Innovative technique for deployment of Iliac Branch Endograft in patient with challenge anatomy

A 72 year-male patient with infrarenal abdominal aortic aneurysms (AAA) of 5.7 cm along with 4 cm right common iliac artery aneurysm presented for repair. The patient had a history of COPD and CAD. After obtaining a medical and cardiac work-up, we elected to pursue an endovascular repair. The central line length as measured from the lowest renal artery to the origin of right internal iliac artery was 157 mm. Therefore, a main aortic device (RLT311413, 31 mm X 14 mm X 13 cm) was deployed via left groin access. Next, a bell-bottom iliac graft (PLC201000, 20 mm X 9.5 cm) to right common iliac artery aneurysm was placed before deploying a right-sided Gore® Excluder® Iliac Branch Endoprosthesis (IBE) (W. L. Gore and Associates, AZ, USA). A through-and-through wire above the follow divider was achieved, and then a 12 Fr. Gore DrySeal Sheath® (W.L. Gore and Associates, AZ, USA) was telescoped without manipulation of the main device. A Gore® Viabahn® VBX balloon (11 mm X 79 mm, W. L. Gore and Associates, AZ, USA) was extended to the right internal iliac artery, and then a right external iliac stent was inserted via right groin access. The final angiogram showed appropriate stents placed without endoleak. The patient was discharged home on postoperative day 1 without any complications.