title: Use of modified Sandwich-graft technique to preserve hypogastric artery in EVAR treatment of complex aortic aneurysm anatomy.
abstract: OBJECTIVE
  Since the introduction of the first endoprosthetic devices, continuous development in techniques and implants has occurred, such as the introduction of a stent graft with branches designed to preserve antegrade flow in the hypogastric artery, a stent-graft designed to treat extreme neck angulation and iliac tortuosity, as well as "Sandwich" and "Chimney" techniques used to maintain perfusion in branch vessels originating in the region to be treated. This paper describes how the Sandwich-Graft technique was adapted, as described by Lobato et al., employing the Aorfix™ system (Lombard Medical) and the Viabahn™ (W.L.Gore) to preserve hypogastric flow in cases with extreme neck angulation and iliac tortuosity.
  
  
  METHODS
  The study included four patients treated from April 2010 until November 2010 with the modified Sandwich technique. All patients eligible for this approach were considered unfit for open repair and were not suitable for an iliac branch graft (Z-BIS Zenith™ Cook Medical).
  
  
  RESULTS
  A bifurcated endograft was implanted with specific, in-situ, branching to the target hypogastric artery and achieved clinical and technical success, in all the patients. After a 11-month follow-up in two cases and a six-month follow-up in the other two, clinical results were successful. All patients were endoleak-free, had patent hypogastric branches and had shrinking or stable aneurysms.
  
  
  CONCLUSIONS
  The initial experience shows that the Sandwich technique with the Aorfix™ stent-graft demonstrated to be effective in endovascular repair of abdominal aortic aneurysms in patients with aortoiliac anatomy hostile to preserving hypogastric artery patency. This graft allows a broader group of patients to be treated with endovascular repair without potential complications of hypogastric artery occlusion; however, further studies are needed to evaluate long-term results in larger numbers of patients.
authors.affiliation: Angiology and Vascular Surgery Department Complexo Hospitalario de Ourense, Ourense, Spain. nmarochena@me.com
authors.forename: N
authors.initials: N
authors.lastname: Mosquera Arochena
authors.forename: G
authors.initials: G
authors.lastname: Rodríguez Feijoo
authors.forename: C
authors.initials: C
authors.lastname: Carballo Fernandez
authors.forename: F
authors.initials: F
authors.lastname: Molina Herrero
authors.forename: R
authors.initials: R
authors.lastname: Fernandez Lebrato
authors.forename: A
authors.initials: A
authors.lastname: Barrios Castro
authors.forename: I
authors.initials: I
authors.lastname: Garcia Fernandez
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*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D011474:Prosthesis Design; D012039:Regional Blood Flow; D013030:Spain; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome