title: Alternative access techniques with thoracic endovascular aortic repair, open iliac conduit versus endoconduit technique.
abstract: BACKGROUND
  Iliac artery endoconduits (ECs) have emerged as important alternatives to retroperitoneal open iliac conduits (ROICs) to aid in transfemoral delivery for thoracic endovascular aortic repair (TEVAR). We present, to our knowledge, the first comparative analysis between these alternative approaches.
  
  
  METHODS
  All patients undergoing TEVAR with either ROIC (n = 23) or internal EC (n = 16) were identified. The mean age of the cohort was 72.4 ± 11.5 years (82.1% female). Device delivery was accomplished in 100% of cases. The primary outcome was the presence of iliofemoral complications, which was defined as: (1) the inability to successfully deliver the device into the aorta via the ROIC or EC approach; (2) rupture, dissection, or thrombosis of the ipsilateral iliac or femoral artery; and/or (3) retroperitoneal hematoma requiring exploration and evacuation. Secondary outcomes were 30-day mortality and rates of limb loss, claudication, or revascularization.
  
  
  RESULTS
  At a median follow-up of 10.1 months, the incidence of iliofemoral complications was less for the EC approach compared with the ROIC technique (12.5% vs 26.1%; P = .301). No patients sustained limb loss. Revascularization was performed in two patients after ROIC. Lower extremity claudication occurred in one patient after EC. Early mortality was seen in one patient who underwent EC. Two-year Kaplan-Meier survival for the entire cohort was 74.4%, and did not differ between groups (ROIC, 78.3% vs EC, 68.8%; P = .350). Two-year Kaplan-Meier freedom from limb loss, claudication, or revascularization did not differ between the two approaches (ROIC, 91.3% vs EC, 93.8%; P = .961).
  
  
  CONCLUSIONS
  Results of this early comparative evaluation of alternative access routes for TEVAR suggest that an EC approach is safe, effective, and associated with low rates of early mortality and late iliofemoral complications. In selected patients, the EC may be considered an appropriate delivery route for transfemoral TEVAR.
authors.affiliation: Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Mich.
authors.forename: Guido H W
authors.initials: GHW
authors.lastname: van Bogerijen
authors.affiliation: Department of Radiology, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Mich.
authors.forename: David M
authors.initials: DM
authors.lastname: Williams
authors.affiliation: Department of Vascular Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Mich.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Eliason
authors.affiliation: Department of Radiology, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Mich.
authors.forename: Narasimham L
authors.initials: NL
authors.lastname: Dasika
authors.affiliation: Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Mich.
authors.forename: G Michael
authors.initials: GM
authors.lastname: Deeb
authors.affiliation: Department of Cardiac Surgery, University of Michigan Frankel 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; D000792:Angiography / Q000379:methods; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D002406:Catheterization, Peripheral / Q000379:methods; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008824:Michigan; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D015641:Radiography, Interventional; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome