Access for Endovascular Aneurysm Repair

Abstract

Despite advancement in stent-graft technology, access-related problems continue to occur during endovascular repair of aortic aneurysms. Various techniques have been adopted to overcome difficult access situations, however. To survey these developments in arterial access, we performed a systematic literature review from 1994 through 2005 to identify relevant articles pertaining to endovascular access techniques and complications. Excessive iliac tortuosity, circumferential vessel wall calcification, significant occlusive disease, and small caliber vessels account for the majority of access problems, most of which are readily apparent with adequate baseline imaging. Even with careful preoperative assessment, however, some access problems may not be foreseen; nonetheless, the majority can be overcome using today's array of ancillary procedures, such as an iliac conduit, a brachiofemoral wire, or arterial reconstruction. Alternatively, other approach routes, such as the common carotid artery or direct aortic access, may be used to facilitate endovascular aneurysm repair.

Retroperitoneal Versus Direct Femoral Artery Approach for Thoracic Endovascular Aortic Repair Access: A Case–Control Study

“…4 Until recently, several alternative approaches for achieving adequate TEVAR access have been described. [2][3][4][5][6] Although none of them have demonstrated superiority, retroperitoneal approach to the iliac arteries seems to be the most popular approach. 5 In this study, we compare the TEVAR procedure using the retroperitoneal approach with those using direct femoral access at our center.…”

Unfavorable iliac artery anatomy causing access limitations during endovascular abdominal aortic aneurysm repair: application of the endoconduit technique

“…Common causes of aortic access difficulties include iliac arteries with naturally small calibers or that have narrowed because of extensive atherosclerosis or calcifications. Certain options have been developed over the years in attempts to surmount these difficulties, including intra-abdominal tunnels or conduits; 6 retroperitoneal conduits; 7 conduits constructed with the aid of video vascular surgery; 8 iliac reconstruction surgeries or bypasses, 9 and angioplasty of the iliac arteries with or without stents. 10 Iliofemoral endarterectomy, 1 dissection and direct puncture of the aortoiliac segment, 9,11 and utilization of internal conduits 2,3,12 have also been described.…”

Successful treatment of an abdominal aortic aneurysm by endovascular graft placement through a previously placed prosthetic graft: Report of a case

“…The EUROSTAR registry reported access problems in 13% of patients selected for EVAR, which along with migration was the leading cause of a 2% primary conversion rate. 2 Access route problems including excessive iliac tortuosity, circumferential vessel wall calcifi cation, signifi cant occlusive disease, and small-caliber vessel have all been described, 2 with various methods to overcome these problems. Criado et al reported use of a 10-mm diameter Dacron graft as an iliac conduit, which provides suffi cient luminal space for the introduction of all delivery systems.…”