Special iliac artery considerations during aneurysm endografting

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.