Creative Options for Large Sheath Access during Aortic Endografting

Access-related limitations, namely small-caliber vessels and tortuous or calcified stenotic vessels, are often encountered during endovascular aneurysm repair (EVAR) and thoracic EVAR (TEVAR). Overcoming these limitations often requires the creation of a conduit through which the endovascular devices can be delivered. If these limitations are not recognized and respected preoperatively, significant morbidity and mortality may ensue because access-related complications are often addressed in emergent and chaotic situations. There are a variety of conduits described in the literature, each with their own advantages and disadvantages. The present report explores the use of conduits during EVAR and TEVAR by discussing the current literature, and the authors also describe a preferred method to address unfavorable iliac anatomy through the use of endoconduits.