Complex Anatomy Challenges

in Aortic Aneurysmal Disease

Applied

Type

Addition

Confidence

75%

Created

Mar 20, 2026

Evidence

1 source

Rationale

The existing section focused primarily on proximal neck anatomy and aneurysm extent. However, iliofemoral access is a critical component of 'Complex Anatomy' in endovascular surgery. The addition of evidence regarding iliac conduits for hostile access provides a more complete clinical picture. All abbreviations were expanded on first use as per the instructions.

Evidence

Litinas K et al. Open Iliac Conduits Enabling the New Era of Endovascular Aortic Repair in Hostile Iliofemoral Anatomy: A Single-Center Retrospective Study. Medicina. 2025. PMID: 41597304.
Verified source
PubMedDOI

Content Changes

* Hostile neck features: short (<10–15 mm), severe angulation (>60°), conical shape, heavy thrombus/calcification—associated with higher Type Ia endoleak/migration [@svs2018].
* TAAA:Thoracoabdominal aortic aneurysm (TAAA): classify extent (Crawford I–V); enumerate visceral involvement; plan for spinal cord protection and access.
* Hostile iliofemoral anatomy: severe calcification, tortuosity, or small vessel diameter may necessitate the use of open iliac conduits to enable the delivery of large-bore endovascular devices [@konstantinos2025].
* Implications include the balance of off-IFUoff-instructions for use (IFU) endovascular aneurysm repair (EVAR) risk against FEVAR/BEVARfenestrated endovascular aneurysm repair (FEVAR), branched endovascular aneurysm repair (BEVAR), or open repair [@oderich2017] [@oikonomou2019] [@svs2018].
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