Complex Anatomy Challenges

in Aortic Aneurysmal Disease

Applied

Type

Reinforcement

Confidence

70%

Created

Mar 26, 2026

Evidence

1 source

Rationale

The new article provides additional clinical evidence supporting the use of open iliac conduits in patients with hostile iliofemoral anatomy. This reinforces the existing claim in the textbook. The existing structure and abbreviations (TAAA, IFU, EVAR, FEVAR, BEVAR) were maintained and verified for first-use expansion according to the guidelines.

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].
* 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].[@konstantinos2025] [@konstantinos2025-b].
* 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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