title: Sandwich technique for aortoiliac aneurysms extending to the internal iliac artery or isolated common/internal iliac artery aneurysms: a new endovascular approach to preserve pelvic circulation.
abstract: OBJECTIVE
  To describe a new endovascular approach to preserve internal iliac artery (IIA) flow in patients with abdominal aortic aneurysm (AAA) involving the common iliac artery(ies) (CIA) or in cases of isolated CIA/IIA aneurysm.
  
  
  METHODS
  The sandwich technique for isolated CIA/IIA aneurysms or aortoiliac aneurysms extending to the IIA includes 5 steps: (1) bifurcated stent-graft main body insertion through an ipsilateral femoral approach and positioned such that the distal end of the iliac limb is 1 cm above the IIA origin; (2) catheterization of the ipsilateral IIA through a left brachial access with a long 5-F multipurpose catheter and a 0.035-inch extra stiff floppy tip guidewire; (3) placement of a covered self-expanding stent 2 cm inside the IIA with a 6-cm overlap into the iliac limb, followed by positioning of an iliac limb extension 1 cm below the covered stent's proximal end (the iliac limb extension is deployed first and then the covered stent); (4) modeling of the iliac limb stent-grafts using a latex balloon and dilation of the covered stent with an angioplasty balloon; and (5) deployment of the contralateral iliac limb. For bilateral CIA aneurysms extending to both IIAs, repeat steps 2-4.
  
  
  CONCLUSIONS
  This technique was developed to overcome current anatomical and device constraints, expanding the limits of endovascular aneurysm repair (EVAR) in a safe, easy to perform, and cost-effective manner. The sandwich technique appears a promising tool in the EVAR armamentarium, but more experience with the method is warranted.
authors.affiliation: São Paulo Vascular and Endovascular Surgery Institute, São Paulo, Brazil. aclobato@icve.com.br
authors.forename: Armando C
authors.initials: AC
authors.lastname: Lobato
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D001938:Brazil; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D017543:Iliac Aneurysm / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D010388:Pelvis / Q000098:blood supply*; D012039:Regional Blood Flow; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome