Hybrid Approach for Type Ib Endoleak After Complex Endovascular Aortic Aneurysm Repair of a Crawford Type II Thoracoabdominal Aortic Aneurysm

Background Despite the availability of iliac branched devices (IBDs), many patients are unsuitable for their use due to unfavorable anatomy (e.g. short common iliac artery, iliac artery tortuosity, aneurysmatic internal iliac artery (IIA), lack of landing zone in internal iliac artery). Therefore, alternative techniques to maintain pelvic perfusion remain crucial. Conclusion This case highlights how an hybrid approach offers a valuable treatment option in anatomically challenging situations where preservation of branch vessel perfusion is critical. This approach allows for durable aneurysm or endoleak exclusion mitigating the risks associated with direct overstenting of the IIA. Other possible approaches for an iliac pathology would be:IIA occlusion and Overstenting: This would be the simplest way, using an Amplatzer in the IIA and extending the Stent-Graft. But maintaining iliac perfusion was critical in this patient due to their extensive aortic coverage.Bell-bottom technique: Was not possible anymore since the patient already had a stent the almost reached the iliac bifurcation and we are not a fan of this tenchique since it includes having a distal seal in an aneurysmatic vessel.IBD: Contraindicated due to significant kinking of the external iliac artery, the insufficient length of the internal iliac artery and the already positioned stent at the level of the iliac bifurcation. Case presentation A 76 female patient presented with a Type Ib endoleak originating from the right iliac artery detected on a CT scan. The patient received a staged endovascular repair of a Crawford Type II thoracoabdominal aortic aneurysm (TAAA). During the follow up a Type Ib endoleak originating from the right iliac artery had been found. Therefore an hybrid approach was chosen, consisting of Internal/External Iliac Artery Bypass and Stent Graft Extension.