A Hybrid Endovascular Procedure to Preserve Internal Iliac Artery Patency during Endovascular Repair of Aortoiliac Aneurysms

Abstract

Purpose: To demonstrate the feasibility of a hybrid endovascular procedure to preserve blood flow in the internal iliac arteries (IIA) during aortoiliac endografting. Technique: When aneurysmal dilatation makes the distal neck in the common iliac artery (CIA) too short for an adequate seal, the CIA bifurcation is exposed via an extraperitoneal approach after endograft deployment. Via an arteriotomy in the CIA, the distal end of the stent-graft is sutured to the CIA bifurcation under direct vision to preserve IIA blood flow. This approach has been successful in preserving IIA blood flow in 5 of 7 endograft procedures; in the other 2, IIA occlusion was a predictable event. Conclusions: Direct suturing of an aortoiliac stent-graft to the CIA bifurcation via an extraperitoneal approach is a useful method of maintaining IIA perfusion. However, further study is required to identify patients at high risk of pelvic ischemia who would benefit from such intervention.