Broadening the applicability of endovascular aneurysm repair: The use of iliac conduits

Objective: Suboptimal iliac anatomy has sometimes precluded endovascular repair of abdominal aortic aneurysm (AAA). In an effort to increase the applicability of endovascular repair, a limited retroperitoneal approach and iliac conduit was used in some patients with unsuitable iliac anatomy at high risk for open repair. Methods: Charts and imaging studies of 312 patients who underwent endovascular (AAA) repair at the Cleveland Clinic Foundation between June 1999 and November 2000 were reviewed. Among these, 22 patients with complex iliac anatomy had an iliac conduit placed. Seventeen of these procedures were planned, but five were unplanned and placed after an iliac artery injury. A group of 17 patients who underwent a standard endovascular repair without conduits was selected and matched to the 17 patients in the planned conduit group by baseline comorbidities. The conduits were 8-mm or 10-mm polyester grafts sewn proximally to the common iliac artery and provided unobstructed access to the aneurysm. After insertion of the endograft device through the conduit, the distal end of the conduit was anastomosed to the external iliac or common femoral vessels. Results: Operative time and estimated blood loss were higher among patients in whom conduits were performed, especially when performed urgently as an unplanned procedure. Although operative time and intensive care unit and hospital stays were longer for the group of patients with iliac conduits, the cardiac pulmonary and renal complication rates were similar for the conduit and the standard endovascular repair group. Conclusion: The use of a limited retroperitoneal approach and iliac conduit for patients with difficult iliac anatomy increases the applicability of the endovascular repair of AAA. This technique should be considered when an open surgical approach is inadvisable on the basis of medical comorbidities.