Transfemoral vs. through-and-through wire technique for iliac branch device implantation – single-center retrospective study

• Internal iliac artery stenting in patients with prior aortic repair is challenging • Transfemoral access with steerable sheath omits the use of upper extremity access. • In comparison to standard crossover approach, this access is technically feasible. • It also results in lower incidence of postoperative internal iliac branch occlusion. • Less manipulation to iliac axis might reduce incidence of target vessel complication. Internal iliac artery stenting in patients with prior aortic repair is challenging Transfemoral access with steerable sheath omits the use of upper extremity access. In comparison to standard crossover approach, this access is technically feasible. It also results in lower incidence of postoperative internal iliac branch occlusion. Less manipulation to iliac axis might reduce incidence of target vessel complication. To report the outcome of a wire-stabilized steerable sheath (SS group) approach for internal iliac artery (IIA) branch catheterization using contralateral transfemoral access and to compare its outcome to through-and-through wire technique (TnT group) for iliac branch device (IBD) procedures. A retrospective analysis of 51 consecutive patients treated for aortoiliac or isolated IIA aneurysm from January 2020 to July 2023 was undertaken. Primary endpoints were radiation exposure, volume of contrast agent (CA), operation time and incidence of intraoperative target vessel (TV) complications. Type IB/C and IIIA/C endoleak, incomplete/complete thrombotic occlusion of TV, re-intervention rates at early (< 30 days after IBD), short (30 days – 6 months) and intermediate (> 6 months) follow-up were secondary endpoints. 12 patients in SS and 39 patients in TnT were identified. History of previous endovascular aneurysm repair (EVAR) was more prevalent in SS, p = 0.001. Non-significantly lower operation time (median, 204 vs. 262 min, p = 0.081) could be found in SS vs. TnT. Dose-area product (median, 301 vs. 361 Gy x cm 2 ), CA (median, 148 vs. 190 mL) were non-significantly lower in SS vs. TnT. TV complications were observed in TnT only (7.7%). Incomplete/complete thrombotic occlusion of IIA branch was less frequently observed in SS vs. TnT at 3 follow-up phases (1 vs. 4 case, 1 vs. 5 case, respectively). SS approach might be considered as a viable and technically safe option for patients with/without prior history of aortoiliac repair.