ABSTRACT
Since receiving approval by the U.S. Food and Drug Administration in 1999, endovascular treatment of abdominal aortic aneurysms has been increasingly performed, especially in high-risk patients. Despite this new approach, a significant number of patients are excluded for various reasons, including unacceptable anatomy and challenging access issues (1-4). Current delivery systems are designed with outer diameters in excess of 18 F (Table 1) for introduction of the primary device, and despite the recognized need for smaller, more flexible delivery catheters (5), they remain unavailable except in clinical trials and design stages. Therefore the current stiff introducer systems may result in access complications that need to be addressed during or after endovascular device implantation. Many times these complications are directly related to the extent of atherosclerotic occlusive disease within the iliac system. These complications fall into three categories: access failure, vessel compromise, and hemodynamic compromise; they result in conversion to open repair in 1-4% of procedures (6-8).
