Novel technique of innerbranch stent-grafts for common iliac artery aneurysm ensured blood flow to the pelvic region and lower extremities

We report a technique to preserve the internal iliac artery (IIA) using a physician-modified contralateral limb (PMCL) with an inner branch stent-graft (IBS) for patients with common iliac artery aneurysms not suitable for commercially-available iliac branch devices (cIBDs). A fenestration was created in the tapered or 13 mm segment of an Endurant II contralateral limb, and an IBS—2 mm larger in diameter than the fenestration—was inserted and deployed with 15–20 mm inside the PMCL and 5 mm externally. The IBS was fixed at three points in parallel to the limb. A preloaded wire was inserted, and the system reloaded and implanted. Two patients were treated using this method, with the IIA stent-graft deployed into the superior gluteal artery. One had a fenestration in the tapered segment, the other in the 13 mm segment. Follow-up computed tomography showed no endoleaks and satisfactory pelvic perfusion in both cases, with no complications. This technique maintains pelvic and lower extremity blood flow, ensures graft stability, and allows future endovascular reintervention. It may be a valuable alternative for patients for whom cIBDs are not indicated. Clinical Impact Preserving the internal iliac artery is essential, but maintaining adequate lower-extremity perfusion during treatment of common iliac artery aneurysms is equally important. Our physician-modified contralateral limb with an inner branch stent-graft successfully achieved both goals in two cases. The construct also maintained its shape without deformation and resisted migration, even when additional endovascular procedures involved the inner branch stent-graft.