A novel technique of aortomonoiliac AAA repair in patients with a single patent iliac artery: a stent-graft sandwich

PURPOSE: To present a novel technique for endovascular repair of abdominal aortic aneurysms (AAA) in patients with an occluded iliac artery on one side. TECHNIQUE: In patients with an occluded iliac artery, the main body of a bifurcated modular endoprosthesis is deployed in standard fashion. Another stent-graft of a similar diameter is placed inside the deployed device so that the proximal end of the second endograft is a few millimeters caudal to the leading edge of the first device, which positions the second contralateral gate caudal to the flow divider of the first device. The second stent-graft is also rotated so that its contralateral gate is 180 degrees opposite to the contralateral gate of the first device. This stent-graft sandwich effectively mimics an aortomonoiliac device. After deployment of the second device, the attachment sites are dilated with appropriately sized balloons according to standard practice for the particular endoprostheses. CONCLUSIONS: Endovascular AAA repair utilizing a stent-graft sandwich technique is an effective method of treating AAAs when one iliac artery is occluded