Iliac Conduit for Deploying Aortic Endografts: An All-Autogenous Option

Unfavorable iliac anatomy, such as small caliber or circumferential calcification, can cause problems dur- ing delivery of aortic endografts and lead to potential complications. An iliac artery conduit “chimney” has been used to deliver the large caliber endoprosthesis using a Dacron graft sewn onto the iliac bifurcation.

U nfavorable iliac anatomy, such as small cal- iber or circumferential calcification, can cause problems during delivery of aortic endografts and can lead to potential complications.¹ Similarly, if the common iliac artery is aneurysmal, the endograft has to be landed into the external iliac artery covering the origin of the hypogastric artery. While coil emboliza- tion is an option, there is a trend toward hypogastric revascularization and preservation of pelvic flow. ² In these situations, a separate bypass is required to the hypogastric artery. An iliac artery conduit “chimney” has been used to deliver the large caliber endoprosthesis using a Dacron graft sewn on to the iliac bifurcation. The “chimney” is used as an ilio-femoral bypass.^1,2

      This paper describes a technique for deploying endografts when treating aortic and common iliac artery aneurysm. This can be used when revasculariza- tion of the internal iliac artery is necessary. An all-auto- genous revascularization option allows for hypogastric bypass while limiting the use of synthetic graft. It also saves the patient from having a separate groin incision for an ilio-femoral bypass.

History

The patient presented with an aneurysm of the infrarenal aorta and the left common iliac artery.

From the Division of Vascular Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas (JFE, ATA).

Address correspondence to: Ahsan T. Ali, MD, Assistant Professor of Surgery, Division of Vascular Surgery, 4301 West Markham Street, Slot # 520, Little Rock, AR 72205; tel: 501- 686-6176; fax: 501-686-5328; email: aali@uams.edu.

Figure 2. The internal iliac artery transected at its origin. The external iliac artery is transected after 2 cm from its origin.

Figure 3. The transected ends of the internal iliac and the external iliac artery are transposed.

artery was mobilized to its first branch. Then the external iliac artery was dissected out down to the inguinal ligament.

The internal iliac artery was controlled distally and then divided at its origin. Next it was oversewn flush at the origin, the common iliac bifurcation. The external iliac artery was divided distally, leaving a 2-3 cm proximal stump still in continuity with the common iliac artery (Figure 2).

The distal end of the external iliac artery was then transposed on to the hypogastric artery

the Dacron conduit was removed. Now a primary anastomosis was performed between the proximal external iliac artery stump and the distal external iliac artery (Figure 5). Thus an autogenous configuration was achieved. The common iliac bifurcation essen- tially was moved distally while flow to the internal iliac artery was preserved.

This technique can be used when there is a redundant external iliac artery without concomitant occlusive disease.