title: Relationship between access side used to deliver the main body of bifurcated prostheses for endovascular aneurysm repair and speed of cannulation of the contralateral limb.
abstract: OBJECTIVE
  To examine the relationship between the orientation of the iliac arteries in infrarenal aortic aneurysms and its effect on the cannulation of the contralateral limb of a bifurcated stent graft system (SGS) used for endovascular aneurysm repair (EVAR).
  
  
  METHODS
  This is a retrospective review of prospectively collected data in 100 consecutive patients treated with EVAR using the Zenith device (Cook Medical Inc., Bloomington, Indiana, USA). We collected data on reciprocal orientation between the origins of the common iliac arteries (OOCIA) on an axial plane, the common femoral artery (right or left) used to deliver the main body of the SGS (access side), and the cannulation time of the contralateral limb. The latter was defined as the time elapsed between the introduction of the selective catheter in the contralateral iliac artery to the time of successful cannulation of the contralateral limb of the SGS. Using an Aquarius workstation (v. 3.5; TeraRecon Inc, San Mateo, Calif), the OOCIA was measured establishing the center of the origin of the right and left common iliac arteries and joining them using a straight line. A horizontal line was then drawn through the origin of the right common iliac artery. The angle created by these two lines was defined as "zero," "positive," or "negative." We examined the relations between cannulation time, access side, and OOCIA using t tests and a multivariate regression analysis.
  
  
  RESULTS
  In 84 patients, the origin of the right common iliac artery was in an anterior position compared with the left; in 16, the origin of the right and left were on the same horizontal line; and the right common iliac artery was posterior in none of the patients. The main body of the prosthesis was delivered using the left femoral artery in 52 patients and the right in 48. When all patients were considered, cannulation time was shorter when the main body of the bifurcated prosthesis was delivered through the left femoral artery (9.3 +/- 5.8 minutes vs 15.4 +/- 7.2 minutes, P < .0001). This effect was more pronounced when only patients with the left common iliac artery located posteriorly were examined (9.3 +/- 5.80 minutes vs 16.4 +/- 7.6 minutes, P < .0001). There was no correlation between increasing negativity of the OOCIA angle and cannulation time, regardless of access side.
  
  
  CONCLUSIONS
  We have shown that in patients with infrarenal aortic aneurysms, the origin of the right iliac artery is often anterior compared with the left and that cannulation time of the contralateral limb is shorter when the main body of the prosthesis is delivered from the left.
authors.affiliation: Division of Vascular Surgery, University of Toronto, St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Wilfred
authors.initials: W
authors.lastname: Dang
authors.forename: Michael
authors.initials: M
authors.lastname: Kilian
authors.forename: Mark D
authors.initials: MD
authors.lastname: Peterson
authors.forename: Claudio
authors.initials: C
authors.lastname: Cinà
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods; D002406:Catheterization, Peripheral; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D011474:Prosthesis Design; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome