title: In situ fenestration of the internal iliac artery as a bailout technique associated with endovascular repair of an abdominal aortic aneurysm: long-term follow-up.
abstract: OBJECTIVE
  To describe a bailout technique for in situ fenestration of an inadvertently covered internal iliac artery (IIA) associated with endovascular repair of an abdominal aortic aneurysm (AAA).
  
  
  METHODS
  The procedure is demonstrated in a 76-year-old patient who underwent elective repair of a 5-cm infrarenal AAA using an Excluder endovascular graft 2 years following thoracic aortic stent-graft repair of a chronic type B aortic dissection. A completion angiogram demonstrated unintentional coverage of the left IIA. The iliac limb of the stent-graft was not able to be displaced away from the ostium, so to preserve IIA perfusion in a patient with prior thoracic aortic stent-grafting, a bailout technique was performed using an Outback re-entry device to successfully fenestrate the polytetrafluoroethylene graft material. An iCast balloon-expandable stent was placed across the fenestration creating a patent side branch to maintain patency. Six-year follow-up demonstrates a stable repair.
  
  
  CONCLUSIONS
  In situ fenestration of a stent-graft overlying the internal iliac artery can be a useful bailout technique when other options are unsuccessful.
authors.affiliation: Department of Cardiovascular Surgery, Arizona Heart Institute, Phoenix, Arizona 85006, USA. gwheatley@abrazohealth.com
authors.forename: Grayson H
authors.initials: GH
authors.lastname: Wheatley
mesh_terms: D000368:Aged; 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; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D011138:Polytetrafluoroethylene