Iliac Conduits for Endovascular Treatment of Aortic Pathologies: A Systematic Review and Meta-analysis

Abstract

Purpose: The treatment of thoracoabdominal aortic aneurysm has largely shifted to endovascular techniques. However, severe iliofemoral arterial disease often presents a challenge during these interventions. As a result, iliac conduits have been introduced to facilitate aortic endovascular therapy. The goal of the current study was to gauge utilization and to analyze iliac artery conduit outcomes to facilitate endovascular therapy to treat aortic pathologies. Materials and Methods: A meta-analysis of 14 studies was conducted with the use of random effects modeling. The incidence of periprocedural adverse events was gauged based on iliac conduit vs nonconduit cases and planned vs unplanned iliac conduit placement. Outcomes of interest included length of hospital stay, morbidity and mortality associated to conduits, and all-cause mortality. Results: Iliac conduits, either open or endo-conduits, were utilized in 17% (95% CI: 9%–27%) of 16,855 cases, with technical successful rate of 94% (95% CI: 80%–100%). Periprocedural complications occurred in 32% (95% CI: 22%–42%) of the cases, with overall bleeding complication rate being 10% (95% CI: 5%–16%). Female patients, positive history for smoking, pulmonary disease, and peripheral artery disease at baseline were associated with more frequent utilization of iliac conduits. Conduit use was associated with longer hospitalization, higher periprocedural all-cause mortality (OR: 2.85; 95% CI: 1.75–4.64; p<0.001), and bleeding complication rate (OR: 2.38; 95% CI: 1.58–3.58; p<0.001). Sensitivity analysis among conduit cases showed that planned conduits were associated with fewer periprocedural complications compared to unplanned conduits (OR: 0.38; 95% CI: 0.20–0.73; p=0.004). Conclusion: Iliac conduit placement is a feasible strategy, associated with high technical success to facilitate complex aortic endovascular repair. However, periprocedural adverse event rate, including bleeding complications is not negligible. All-cause mortality and morbidity rates among cases that require iliac conduits should be strongly considered during clinical decision making. High-quality comparative analyses between iliac conduit vs nonconduit cases and between several types of iliac conduit grafts aiming at facilitating endovascular aortic repair are still needed to determine the best strategy to address challenging iliac artery accesses.

Predicting Outcomes Following Endovascular Abdominal Aortic Aneurysm Repair Using Machine Learning

“…In particular, there is a strong recommendation for smoking cessation at least 2 weeks before aneurysm repair, 2 yet over 30% of patients in our cohort were current smokers at the time of intervention. Our data also demonstrated that patients with 30-day MACE were more likely to require open vascular access and iliac conduits, suggesting a greater degree of systemic atherosclerosis 33 . Therefore, there are important opportunities to improve care for patients by understanding their surgical risk and medically optimizing them before intervention.…”

“…Our data also demonstrated that patients with 30-day MACE were more likely to require open vascular access and iliac conduits, suggesting a greater degree of systemic atherosclerosis. 33 Therefore, there are important opportunities to improve care for patients by understanding their surgical risk and medically optimizing them before intervention. In addition, we demonstrate the contribution of anatomic complexity to adverse outcomes because of distal AAA extent and prior EVAR, which is corroborated by previous literature.…”

Use of iliofemoral conduits to reduce neurological and vascular morbimortality asso-ciated with complex EVAR

“…Hay diversas publicaciones que describen una mayor estancia hospitalaria, pérdida hemática y mortalidad a 30 días en pacientes que requieren conductos iliofemorales (9,17,18). Nuestra experiencia es muy distinta, incluso aunque nuestra serie es sobre F/BEVAR; sin embargo, es cierto que nosotros realizamos los conductos permanentes siempre en un procedimiento previo.…”

Direct puncture of an occluded common femoral artery as a new approach for endovascular aortic aneurysm repair

“…Hostile iliac access is an obstacle to perform endovascular aneurysm repair (EVAR), and it reportedly precludes EVAR in 6-15.4% of patients with abdominal aortic aneurysms (AAA) (Arko et al 2004). These occlusive iliac accesses are manageable in most cases by endovascular revascularization alone or combining surgical procedures such as creating iliac conduit for delivery of the endograft (Uchiyamada et al 2013;Vallabhaneni et al 2012;Takeuchi et al 2019;Giannopoulos et al 2021). However, in cases where the occlusion of the iliac artery extends to the common femoral artery (CFA), a concomitant surgical intervention such as endarterectomy of the CFA is also necessary.…”