Complex Anatomy Challenges

in Aortic Aneurysmal Disease

Applied

Type

Modification

Confidence

75%

Created

Mar 26, 2026

Evidence

1 source

Rationale

The section was updated to integrate a new 2025 retrospective cohort study (Litinas 2025) that reinforces the use of open iliac conduits in patients with hostile iliofemoral anatomy. Additionally, following the geographic guideline balance rule, the ESVS 2020 (2019) guidelines were added to balance the existing SVS 2018 citations in the hostile neck and repair implications bullets. All existing abbreviations were preserved or expanded as required.

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].[@svs2018] [@esvs2020].
* 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-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].[@svs2018] [@esvs2020].
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