Incorporation of internal iliac arteries as target vessels during physician-modified fenestrated branched endovascular repair of pararenal abdominal aortic aneurysm with concomitant bilateral short common iliac artery aneurysms

Michelle Manesh; Herbert I James 3rd; Alyssa Pyun; Young Hong; Jacquelyn Paige; Sukgu M Han

doi:10.1016/j.jvscit.2023.101357

Incorporation of internal iliac arteries as target vessels during physician-modified fenestrated branched endovascular repair of pararenal abdominal aortic aneurysm with concomitant bilateral short common iliac artery aneurysms

J Vasc Surg Cases Innov Tech. 2023 Oct 23;9(4):101357. doi: 10.1016/j.jvscit.2023.101357. eCollection 2023 Dec.

Authors

Michelle Manesh¹, Herbert I James 3rd¹, Alyssa Pyun¹, Young Hong¹, Jacquelyn Paige¹, Sukgu M Han¹

Affiliation

¹ Division of Vascular Surgery and Endovascular Therapy, Keck Hospital of University of Southern California, Los Angeles, CA.

Abstract

This report describes an alternative endovascular approach to iliac branch devices for treatment of an abdominal aortic aneurysm with concomitant bilateral short common iliac aneurysms. The short distance between the renal arteries and internal iliac artery origins made the addition of distal iliac branch devices to the proximal fenestrated stent graft challenging. We elected to perform physician-modified fenestrated branched endovascular repair, using four fenestrations for the visceral and renal arteries and an additional two directional branches for the bilateral internal iliac arteries. The patient recovered uneventfully, and the 24-month follow-up imaging shows successful aneurysm exclusion with patent internal iliac artery branches.

Keywords: Abdominal aortic aneurysm; Fenestrated branched endovascular repair; Iliac artery aneurysm; Iliac branch device.