Combined transbrachial and transfemoral strategy to deploy an iliac branch endoprosthesis in the setting of a pre-existing endovascular aortic aneurysm.

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Combined transbrachial and transfemoral strategy to deploy an iliac branch endoprosthesis in the setting of a pre-existing endovascular aortic aneurysm repair S. Keisin Wang, MD, Julia N. Miladore, MD, Elliott J. Yee, BS, Jane L. Liao, BS, Nikunj N. Donde, BS, Raghu L. Motaganahalli, MD Journal of Vascular Surgery Cases and Innovative Techniques Volume 5, Issue 3, Pages 305-309 (September 2019) DOI: 10.1016/j.jvscit.2019.03.007 Copyright © 2019 Terms and Conditions

Fig 1 Representative preoperative images demonstrating an ectatic right common iliac artery (CIA) (A) at the level of the external iliac artery (EIA) (arrow) and hypogastric artery (arrowhead) takeoff. Distally, the caliber of both vessels returns to normal (B). On the opposite side (C), the hypogastric artery (arrowhead) fills from pelvic collaterals and the CIA and EIA remains within normal diameter limits. Journal of Vascular Surgery Cases and Innovative Techniques 2019 5, 305-309DOI: (10.1016/j.jvscit.2019.03.007) Copyright © 2019 Terms and Conditions

Fig 2 Steps in the procedure demonstrating simultaneous positioning of the brachial and femoral sheaths on either side of the target iliac aneurysm (A). After snaring the 0.018 bodyfloss wire, a stiff wire is positioned into the thoracic aorta to allow for the delivery of the iliac branch endoprosthesis (IBE) (B). After the IBE is positioned, the hypogastric artery is cannulated and a covered stent is deployed (C). Journal of Vascular Surgery Cases and Innovative Techniques 2019 5, 305-309DOI: (10.1016/j.jvscit.2019.03.007) Copyright © 2019 Terms and Conditions

Fig 3 The iliac branch endoprosthesis endovascular aortic aneurysm repair (IBE-EVAR) structure at the completion of stent deployment demonstrating complete exclusion of the iliac artery aneurysm with preservation of the hypogastric artery. Journal of Vascular Surgery Cases and Innovative Techniques 2019 5, 305-309DOI: (10.1016/j.jvscit.2019.03.007) Copyright © 2019 Terms and Conditions

Fig 4 Intraoperative angiogram (A) before stent deployment demonstrating the iliac aneurysm along with the external iliac artery (EIA; arrow) and hypogastric (arrowhead). B, Positioning of the iliac branch endoprosthesis (IBE) before deployment in the common iliac artery (CIA). Both the IBE and VBX stents are deployed (C) to exclude the iliac artery aneurysm while maintaining hypogastric artery flow. Completion angiogram (D) demonstrating the IBE-endovascular aortic aneurysm repair (EVAR) structure. Journal of Vascular Surgery Cases and Innovative Techniques 2019 5, 305-309DOI: (10.1016/j.jvscit.2019.03.007) Copyright © 2019 Terms and Conditions