Hypogastric preservation with Viabahn stent graft during endovascular aneurysm repair

Abstract

The presence of bilateral iliac aneurysms extending to the iliac bifurcations, in conjunction with an abdominal aortic aneurysm, complicates endovascular repair because of the difficulty of preserving one or both hypogastric arteries. Several open techniques have been suggested for hypogastric preservation, but they usually involve some type of anatomic or extra-anatomic bypass. Endovascular techniques for hypogastric preservation include branch iliac grafts, chimney grafts, and bellbottom limbs. We report the use of a Viabahn stent graft (W. L. Gore and Associates, Flagstaff, Ariz) within the iliac limb of a Powerlink device (Endologix, Inc, Irvine, Calif) to preserve a hypogastric artery.

Results of a double-barrel technique with commercially available devices for hypogastric preservation during aortoilac endovascular abdominal aortic aneurysm repair

“…Once the bifurcated endografts were in place, a sheath of sufficient diameter (8)(9)(10)(11)(12)(13)(14) to fit the hypogastric graft and an 0.035-inch "buddy-wire" was brought to the origin of the ipsilateral hypogastric artery. In patients receiving the Excluder, Talent, or Zenith devices (n ϭ 6), the brachial approach was used to deliver this sheath (8-12 Fr) by means of surgical exposure of the midbrachial artery.…”

“…These include both hybrid procedures and fully endovascular approaches utilizing investigational branched-endograft devices or "off-the-shelf" devices in an off-label manner. [8][9][10][11][12][13][14][15][16] At our institutions, we have begun using a double-barreled technique with commercially available devices to preserve hypogastric blood flow in these patients, and the purpose of this report is to describe the outcomes associated with this novel technique.…”

A multicenter 12-month experience with a new iliac side-branched device for revascularization of hypogastric arteries

“…10 Off-label combinations of various endovascular devices (eg, chimney, sandwich, reversed U technique) have been suggested for the preservation of pelvic flow in cases of complex aortoiliac aneurysmatic disease. [11][12][13][14] The efficacy and durability of these configurations, though, have been described only in case reports or small case series.…”

Results of Repair of Iliac Artery Aneurysms with the Sandwich Technique

“…Because of this risk, attempts have been made at IIA preservation during EVAR. Th e fi rst Food and Drug Administration-approved commercial grafts for this purpose only became available in 2016, so IIA preservation has been accomplished using surgical revascularization, the bell-bottom technique, or surgeon-modifi ed grafts ( 1,(7)(8)(9). Each of these methods has its limitations, so the sandwich technique ( 10 ) was developed ( Figure 1 ).…”