In situ fenestration of the internal iliac artery as a bailout technique associated with endovascular repair of an abdominal aortic aneurysm: long-term follow-up.

PURPOSE

To describe a bailout technique for in situ fenestration of an inadvertently covered internal iliac artery (IIA) associated with endovascular repair of an abdominal aortic aneurysm (AAA).

TECHNIQUE

The procedure is demonstrated in a 76-year-old patient who underwent elective repair of a 5-cm infrarenal AAA using an Excluder endovascular graft 2 years following thoracic aortic stent-graft repair of a chronic type B aortic dissection. A completion angiogram demonstrated unintentional coverage of the left IIA. The iliac limb of the stent-graft was not able to be displaced away from the ostium, so to preserve IIA perfusion in a patient with prior thoracic aortic stent-grafting, a bailout technique was performed using an Outback re-entry device to successfully fenestrate the polytetrafluoroethylene graft material. An iCast balloon-expandable stent was placed across the fenestration creating a patent side branch to maintain patency. Six-year follow-up demonstrates a stable repair.

CONCLUSION

In situ fenestration of a stent-graft overlying the internal iliac artery can be a useful bailout technique when other options are unsuccessful.