title: Iliofemoral complications associated with thoracic endovascular aortic repair: frequency, risk factors, and early and late outcomes.
abstract: BACKGROUND
  Risk factors and outcomes after iliofemoral complications after thoracic aortic endovascular repair remain poorly characterized. This study was performed to characterize factors influencing perioperative iliofemoral complications during thoracic aortic endovascular repair.
  
  
  METHODS
  All patients undergoing transfemoral thoracic aortic endovascular repair since 2005 with adequate preoperative aortoiliac 3-dimensional imaging (n = 126) were identified. Assessment of imaging was blinded with regard to occurrence of iliofemoral complications, defined as anything other than successful transfemoral device delivery and primary closure of an arteriotomy.
  
  
  RESULTS
  The complication rate was 12% (n = 15). Univariate analysis identified that female gender, preoperative ankle-brachial index, average and minimal iliac diameters, diameter difference between iliac artery and sheath size, and iliac morphology score (calculated by combining iliac tortuosity, calcification, and vessel diameter) were associated with iliofemoral complications (all P < .05). Multivariate analysis identified the (1) difference between average iliac diameter and sheath size (P = .014), (2) iliac artery morphology score (P = .033), and (3) ankle-brachial index (P = .012) as independent predictors for iliofemoral complications. Early mortality was higher in those with complications (13.3% vs 1.8%, P = .069). Four-year freedom from limb loss, claudication, or revascularization was 97.9%. Iliofemoral complications reduced late survival primarily as a result of increased mortality within the first year (P = .047).
  
  
  CONCLUSIONS
  Thoracic aortic endovascular repair can be performed safely via a transfemoral approach. Alternative access in patients with high preoperative iliac artery morphology scores and device delivery size requirements over the native iliofemoral size may reduce iliofemoral complications. If early complications occur, prompt repair results in low rates of ischemic limb complications at late follow-up.
authors.affiliation: Department of Surgery, University of Michigan Cardiovascular Center, Ann Arbor, Mich.
authors.forename: Frank C
authors.initials: FC
authors.lastname: Vandy
authors.affiliation: Department of Cardiac Surgery, University of Michigan Cardiovascular Center, Ann Arbor, Mich.
authors.forename: Micah
authors.initials: M
authors.lastname: Girotti
authors.affiliation: Department of Radiology, University of Michigan Cardiovascular Center, Ann Arbor, Mich.
authors.forename: David M
authors.initials: DM
authors.lastname: Williams
authors.affiliation: Department of Surgery, University of Michigan Cardiovascular Center, Ann Arbor, Mich.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Eliason
authors.affiliation: Department of Radiology, University of Michigan Cardiovascular Center, Ann Arbor, Mich.
authors.forename: Narasimham L
authors.initials: NL
authors.lastname: Dasika
authors.affiliation: Department of Cardiac Surgery, University of Michigan Cardiovascular Center, Ann Arbor, Mich.
authors.forename: G
authors.initials: G
authors.lastname: Michael Deeb
authors.affiliation: Department of Cardiac Surgery, University of Michigan Cardiovascular Center, Ann Arbor, Mich. Electronic address: hjpatel@med.umich.edu.
authors.forename: Himanshu J
authors.initials: HJ
authors.lastname: Patel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D016009:Chi-Square Distribution; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome