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Alternative access techniques with thoracic endovascular aortic repair: open iliac conduit vs. endoconduit technique
Guido H. van Bogerijen, MD1, David M. Williams, MD2, Jonathan L. Eliason, MD3, Narasimham L. Dasika, MD2, G. Michael Deeb, MD4, Himanshu J. Patel, MD4.
1Departments of Vascular and Cardiac Surgery, University of Michigan Cardiovascular Center, Ann Arbor, MI, USA, 2Department of Radiology, University of Michigan Cardiovascular Center, Ann Arbor, MI, USA, 3Department of Vascular Surgery, University of Michigan Cardiovascular Center, Ann Arbor, MI, USA, 4Department of Cardiac Surgery, University of Michigan Cardiovascular Center, Ann Arbor, MI, USA.


OBJECTIVES:

Iliac artery endoconduits have emerged as important alternatives to retroperitoneal open iliac conduits to aid in transfemoral delivery for thoracic endovascular aortic repair (TEVAR). We present the first comparative analysis of these alternative approaches.
METHODS:
All patients undergoing TEVAR (n=577, 1993-2013) with either retroperitoneal open iliac conduit (ROIC, n=23) or internal endoconduit (EC, n=15) were identified. The mean age of the cohort was 72.3 ± 11.6 years (81.6% female). A univariate analysis comparing the two groups is listed in Table 1. The primary outcome was the composite rate of late limb loss, claudication or repeat revascularization.
RESULTS:
Device delivery was accomplished in 100% of cases. Early mortality was seen in 1 patient (2.6%) undergoing endoconduit. 2 year KM survival for the entire cohort was 76.3%, and did not differ between groups (ROIC 78.3% vs. endoconduit 73.3%, p=0.583). At a median follow-up of 10.3 months, the incidence of iliofemoral complications was 7.9%. Limb loss was seen in 1 patient after endoconduit. Repeat revascularization occurred in 1 patient after ROIC. Finally, claudication occurred in 1 patient after endoconduit. No variables were identified on univariate analysis as predictive of iliofemoral complications, likely due to the low event rate. Actuarial analysis showed that 12 month freedom from iliofemoral complications was 92.1%, and did not differ between device delivery strategies.
CONCLUSIONS:
This early comparative evaluation of alternative access routes for TEVAR suggests that an endoconduit approach is safe, effective and associated with low rates of early mortality and late iliofemoral complications. The endoconduit may be considered an appropriate delivery route for transfemoral thoracic endovascular aortic repair.
Patient characteristics with univariate analysis
VariableEndoconduit (N = 15)Open conduit (N = 23)P value
Age (years)72.2 ± 7.272.3 ± 7.30.98
Female sex12 (80.0%)19 (82.6%)1.00
Peripheral vascular occlusive disease5 (33.3%)6 (27.3%)0.73
Preoperative ipsilateral ankle-brachial index0.93 ± 0.281.03 ± 0.090.22
Minimum iliofemoral size (mm)4.62 ± 1.966.11 ± 1.250.03
Device delivery size (French)22.46 ± 1.8524.14 ± 1.030.01


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