Alternative access techniques with thoracic endovascular aortic repair, open iliac conduit versus endoconduit technique

• Published in: Journal of vascular surgery 2014-11, Vol.60 (5), p.1168-1176
• Main Authors: van Bogerijen, Guido H.W., MD, Williams, David M., MD, Eliason, Jonathan L., MD, Dasika, Narasimham L., MD, Deeb, G. Michael, MD, Patel, Himanshu J., MD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Angiography - methods; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - surgery; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Blood Vessel Prosthesis Implantation - methods; Blood Vessel Prosthesis Implantation - mortality; Catheterization, Peripheral - methods; Endovascular Procedures - adverse effects; Endovascular Procedures - instrumentation; Endovascular Procedures - methods; Endovascular Procedures - mortality; Female; Femoral Artery - diagnostic imaging; Humans; Iliac Artery - diagnostic imaging; Iliac Artery - surgery; Kaplan-Meier Estimate; Male; Michigan; Middle Aged; Postoperative Complications - etiology; Radiography, Interventional; Retrospective Studies; Risk Factors; Stents; Surgery; Time Factors; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2014.05.006

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.