BACKGROUND: The feasibility of endograft exclusion of abdominal aortic aneu
rysms (AAA) has been established. However, the technical challenges of graf
t delivery through tortuous or diseased iliac arteries and the treatment of
associated lilac aneurysmal disease have received little attention.
METHODS: Over 19 months, 74 patients underwent endoluminal repair of AAA an
d/or iliac artery aneurysms. Iliac anatomy that required special considerat
ion during endografting was reviewed.
RESULTS: Of the 74 patients, 35 (47%) had iliac anatomy that required speci
al attention. Thirteen patients (18%) had aneurysmal involvement of a commo
n iliac artery. Eleven of these patients required endograft extension into
the external iliac artery (EIA) and hypogastric coil embolization due to th
e proximity of the aneurysm to the hypogastric origin. Eleven patients with
ectatic, nonaneurysmal iliac arteries required aortic cuffs to achieve a d
istal seal in these oversized vessels. Iliac artery tortuosity or stenosis
were complicating factors in 27 of the 74 patients (36%), requiring the use
of brachial guidewire tension in 2 patients to facilitate tracking of the
delivery device. Five patients with severely splayed aortic bifurcations re
quired crossed placement of the iliac limbs to prevent kinking of the endog
raft, Occlusive atherosclerotic disease of the EIA mandated preprocedural d
ilatation and stenting in 3 patients and postprocedural surgical EIA recons
truction in another 5 patients, Three patients who underwent successful end
ograft placement required subsequent endovascular repair of traumatized EIA
s.
CONCLUSIONS: Iliac artery anatomy plays a significant role in the endolumin
al treatment of infrarenal abdominal aortic aneurysms, complicating the pro
cedure in up to 47% of patients with otherwise suitable anatomy, A variety
of supplemental procedures, both surgical and endovascular, may be required
to facilitate endograft placement. A special understanding of these constr
aints and proper planning is required for optimal therapy. (C) 1999 by Exce
rpta Medica, Inc.