title: Perioperative Outcomes in Patients Requiring Iliac Conduits or Direct Access for Endovascular Abdominal Aortic Aneurysm Repair.
abstract: BACKGROUND
  Iliac conduit or direct iliac access (ICDA) can be used when anatomy is unfavorable for femoral access during abdominal endovascular aortic aneurysm repair (EVAR). The impact of this approach has not been adequately addressed. The objective of this study was to analyze perioperative outcomes of patients requiring use of ICDAs for EVAR.
  
  
  METHODS
  Patients undergoing EVAR with and without ICDA were identified in the 2005-2012 National Surgical Quality Improvement Program data sets. Perioperative morbidity and mortality were assessed by crude comparison of matched groups and multivariate analyses.
  
  
  RESULTS
  Of 15,082 patients undergoing infrarenal EVAR 147 (1%) required ICDA. The ICDA group had a higher proportion of females (25.9% vs. 17.8%, P = 0.017), peripheral vascular disease (12.9% vs. 5.5%, P = 0.001), and patients with a history of dyspnea (31.3% vs. 23.1%, P = 0.024). There was no difference in age (74.5 ± 8.4 conduit vs. 73.5 ± 8.5). On multivariate analysis, the ICDA cohort had a higher rate of mortality (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.4-5.4; P = 0.004) and an increase in other major complications including cardiac arrest and/or myocardial infarction (OR, 2.9; 95% CI, 1.3-6.3; P = 0.007), pulmonary complications (OR, 2.1; 95% CI, 1.2-3.9; P = 0.013), and postoperative length of stay (means ratio, 1.3; 95% CI, 1.1-1.4; P = 0.001). There was a trend toward increased bleeding complications with ICDA. Matched analyses of comorbidities revealed that patients requiring ICDA had higher perioperative mortality (6.8% vs. 2.3%, P = 0.008), cardiac (4.8% vs. 1%, P = 0.004), pulmonary (8.8% vs. 3.4%, P = 0.006), and bleeding complications (10.2% vs. 4.6%, P = 0.016).
  
  
  CONCLUSIONS
  Our results demonstrate that the use of ICDA during EVAR is associated with increased morbidity and mortality. In situations where anatomy mandates the use of iliac conduits or access for EVAR, surgeons should consider this increased risk. Open repair or the use of lower profile devices, if possible, should be considered as options for these patients.
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Biostatistics, Boston Medical Center, Boston University School of Medicine, Boston, MA.
authors.forename: Rumbidzayi
authors.initials: R
authors.lastname: Nzara
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Biostatistics, Boston Medical Center, Boston University School of Medicine, Boston, MA.
authors.forename: Denis
authors.initials: D
authors.lastname: Rybin
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Biostatistics, Boston Medical Center, Boston University School of Medicine, Boston, MA.
authors.forename: Gheorghe
authors.initials: G
authors.lastname: Doros
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Biostatistics, Boston Medical Center, Boston University School of Medicine, Boston, MA.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Didato
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Biostatistics, Boston Medical Center, Boston University School of Medicine, Boston, MA.
authors.forename: Alik
authors.initials: A
authors.lastname: Farber
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Biostatistics, Boston Medical Center, Boston University School of Medicine, Boston, MA.
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Eslami
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Biostatistics, Boston Medical Center, Boston University School of Medicine, Boston, MA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kalish
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Biostatistics, Boston Medical Center, Boston University School of Medicine, Boston, MA. Electronic address: jeffrey.siracuse@bmc.org.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Siracuse
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000401:mortality / Q000601:surgery*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D007083:Iliac Artery; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012737:Sex Factors; D016896:Treatment Outcome