Temporal Trends In The Incidence And Type Of Conduits During Endovascular Aneurysm Repair
Parvathi B. Wilkins, MD PhD, Gustavo S. Oderich, Bernardo C. Mendes, Randall R. DeMartino, Jill J. Colglazier, Fahad Shuja, Todd E. Rasmussen, Manju Kalra.
Mayo Clinic, Rochester, MN, USA.
OBJECTIVE: Conduit placement for arterial access is historically reported in 9-21% of endovascular aortic aneurysm repairs. The caliber of endograft delivery systems has decreased over the last decade. The aim of this study was to determine how this has affected the need for conduits during endovascular aneurysm repairs. METHODS: Data from consecutive patients who underwent EVAR, TEVAR and F/B-EVAR from 2000 to 2020 in our institution were retrospectively reviewed. The number and anatomic locations of open or endovascular conduits used in the 20-year time period were analyzed in 5-year intervals. Isolated balloon angioplasty of the external iliac arteries for access was excluded from the analysis. RESULTS: Of a total of 2724 procedures (1661 EVAR, 405 TEVAR, 658 F/B-EVAR) during the study period, 194 (7%) required conduits. Conduit need was significantly lower for standard EVAR (4%) compared to TEVAR (12%) and F/B-EVAR (11%), p=0.02. Temporal trends in 5-year intervals are summarized in the Table. The use of open conduits during EVAR remained steady over the years (1-3%, p=0.8), with more frequent use of endovascular conduits (1-7%). The contemporary need for conduits during TEVAR remains steady (10-13%), predominantly of open iliac conduits (9-11%). The need for open iliac conduits during F/B-EVAR has decreased dramatically from 8% to < 1%. However, 7-8% of F/B-EVARs in the last decade were performed through open common femoral artery conduits to park the sheath during longer procedures. This facilitates pelvic blood flow restoration and reduces risk of spinal cord injury. The need for conduits was significantly higher in females for all procedures through the study period. CONCLUSIONS: The smaller profile of new aortic devices has diminished the need for open iliac conduits during standard EVAR and F/B-EVAR. Larger caliber TEVAR devices still pose iliac access challenges, especially in women. Although not necessarily for iliac access concerns, the use of open femoral conduits will continue to reduce spinal cord injury during complex F/B-EVAR.
| Procedures and Conduits | 2000-2005 | 2006-2010 | 2011-2015 | 2016-2020 | p value | |
| EVAR | 421 | 503 | 351 | 386 | ||
| Conduits | 6 (1%) | 17 (3%) | 33 (9%) | 9 (2%) | ||
| Open | 2 (0.5%) | 12 (2%) | 9 (3%) | 4 (1%) | 0.8 | |
| Endovascular | 0 | 5 (1%) | 24 (7%) | 5 (1%) | 0.6 | |
| TEVAR | 35 | 81 | 113 | 176 | ||
| Conduits | 2 (6%) | 8 (10%) | 15 (13%) | 22 (13%) | ||
| Open | 1 (3%) | 7 (9%) | 10 (9%) | 19 (11%) | 0.3 | |
| Endovascular | 1 (3%) | 1 (1%) | 5 (4%) | 3 (2%) | 0.3 | |
| F/B-EVAR | 0 | 63 | 234 | 361 | ||
| Conduits | 0 | 6 (10%) | 38 (16%) | 29 (8%) | ||
| Open | 0 | 6 (10%) | 37 (16%) | 28 (8%) | 0.04 | |
| Endovascular | 0 | 0 | 1 (1%) | 1 (1%) | 0.2 | |
| Types of conduits | ||||||
| EVAR | Femoral | 0 | 7 (1%) | 7 (2%) | 2 (1%) | 0.6 |
| Iliac | 2 (0.5%) | 10 (2%) | 26 (7%) | 7 (2%) | 0.03 | |
| TEVAR | Femoral | 1 (3%) | 1 (1%) | 0 | 4 (2%) | 0.1 |
| Iliac | 1 (3%) | 6 (7%) | 11 (10%) | 16 (9%) | 0.7 | |
| Brachial | 0 | 1 (1%) | 4 (4%) | 2 (1%) | 0.1 | |
| F/B-EVAR | Femoral | 0 | 1 (2%) | 19 (8%) | 26 (7%) | 0.8 |
| Iliac | 0 | 4 (6%) | 18 (8%) | 2 (0.6%) | 0.03 | |
| Axillary | 0 | 1 (2%) | 1(1%) | 1 (1%) | 0.1 | |
| Conduits by Gender | ||||||
| EVAR | Male | 1 (0.3%) | 13 (3%) | 18 (6%) | 8 (2%) | 0.01 |
| Female | 1 (2%) | 4 (7%) | 15 (28%) | 3 (5%) | ||
| TEVAR | Male | 1 (5%) | 0 | 6 (8%) | 5 (4%) | |
| Female | 1 (7%) | 8 (28%) | 9 (23%) | 17 (25%) | ||
| F/B-EVAR | Male | 0 | 4 (8%) | 21 (12%) | 13 (5%) | |
| Female | 0 | 2 (20%) | 17 (29%) | 17 (15%) | ||
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