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. 2015 Jun;88(6):334-40.
doi: 10.4174/astr.2015.88.6.334. Epub 2015 May 14.

Iliac Anatomy and the Incidence of Adjunctive Maneuvers During Endovascular Abdominal Aortic Aneurysm Repair

Free PMC article

Iliac Anatomy and the Incidence of Adjunctive Maneuvers During Endovascular Abdominal Aortic Aneurysm Repair

Woo-Sung Yun et al. Ann Surg Treat Res. .
Free PMC article


Purpose: Challenging iliac anatomy remains an important issue during endovascular aneurysm repair (EVAR), and it is known that the length of the common iliac artery (CIA) is shorter in Asians than in Western groups. We analyzed both the iliac anatomy and the incidence of adjunctive maneuvers to overcome iliac artery-related difficulties during EVAR.

Methods: Seventy-four EVARs were performed for abdominal aortic aneurysm between January 2010 and March 2013. Patient demographic data, iliac anatomical characteristics (presence of iliac artery aneurysm, iliac artery diameter and length, and iliac tortuosity), and adjunctive iliac artery maneuvers were reviewed retrospectively.

Results: Mean CIA length was 52.8 mm (range, 6.6-98.0 mm) on the right and 56.3 mm (range, 0-94.8 mm) on the left. CIA length was ≥20 mm, except in one patient with bilateral short CIAs. Forty patients (54%) had a CIA aneurysm, and 18 had aneurysms on both sides. Iliac adjunctive procedures were performed in 38 patients (51%) as follows: 23 internal iliac artery (IIA) embolizations or ligations, seven IIA revascularizations, 16 external iliac artery (EIA) balloon angioplasties or stenting, one EIA patch angioplasty, one EIA interposition, two femoral endarterectomies with patch angioplasty, and nine femoro-femoral bypasses after EVAR with an aorto-uni-iliac device. Technical success for the adjunctive iliac procedures was achieved in all patients.

Conclusion: Short CIA length was uncommon. Although many patients had access-related difficulties, most were overcome by an endovascular or hybrid technique. Liberal use of iliac adjunctive procedures can facilitate EVAR.

Keywords: Abdominal aortic aneurysm; Endovascular procedures.

Conflict of interest statement

CONFLICTS OF INTEREST: No potential conflict of interest relevant to this article was reported.


Fig. 1
Fig. 1. Measuring the iliac tortuosity index. The iliac tortuosity index was defined by dividing L1 by L2, where L1 (A and B) was the distance along the central lumen line between the common femoral artery and the aortic bifurcation, and L2 (C) was the straight-line distance from the common femoral artery and the aortic bifurcation. In this case, the iliac tortuosity index was 1.65 (233/141).
Fig. 2
Fig. 2. A 70-year-old male presented with an abdominal aortic aneurysm (AAA) and bilateral short common iliac arteries (A and B). Both iliac stent graft limbs were deployed on external iliac arteries (EIAs). The left internal iliac artery (IIA) was embolized with coils, and the right IIA was perfused by the EIA to IIA bypass (C).

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