Bilateral Internal Iliac Preservation Using a Short-Tip Distal Branched Custom-Made Device During Fenestrated or Branched Aortic Repair

Figures

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  Fig 1. Distal branched custom-made device configurations. Device plans and bench photographs of the two distal branched custom-made devices used for iliac reconstruction in short common iliac artery anatomy. Ia, Device plan for the aneurysmal case, demonstrating the asymmetric configuration based on an aortouni-iliac concept; each external side branch measured 8 mm in diameter and 18 mm in length. Ib and c, Bench photographs showing branch orientation, distal limb configuration, proximal barbs, and diameter-reducing ties. The device was preloaded within a 20F introducer sheath (Flexor; Cook Medical) with a 7.7-mm outer diameter. Id, Short-tip delivery system. IIa, Device plan for the dissection case, showing the smaller, nonbarbed configuration adapted to constrained true lumen anatomy. The device was preloaded within an 18F introducer sheath (Flexor; Cook Medical) with a 7.1-mm outer diameter. IIb and c, Bench photographs of the corresponding device, including an endoluminal view of the branch openings.

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  Fig 2. Complete release and access recovery in short, ectatic common iliac artery anatomy. Aneurysmal case. a, Preoperative three-dimensional computed tomography angiographic reconstruction showing short, ectatic common iliac arteries unsuitable for standard iliac branch device implantation. b and c, Complete release of the distal branched component altered the working lumen at the right iliac bifurcation, preventing antegrade access to the ipsilateral internal iliac artery branch. d and e, Through-and-through wire control and balloon-assisted luminal modulation restored an antegrade access corridor. f, Antegrade cannulation of the right internal iliac artery branch. g and h, Cannulation and reconstruction of the contralateral internal and external iliac artery branches. i and j, Postoperative computed tomography angiographic reconstructions in anteroposterior and posteroanterior views, respectively, demonstrating patency and preserved configuration of the reconstructed aortoiliac branches.

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  Fig 3. Staggered release in chronic dissection with compressed true lumen. Dissection case. a, Preoperative three-dimensional computed tomography angiographic reconstruction showing chronic thoracoabdominal aortic dissection with aneurysmal degeneration, short calcified common iliac arteries, and compressed true lumen. b, Staggered opening of the contralateral branches while the remaining distal component remained constrained. c and d, Cannulation and reconstruction of the ipsilateral left internal iliac artery within the constrained true lumen. e, Completion fluoroscopic image demonstrating the integrity and configuration of the implanted stents. f, Postoperative three-dimensional computed tomography angiographic reconstruction in an anteroposterior view, showing the completed aortoiliac reconstruction with patent bilateral internal iliac artery branches.