Complex Anatomy Challenges

in Aortic Aneurysmal Disease

Applied

Type

Reinforcement

Confidence

70%

Created

Mar 26, 2026

Evidence

1 source

Rationale

The integration reinforces the existing point about hostile iliofemoral anatomy by adding a specific 2025 cohort study that validates the use of open iliac conduits as a safe and effective adjunct for delivering large-bore devices. The abbreviation OIC was expanded on first use per the guidelines, and the existing structure and citations were preserved.

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;61(1):17. 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].
* 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 (OIC) to enable the delivery of large-bore endovascular devicesdevices, [@konstantinos2025].providing a safe and effective adjunct for patients with challenging access [@konstantinos2025] [@konstantinos2025-open].
* Implications include the balance of off-instructions for use (IFU) endovascular aneurysm repair (EVAR) risk against fenestrated endovascular aneurysm repair (FEVAR), branched endovascular aneurysm repair (BEVAR), or open repair [@oderich2017] [@oikonomou2019] [@svs2018].
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