy*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000639:trends; D004691:Endarterectomy; D004867:Equipment Design; D006801:Humans; D007083:Iliac Artery; D018579:Patient Selection; D011300:Preoperative Care / Q000379:methods; D011474:Prosthesis Design; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome