Complex Anatomy Challenges

in Aortic Aneurysmal Disease

Applied

Type

Reinforcement

Confidence

75%

Created

Mar 26, 2026

Evidence

1 source

Rationale

The new article by Litinas (2025) provides additional retrospective cohort evidence that supports the existing text regarding the use of open iliac conduits to facilitate endovascular access in patients with hostile iliofemoral anatomy. The citation was added to the relevant bullet point, and the abbreviation OIC was expanded upon first use as per the instructions.

Evidence

Litinas K. 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 (OIC) to enable the delivery of large-bore endovascular devices [@konstantinos2025].[@konstantinos2025] [@konstantinos2025-c].
* 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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