title: Single-center experience and 1-year follow-up results of "sandwich technique" in the management of common iliac artery aneurysms during EVAR.
abstract: OBJECTIVE
  Abdominal aortic aneurysm (AAA) accompanied by common iliac artery (CIA) aneurysms requires a more demanding procedure owing to the difficulties in obtaining an adequate distal landing zone for the stent-graft limb(s), a potential site of endoleak. The "sandwich technique" is a procedure to increase EVAR feasibility in the setting of adverse or challenging CIA anatomy. Its main advantages include no restrictions in terms of CIA diameter or length or internal iliac artery (IIA) diameter, no need to wait for a specific stent-graft. Our purpose is to describe our single-center experience and one year follow-up results of this new procedure.
  
  
  METHODS
  From April 2009 to June 2010, the sandwich technique was performed in our institution in 7 patients treated for AAA and unilateral CIA aneurysms (n. 5) or bilateral CIA aneurysms (n. 2). Inclusion criteria were the presence of unilateral or bilateral CIA aneurysm (independently from its diameter), IIA artery measuring up to 9 mm in its maximum diameter, not dilatation of IIA and EIA.
  
  
  RESULTS
  The mean follow-up length was 15 months (range: 14-20 months). All stent-implanted iliac branches remained patent on 1 year follow-up and IIA flow was preserved. None of the patients had symptoms of pelvic ischemia. CT scan follow-up showed aneurysm shrinkage in five patients, without any sign of endoleaks in all cases.
  
  
  CONCLUSIONS
  In selected cases, the "sandwich technique" showed good outcomes confirming to be a safe and easy to perform way to overcome anatomical constraints and expanding the limits of EVAR.
authors.affiliation: Policlinico Santa Maria alle Scotte, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Ricci
authors.forename: Claudio
authors.initials: C
authors.lastname: Ceccherini
authors.forename: Marco
authors.initials: M
authors.lastname: Cini
authors.forename: Francesco
authors.initials: F
authors.lastname: Vigni
authors.forename: Sara
authors.initials: S
authors.lastname: Leonini
authors.forename: Giulio
authors.initials: G
authors.lastname: Tommasino
authors.forename: Luigi
authors.initials: L
authors.lastname: Muzzi
authors.forename: Enrico
authors.initials: E
authors.lastname: Tucci
authors.forename: Antonio
authors.initials: A
authors.lastname: Benvenuti
authors.forename: Eugenio
authors.initials: E
authors.lastname: Neri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D057867:Endoleak / Q000517:prevention & control; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017543:Iliac Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency