Iliac Conduits for Endovascular Treatment of Aortic Pathologies: A Systematic Review and Meta-analysis

Abstract

Purpose:

The treatment of thoracoabdominal aortic aneurysm has largely shifted to endovascular techniques. However, severe iliofemoral arterial disease often presents a challenge during these interventions. As a result, iliac conduits have been introduced to facilitate aortic endovascular therapy. The goal of the current study was to gauge utilization and to analyze iliac artery conduit outcomes to facilitate endovascular therapy to treat aortic pathologies.

Materials and Methods:

A meta-analysis of 14 studies was conducted with the use of random effects modeling. The incidence of periprocedural adverse events was gauged based on iliac conduit vs nonconduit cases and planned vs unplanned iliac conduit placement. Outcomes of interest included length of hospital stay, morbidity and mortality associated to conduits, and all-cause mortality.

Results:

Iliac conduits, either open or endo-conduits, were utilized in 17% (95% CI: 9%–27%) of 16,855 cases, with technical successful rate of 94% (95% CI: 80%–100%). Periprocedural complications occurred in 32% (95% CI: 22%–42%) of the cases, with overall bleeding complication rate being 10% (95% CI: 5%–16%). Female patients, positive history for smoking, pulmonary disease, and peripheral artery disease at baseline were associated with more frequent utilization of iliac conduits. Conduit use was associated with longer hospitalization, higher periprocedural all-cause mortality (OR: 2.85; 95% CI: 1.75–4.64; p<0.001), and bleeding complication rate (OR: 2.38; 95% CI: 1.58–3.58; p<0.001). Sensitivity analysis among conduit cases showed that planned conduits were associated with fewer periprocedural complications compared to unplanned conduits (OR: 0.38; 95% CI: 0.20–0.73; p=0.004).

Conclusion:

Iliac conduit placement is a feasible strategy, associated with high technical success to facilitate complex aortic endovascular repair. However, periprocedural adverse event rate, including bleeding complications is not negligible. All-cause mortality and morbidity rates among cases that require iliac conduits should be strongly considered during clinical decision making. High-quality comparative analyses between iliac conduit vs nonconduit cases and between several types of iliac conduit grafts aiming at facilitating endovascular aortic repair are still needed to determine the best strategy to address challenging iliac artery accesses.

Keywords

EVAR TEVAR AAA iliac conduit endo-conduit covered stent endovascular treatment/therapy EVT

Introduction

The epidemiology and clinical landscape of aortic aneurysmal disease have rapidly changed over the past three decades.¹ Endovascular therapy (EVT) for aortic pathologies, involving either the thoracic and/or abdominal aorta, in suitable candidates has been associated with lower perioperative morbidity and all-cause mortality compared with open vascular repair.^2–4 During the past decades, the treatment of these entities has largely shifted to endovascular procedures,^5,6 with endovascular abdominal aortic aneurysm repair (EVAR) being performed in almost 70% of all aneurysms repairs in the United States.⁷

Individualized aortic stent grafts are most often delivered via a transfemoral route.^8,9 However, device characteristics (ie, size, flexibility, deployment accuracy) and anatomic variations (ie, aneurysm characteristics, small vessel caliber, occlusive iliac disease, tortuosity) limit endovascular interventions for aortic aneurysms, corresponding to a feasibility rate up to two-thirds of all cases.^8–11 Techniques that involve open and endovascular iliac conduit placement have been developed in order to overcome severe aortoiliac occlusive disease in order to increase the applicability of EVT to treat aortic pathologies.^12,13 Some disadvantages related to creation of iliac conduits (ie, direct access or pave and crack with endo-conduits) and/or surgical bypass are prolonged procedural time, wound complications, and prolonged hospitalization in patients already deemed high-risk for periprocedural complications.^14–16

The current study summarized all available literature about creation of iliac conduits to facilitate EVT for aneurysmal aortic disease, while determining the utilization of iliac conduits using real-world studies and investigating whether iliac conduits are associated with increased risk for periprocedural complications compared with nonconduit cases.

Materials and Methods

Search Strategy and Selection Criteria

This systematic review and meta-analysis was performed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines.¹⁷ Systematic searches were conducted in PubMed/Medline, Scopus and Cochrane Central, by three independent and blind to each other investigators (MLS, SSS, DR), while any disagreements were resolved by consensus among the remaining authors (RDM, MAM, EAM, SG, DLJ). Keywords that were used for the search algorithm were “iliac,” “artery,” “conduit,” “aorta,” and “aortic.” A study was considered to be eligible for this meta-analysis if it fulfilled the following predefined inclusion criteria: (1) prospective/retrospective analyses reporting on patients with aortic pathologies (ie, thoracic and/or abdominal aortic aneurysms) treated endovascularly; (2) single-arm or comparative studies reporting on short- and/or long-term outcomes of EVT for aortic pathologies with/without the creation of iliac conduits; and (3) studies published up to April 2020. When overlapping populations were identified, the most recent study was included in the respective analysis, unless the earlier version reported more relevant outcomes.

Data Extraction, Outcomes, and Risk of Bias Assessment

Three independent investigators (MLS, SSS, DG), blind to each other abstracted all available information from the eligible studies. Any disagreements were discussed with senior investigators and the final decision was reached by consensus. The primary endpoints of this meta-analysis were (1) iliac conduit success (ie, technically successful iliac conduit utilization), (2) EVT success (ie, successful aneurysm treatment; absence of sack expansion), and (3) bleeding complications. Secondary endpoints included any perioperative complications, 30-day all-cause mortality, 30-day cerebrovascular accidents (CVA), cardiovascular complications [cardiac arrhythmia/arrest and/or myocardial infarction (MI)], pulmonary complications, renal insufficiency, need to return to operating room, urinary tract infection, and wound complications. Risk of bias for all double arm nonrandomized studies was assessed by 2 investigators with the Robins-I tool and differences in risk of bias assessment were resolved via consensus.¹⁸ Assessment of risk of bias is presented in Supplementary Table 1. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was utilized to assess the certainty in evidence of outcomes.¹⁹ Publication bias was quantified by the Egger method and no publication bias was detected.²⁰

Statistical Synthesis and Analysis

Two groups were created including cases of aortic aneurysms treated with iliac conduits vs nonconduit cases, respectively. The utilization of iliac conduits, the frequency and the corresponding 95% confidence intervals (CIs) of perioperative complications among the iliac conduit cohort were estimated. Additionally, odds ratios (ORs) between conduit vs nonconduit cases for primary and secondary outcomes were calculated. Baseline demographic and disease characteristics between the 2 groups were compared as well. Furthermore, a comparison was made between cases that needed planned vs unplanned iliac conduit placement in terms of perioperative complications. In all tests, a random effects model was used to account for dispersion of effects among the corresponding studies. In cases of I²>75%, the variation across studies was attributed to heterogeneity.²¹ Forest plots were used to graphically display the effect size in each study and the pooled estimates of outcomes. STATA 14.1 (StataCorp, College Station, TX) was used as statistical software.

Results

After duplicates were removed, literature search yielded 55 eligible studies for full text evaluation. Fourteen studies fulfilled all predefined inclusion criteria, as illustrated in the PRISMA flow diagram (Figure 1). Ten studies provided (N=16855) information regarding conduit utilization,^{14–16,22–28} while 13 studies reported on the periprocedural outcomes of patients receiving iliac conduits (N=791).^{14–16,22–31} Ten (conduit: N=505 vs nonconduit: N=2891)^{14,16,22–28,32} and 3 (planned: N=168 vs unplanned: N=52)^14,24,31 double arm studies compared the outcomes of conduit vs nonconduit EVT and planned vs unplanned conduit utilization, respectively. In all studies, pathologies of the abdominal and/or the thoracic aorta were treated endovascularly. Across the included literature, iliac conduits were clearly indicated at the discretion of the operator in order to facilitate complex aortic EVT.

Demographics and Patients Characteristics (Conduit vs Nonconduit)

Iliac conduits, either open or endo-conduits, were utilized in 17% (95% CI: 9%–27%) of cases, with male patients requiring a conduit less often than female patients (conduit: 50.5%; N=250/495 vs nonconduit: 80.3%; N=12679/15787; OR: 0.30; 95% CI: 0.21–0.43; p<0.001). Patients that needed an iliac conduit more frequently had a positive history of smoking (conduit: 41.4%; N=144/348 vs nonconduit: 29.7%; N=4492/15145; OR: 1.71; 95% CI: 1.16–2.53; p=0.094), pulmonary disease (conduit: 25.4%; N=94/370 vs nonconduit: 19.1%; 2903/15162; OR: 1.31; 95% CI: 1.02–1.68; p=0.036) and peripheral artery disease (PAD) (conduit: 8.6%; N=30/348 vs nonconduit: 5.1%; N=768/15145; OR: 2.44; 95% CI: 1.66–3.60; p<0.001).

Prevalence of hypertension (HTN) (conduit: 62.4%; N=231/370 vs nonconduit: 76.3%; N=11568/15162; OR: 0.90; 95% CI: 0.41–1.97; p=0.788), history of MI (conduit: 36.5%; N=135/370 vs nonconduit: 35.5%; N=5385/15162; OR: 1.05; 95% CI: 0.84–1.31; p=0.672), diabetes (conduit: 10.0%; N=37/370 vs nonconduit: 8.4%; N=1273/15162; OR: 0.97; 95% CI: 0.64–1.48; p=0.890), history of CVA (conduit: 13.5%; N=50/370 vs nonconduit: 13.1%; N=1989/15162; OR: 1.05; 95% CI: 0.77–1.43; p=0.773) and renal disease (conduit: 4.3%; N=6/139 vs nonconduit: 3.5%; N=37/1054; OR: 0.76; 95% CI: 0.29–2.05; p=0.592) at baseline were equally distributed between the 2 groups. Details regarding demographic characteristics are presented in Table 1, while the pooled proportions of baseline characteristics among conduit vs nonconduit cases are illustrated in Figure 2.

Table 1.

Important Baseline Characteristics.

Study	Males Conduit Group, %	Males Nonconduit Group, %	Smoking Conduit Group, %	Smoking Nonconduit Group, %	HTN Conduit Group, %	HTN Nonconduit Group, %	DM Conduit Group, %	DM Nonconduit Group, %	Pulmonary Disease Conduit Group, %	Pulmonary Disease Nonconduit Group, %	History of CVA Conduit Group, %	History of CVA Nonconduit Group, %	PAD Conduit Group, %	PAD Nonconduit Group, %	Renal Disease Conduit Group, %	Renal Disease Nonconduit Group, %
D’Oria 2020	71.4		88.3		89.2		15.2		35.5		10.0		21.6		3.9
Ramanan 2016	56.7	80.8	90.3		94.8		11.9		52.2		20.9		24.6		3.0
Gupta 2015	68.0	82.4	37.7	29.6	86.1	80.2	9.5	8.0	23.8	19.1	13.9	13.1	12.6	5.4	NR	NR
Tsilimparis 2013	31.6	58.4	48.7	30.7	14.5	22.8	9.4	13.7	23.1	19.2	12.8	12.8	0.9	0.9	2.6	3.3
Etezadi 2011	72.2		NR	NR	NR	NR	15.8		40.6		NR	NR	23.3	NR	22.6
Jackson 2011	24.4	68.2	NR	NR	NR	NR	NR	NR	NR	NR	NR	NR	NR	NR	NR	NR
Kasirajan 2011	29.6	67.8	NR	NR	NR	NR	NR	NR	NR	NR	NR	NR	NR	NR	NR	NR
Khoynezhad 2007	65.7		44.9		NR	NR	9.6		18.0		NR	NR	14.0		12.4
Zhou 2006	NR	NR	NR	NR	67.7		19.4		32.3		NR	NR	NR	NR	12.9
Abu-Ghaida 2002	59.1	82.4	NR	NR	68.2	76.5	18.2	17.6	54.5	47.1	13.6	11.8	NR	NR	13.6	17.6

Abbreviations: CVA, cerebrovascular accident; DM, diabetes mellitus; HTN, hypertension; NR, not reported; PAD, peripheral artery disease.

Comparison of Periprocedural (30-Day) Outcomes Between Iliac Conduit vs Nonconduit Cases

Aortic endovascular repair was technically successful in almost all cases with no statistically significant difference detected between the iliac conduit vs nonconduit groups (2 studies; OR: 0.73; 95% CI: 0.06–8.99; p=0.809). The length of hospitalization was longer among the patients who underwent EVT with iliac conduit utilization (3 studies; weighted mean difference (WMD): 1.05; 95% CI: 0.22–1.87; p=0.013). Although the overall periprocedural all-cause mortality rate was low, significantly more patients from the iliac conduit vs nonconduit group died within 30 days from the index procedure (5 studies; OR: 2.85; 95% CI: 1.75–4.64; p<0.001) (Figure 3). However, this observation was mostly driven by the studies with the largest population (2 studies; OR: 2.94; 95% CI: 1.79–4.83; p<0.001), as sensitivity analysis with the smaller studies failed to detect a difference in 30-day death rates (3 studies; OR: 1.15; 95% CI: 0.08–15.90; p=0.918). Bleeding complications occurred more frequently among iliac conduit cases (5 studies; OR: 2.38; 95% CI: 1.58–3.58; p<0.001) (Figure 4).

The statistically significant higher prevalence of bleeding complications among iliac conduit cases remained in sensitivity analysis excluding the studies with the largest population (3 studies; OR: 6.39; 95% CI: 1.50–27.18; p=0.012). Pulmonary (3 studies; OR: 1.87; 95% CI: 1.20–2.91; p=0.006) and cardiovascular complications (3 studies; OR: 2.68; 95% CI: 1.03–7.01; p=0.044) occurred also more frequently among cases requiring iliac conduit to enable EVT for aortic pathologies. No differences were observed between the iliac conduit vs nonconduit cases in terms of 30-day CVA (2 studies; OR: 1.42; 95% CI: 0.65–3.08; p=0.379), perioperative renal insufficiency (2 studies; OR: 1.04; 95% CI: 0.34–3.16; p=0.940), urinary tract infection (2 studies; OR: 1.78; 95% CI: 0.99–3.17; p=0.052), and wound complications (3 studies; OR: 2.40; 95% CI: 0.21–27.29; p=0.480). The rates of reoperation/reintervention and as such return to operating room were similar between the 2 groups (3 studies; OR: 1.65; 95% CI: 0.73–3.74; p=0.229). Details about the comparison of periprocedural outcomes among iliac conduit vs nonconduit cases and the corresponding confidence in effect estimates as per the GRADE are presented in Supplementary Table 2.

Outcomes of the Iliac Conduit Cohort

Overall, 13 single- and double-arm studies reported on the outcomes of iliac conduit utilization for EVT of aortic pathologies among 791 cases.^{14–16,22–31} The overall technical success of iliac conduits was 98% (6 studies; 95% CI: 92%–100%), with EVT being successful in 94% (5 studies; 95% CI: 80%–100%) of the cases. Seven studies reported that any periprocedural complications occurred in 32% (95% CI: 22%–42%). Bleeding complications were observed in 10% (7 studies; 95% CI: 5%–16%) of the cases, while wound complications (ie, local hematoma, infection, dehiscence) were reported in 5% (7 studies; 95% CI: 3%–7%). Overall, 4% (6 studies; 95% CI: 1%–6%) of the cases were returned to operating room. The cardiovascular complication rate, including cardiac arrest/arrhythmia and/or MI was 6% (5 studies; 95% CI: 4%–10%), while pulmonary complications were reported in 8% (5 studies; 95% CI: 3%–14%).

Urinary tract infections occurred in 4% (3 studies; 95% CI: 2%–6%) of the patients undergoing EVT for aortic pathologies, with renal insufficiency observed in 3% (3 studies; 95% CI: 2%–5%). The perioperative (within 30 days) CVA and all-cause mortality rates were 3% (5 studies; 95% CI: 1%–5%) and 3% (8 studies; 95% CI: 1%–6%), respectively. Details regarding the frequency of primary and secondary endpoints among iliac conduit cases can be found in Tables 2 and are illustrated in Figure 5. Overall, 3 studies separately reported on outcomes of planned vs unplanned iliac conduit utilization.^14,24,31 Periprocedural complications were more commonly observed in the unplanned iliac conduit cohort (planned vs unplanned: 3 studies; OR: 0.38; 95% CI: 0.20–0.73; p=0.004). However, the 30-day all-cause mortality rate was similar between the 2 groups (2 studies; OR: 0.34; 95% CI: 0.05–2.24; p=0.260). Important details about the periprocedural outcomes of planned vs unplanned iliac conduit cases and the corresponding confidence in effect estimates as per the GRADE are shown in Supplementary Table 2.

Table 2.

Thirty-Day Outcomes Among Patients Undergoing EVT for Aortic Pathologies With Iliac Conduit Utilization.

Outcome	Proportion, % (95% CI)	No. of Studies	No. of Patients (Event/Total)
Iliac conduit success	98 (92–100)	6	232/245
EVT success	94 (80–100)	5	220/238
Any periprocedural complications	32 (22–42)	7	169/626
Bleeding complications	10 (5–16)	7	63/447
Wound complications	5 (3–7)	7	32/602
Return to operating room^a	4 (1–6)	6	48/580
Cardiac arrest/arrhythmia and/or MI	6 (4–10)	5	37/533
Pulmonary complications	8 (3–14)	5	41/533
Urinary tract infection	4 (2–6)	3	18/492
Renal insufficiency	3 (2–5)	3	15/492
30-day CVA (i.e. stroke, TIA)	3 (1–5)	5	15/561
30-day all-cause mortality	3 (1–6)	8	27/624

Abbreviations: CVA, cerebrovascular accident; EVT, endovascular therapy; MI, myocardial infarction; TIA, transient ischemic attack.

Two studies reported on return to operating room during follow-up.

Discussion

This study was a meta-analysis and systematic review of 14 studies, including patients that underwent endovascular therapy for aortic pathologies with or without the utilization of iliac conduits. This study demonstrated favorable technical success rate among the iliac conduit cohort, however the periprocedural complication rate is not negligible. Comparison of iliac conduit with nonconduit cases demonstrated that bleeding complications were more common among iliac conduit cases, which could explain higher periprocedural all-cause mortality and need for longer hospitalization.

Complex iliac anatomy remains a challenge to endovascular repair. Thus, low-profile devices have been developed over years to overcome the burden of complex iliac anatomy. However small, tortuous and/or calcified iliac arteries are still a significant hurdle for treatment, constituting the main reason 28% to 47% of patients being considered ineligible for EVT.^33,34 Additionally, challenging iliac anatomy has been associated with overall 15% higher risk for complications, including bleeding, arterial rupture and/or dissection necessitating further therapeutic interventions (open or endovascular).³⁵ Iliac conduits (ie, “crack and pave” technique with endo-conduits and open retroperitoneal exposure and graft placement) have been adopted in order to establish adequate access and facilitate endovascular interventions.^36,37

Previous studies have shown that iliac conduits are required in 7.1% to 13.4% of abdominal aortic aneurysm repairs,^14,38 while 10% of thoracic endovascular aortic repairs (TEVAR) need an iliac conduit.¹⁶ In this study, the combined iliac conduit utilization rate to treat abdominal and/or thoracic aortic pathologies was 17%. This was higher compared with older reports, which could be related to increasing experience with iliac conduits, increasing EVT treatment of more complex aneurysms and improving design of EVT devices over time (eg, endografts for larger aortic neck). This study demonstrated favorable technical (98%) and procedure (94%) success rates of iliac conduit utilization, which was not inferior to nonconduit cases. Therefore, based on these results iliac conduit utilization could be a viable treatment option of aortic aneurysms with concomitant severe iliofemoral occlusive disease, permitting adequate vascular access, while at the same time allowing prompt revascularization of peripheral arterial lesions if needed.³¹

Furthermore, recent retrospective studies analyzing data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database have shown up to 6.8% and 12% associated mortality with EVAR and TEVAR, when iliac conduit placement was required.^15,16,39 However, this meta-analysis, summarizing all available data across literature, showed a pooled 30-day all-cause mortality of 3% (1%–6%) among iliac conduit cases. The 30-day all-cause mortality estimate by this meta-analysis of endo-conduit and open conduit cases was lower than previous reports. This was likely due to increasing preference of endo-conduits over time. Endo-conduits have been hypothesized to be associated with lower risk of intraprocedural hemodynamic instability and fewer cardiovascular complications, which might have been the cause of the relatively low 30-day all-cause mortality shown by this meta-analysis, compared with previous reports with higher open conduit utilization.^29,30,35 Nonetheless, it should be noted that the periprocedural death rate was significantly higher among iliac conduit vs noniliac conduit cases, which was in accordance with previous reports.^16,32 A sensitivity analysis in this study provided evidence that this observation could be attributed to unplanned rather than planned iliac conduit placement, indicating the need for further research in order to optimize current treatment algorithms.

In addition to increased periprocedural mortality, iliac conduit use has also been correlated with higher incidence of systemic complications.³² In this study, bleeding, cardiovascular, and pulmonary complications occurred more frequently among iliac conduit vs nonconduit cases, reflecting an overall complication rate of 32% among the conduit cohort. Confounders that might be related to conduit indication in certain cohort of patients (eg, female patients, patients with smoking history, pulmonary disease, and PAD), who underwent EVT with iliac conduit placement, have to be considered. However, these are factors that could challenge endovascular interventions placing the patients at higher risk for adverse events regardless of iliac artery disease. Classically, female sex has been associated with smaller arteries and worse outcomes after EVAR, likely related to more frequent access site complications.^40–42 Additionally, operators are more likely to treat higher risk patients with PAD, pulmonary disease and/or smoking history endovascularly with iliac conduits in order to avoid performing open aortic repair based on its inherent risks.³²

Gupta and colleagues¹⁵ in a large retrospective study utilizing data from the ACS NSQIP showing higher major morbidity rate among patients undergoing EVT for abdominal aortic aneurysm with vs without iliac conduit placement. The authors attributed the observed difference in complications’ frequency to more comorbid conditions, increased age, and poorer functional status of patients with iliac conduits.¹⁵ Interestingly, this study showed that most of the periprocedural complications were observed in the unplanned iliac conduit cohort, indicating that planned iliac conduit use might not be inferior to nonconduit cases, in terms of safety. However, as these are just hypotheses future research is warranted in order to determine risk factors for iliac conduit use and help clinical decision making regarding unplanned iliac conduit utilization.

Limitations

The results of this study should be interpreted in the context of several limitations. The data were provided by observational studies and, as such might be limited by potential selection bias, corresponding to a moderate confidence in effect estimates. Second, single-arm studies were included as well in order to increase the sample size of the meta-analysis in an effort to increase statistical accuracy. Third, due to dispersion of effect sizes and heterogeneity in reported outcomes, only limited direct comparisons could be made between iliac conduit vs nonconduit and planned vs unplanned iliac conduit cases. It should be also taken into account that most of the pooled estimates were unadjusted risk estimates, indicating that patient, procedural, and study characteristics might have confounded the outcomes. Moreover, due to sparse data, it was not feasible to perform separate analyses based on the iliac conduit used (ie, open vs endoconduit) and the aortic pathologies treated (ie, abdominal vs thoracic aortic aneurysm). Last, because of high variability in long-term outcomes and the follow-up periods among the included studies, no pool estimates could be calculated regarding safety and efficacy of iliac conduits over time.

Conclusion

Iliac conduit placement is a feasible strategy, associated with high technical success to facilitate aortic endovascular repair. However, periprocedural adverse event rate, including bleeding complications is not negligible. All-cause mortality and morbidity rates among cases that require iliac conduits should be strongly considered during clinical decision making. High-quality comparative analyses between iliac conduit (planned/unplanned) vs nonconduit cases and between several types of iliac conduit grafts aiming at facilitating endovascular aortic repair are still needed to determine the best strategy to address challenging iliac artery accesses. Additionally, as iliac conduit placement might increase the utilization of health care resources (eg, cost of the graft, longer hospitalization), it should be investigated whether the iliac conduit technique is a cost-effective approach.

Supplemental Material

sj-docx-1-jet-10.1177_15266028211007468 – Supplemental material for Iliac Conduits for Endovascular Treatment of Aortic Pathologies: A Systematic Review and Meta-analysis

Supplemental material, sj-docx-1-jet-10.1177_15266028211007468 for Iliac Conduits for Endovascular Treatment of Aortic Pathologies: A Systematic Review and Meta-analysis by Stefanos Giannopoulos, Rafael D. Malgor, Marcone L. Sobreira, Sammy S. Siada, Diego Rodrigues, Mohammed Al-Musawi, Emily A. Malgor and Donald L. Jacobs in Journal of Endovascular Therapy

Supplemental Material

sj-docx-2-jet-10.1177_15266028211007468 – Supplemental material for Iliac Conduits for Endovascular Treatment of Aortic Pathologies: A Systematic Review and Meta-analysis

Supplemental material, sj-docx-2-jet-10.1177_15266028211007468 for Iliac Conduits for Endovascular Treatment of Aortic Pathologies: A Systematic Review and Meta-analysis by Stefanos Giannopoulos, Rafael D. Malgor, Marcone L. Sobreira, Sammy S. Siada, Diego Rodrigues, Mohammed Al-Musawi, Emily A. Malgor and Donald L. Jacobs in Journal of Endovascular Therapy

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Stefanos Giannopoulos

Rafael D. Malgor

Marcone L. Sobreira

Diego Rodrigues

Supplemental Material

Supplemental material for this article is available online.

References

Lilja

Wanhainen

Mani

. Changes in abdominal aortic aneurysm epidemiology. J Cardiovasc Surg. 2017;58:848–853.

Makaroun

Dillavou

Kee

, et al. Endovascular treatment of thoracic aortic aneurysms: results of the phase II multicenter trial of the GORE TAG thoracic endoprosthesis. J Vasc Surg. 2005;41:1–9.

Matsumura

. Worldwide survey of thoracic endografts: practical clinical application. J Vasc Surg. 2006;43(suppl A):20a–21a.

Fairman

Criado

Farber

, et al. Pivotal results of the Medtronic Vascular Talent Thoracic Stent Graft System: the VALOR trial. J Vasc Surg. 2008;48:546–554.

Wanhainen

Verzini

Van Herzeele

, et al. Editor’s Choice. European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57:8–93.

Goodney

Travis

Lucas

, et al. Survival after open versus endovascular thoracic aortic aneurysm repair in an observational study of the Medicare population. Circulation. 2011;124:2661–2669.

Chaikof

Brewster

Dalman

, et al. The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. J Vasc Surg. 2009;50(4 suppl):S2–S49.

Criado

McKendrick

Criado

. Technical solutions for common problems in TEVAR: managing access and aortic branches. J Endovasc Ther. 2009;16(suppl 1):I63–I79.

Henretta

Karch

Hodgson

, et al. Special iliac artery considerations during aneurysm endografting. Am J Surg. 1999;178:212–218.

10.

Vandy

Girotti

Williams

, et al. Iliofemoral complications associated with thoracic endovascular aortic repair: frequency, risk factors, and early and late outcomes. J Thorac Cardiovasc Surg. 2014;147:960–965.

11.

Gallitto

Gargiulo

Faggioli

, et al. Impact of iliac artery anatomy on the outcome of fenestrated and branched endovascular aortic repair. J Vasc Surg. 2017;66:1659–1667.

12.

Criado

. Iliac arterial conduits for endovascular access: technical considerations. J Endovasc Ther. 2007;14:347–351.

13.

Peterson

. Conduits and endoconduits, percutaneous access. J Vasc Surg. 2010;52(4 suppl):60S–64S.

14.

Abu-Ghaida

Clair

Greenberg

, et al. Broadening the applicability of endovascular aneurysm repair: the use of iliac conduits. J Vasc Surg. 2002;36:111–117.

15.

Gupta

Sundaram

Kent

. Morbidity and mortality after use of iliac conduits for endovascular aortic aneurysm repair. J Vasc Surg. 2015;62:22–26.

16.

Tsilimparis

Dayama

Perez

, et al. Iliac conduits for endovascular repair of aortic pathologies. Eur J Vasc Endovasc Surg. 2013;45:443–448.

17.

Liberati

Altman

Tetzlaff

, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6:e1000100.

18.

Hinneburg

. ROBINS-1: a tool for assessing risk of bias in non-randomised studies of interventions. Med Monatsschr Pharm. 2017;40:175–177.

19.

Guyatt

Oxman

Vist

, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924–926.

20.

Egger

Davey Smith

Schneider

, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–634.

21.

Higgins

Thompson

Deeks

, et al. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–560.

