Iliac arterial conduits for endovascular access: Technical considerations

Purpose: To describe the relevant technical details that have proved helpful in a 10-year experience using iliac access conduits. Techniques: Standard surgical techniques are used to achieve retroperitoneal exposure of the common iliac artery (CIA) via a relatively short oblique incision in the lower quadrant of the abdomen. On occasion, the distal abdominal aorta is the only reasonable or available target for anastomosis and conduit attachment. A left-side approach is preferred. A 10-mm-diameter Dacron graft is the best conduit because it provides enough luminal space for introduction of all delivery systems. The anastomosis is sewn end-to-side between the graft and the CIA using a running suture technique. After completion of the anastomosis, the conduit is exited through the abdominal wall via a small stab incision made just above the inguinal ligament, providing a smooth angle of entry that will facilitate introduction of the large devices to be passed through the conduit. Upon completion of the endovascular procedure, the iliac conduit is excised, leaving behind only a short stub that is carefully oversewn with a running propylene suture. After achieving perfect hemostasis, the incision is closed in layers using standard technique. Conclusion: Access challenges requiring an iliac conduit may also be overcome by direct puncture and repair of the CIA following retroperitoneal exposure, without attaching a conduit or retrograde endarterectomy via a femoral artery exposure, with or without subsequent relining with a covered stent. While such techniques may have merit, we continue to rely on the iliac conduit approach for all such cases.