22.

Zhou

Reardon

Peden

, et al. Hybrid approach to complex thoracic aortic aneurysms in high-risk patients: surgical challenges and clinical outcomes. J Vasc Surg. 2006;44:688–693.

23.

Ramanan

Fernandez

Sobel

, et al. Low-profile versus standard-profile multibranched thoracoabdominal aortic stent grafts. J Vasc Surg. 2016;64:39–45.

24.

Kasirajan

Morasch

Makaroun

. Sex-based outcomes after endovascular repair of thoracic aortic aneurysms. J Vasc Surg. 2011;54:669–675.

25.

Etezadi

Katzen

Benenati

, et al. Retroperitoneal versus direct femoral artery approach for thoracic endovascular aortic repair access: a case-control study. Ann Vasc Surg. 2011;25:340–344.

26.

D’Oria

Oderich

Tenorio

, et al. Safety and efficacy of totally percutaneous femoral access for fenestrated-branched endovascular aortic repair of pararenal-thoracoabdominal aortic aneurysms. Cardiovasc Intervent Radiol. 2020;43:547–555.

27.

Khoynezhad

Donayre

Bui

, et al. Risk factors of neurologic deficit after thoracic aortic endografting. Ann Thorac Surg. 2007;83:S882–S889.

28.

Jackson

Woo

Bavaria

, et al. Gender analysis of the pivotal results of the Medtronic Talent Thoracic Stent Graft System (VALOR) trial. J Vasc Surg. 2011;54:358–363.

29.

Asciutto

Aronici

Resch

, et al. Endoconduits with “pave and crack” technique avoid open ilio-femoral conduits with sustainable mid-term results. Eur J Vasc Endovasc Surg. 2017;54:472–479.

30.

van Bogerijen

GHW

Williams

Eliason

, et al. Alternative access techniques with thoracic endovascular aortic repair, open iliac conduit versus endoconduit technique. J Vasc Surg. 2014;60:1168–1176.

31.

Rowse

Morrow

Bena

, et al. Iliac conduits remain safe in complex endovascular aortic repair. J Vasc Surg. 2019;70:424–431.

32.

Nzara

Rybin

Doros

, et al. Perioperative outcomes in patients requiring iliac conduits or direct access for endovascular abdominal aortic aneurysm repair. Ann Vasc Surg. 2015;29:1548–1553.

33.

Zarins

Wolf

Lee

, et al. Will endovascular repair replace open surgery for abdominal aortic aneurysm repair? Ann Surg. 2000;232:501–507.

34.

Carpenter

Baum

Barker

, et al. Impact of exclusion criteria on patient selection for endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2001;34:1050–1054.

35.

Yano

Faries

Morrissey

, et al. Ancillary techniques to facilitate endovascular repair of aortic aneurysms. J Vasc Surg. 2001;34:69–75.

36.

Hinchliffe

Ivancev

Sonesson

, et al. “Paving and cracking”: an endovascular technique to facilitate the introduction of aortic stent-grafts through stenosed iliac arteries. J Endovasc Ther. 2007;14:630–633.

37.

Matsumoto

Tanaka

Okadome

, et al. Midterm outcomes of endovascular repair for abdominal aortic aneurysms with the on-label use compared with the off-label use of an endoprosthesis. Surg Today. 2015;45:880–885.

38.

Lee

Berceli

Huber

, et al. Morbidity with retroperitoneal procedures during endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2003;38:459–463.

39.

Eagleton

Follansbee

Wolski

, et al. Fenestrated and branched endovascular aneurysm repair outcomes for type II and III thoracoabdominal aortic aneurysms. J Vasc Surg. 2016;63:930–942.

40.

Mehta

Byrne

Robinson

, et al. Women derive less benefit from elective endovascular aneurysm repair than men. J Vasc Surg. 2012;55:906–913.

41.

Wolf

Arko

Hill

, et al. Gender differences in endovascular abdominal aortic aneurysm repair with the AneuRx stent graft. J Vasc Surg. 2002;35:882–886.

42.

Fokkema

, et al. Relative importance of aneurysm diameter and body size for predicting abdominal aortic aneurysm rupture in men and women. J Vasc Surg. 2014;59:1209–1216.

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