title: Technical tips and procedural steps in endovascular aortic aneurysm repair with concomitant recanalization of iliac artery occlusions.
abstract: OBJECTIVE
  The goal of this paper is to describe our technical strategy and procedural steps for endovascular aneurysm repair (EVAR) when performed with concomitant recanalization of the iliac artery occlusion.
  
  
  METHODS
  Three octogenarians having abdominal aortic aneurysm (AAA)/common iliac artery aneurysms (CIAA) with unilateral external iliac artery (EIA) occlusion underwent EVAR with recanalization of the occluded iliac arteries. Crossing the iliac artery occlusions was attempted in a retrograde approach using a 0.035 inch-hydrophilic guidewire. After passage of a guidewire, predilation was performed using 6mm balloon. Then a 12-Fr sheath was advanced via the occluded EIA for contralateral iliac limb delivery. Internal iliac artery embolization was subsequently performed as needed. A self-expanding stent was then placed in the occluded EIA after EVAR.
  
  
  RESULTS
  Recanalization of the EIA occlusion, followed by stentgraft delivery through the occlusion and EVAR, was successfully performed in all three patients. Penetration of the occluded EIA was successfully achieved only by retrograde approach in two patients, and by bidirectional approach in the other patient. No perioperative complication or death occurred. Postoperative CT showed no type I or III endoleaks in the aneurysms and patent iliac arteries in all patients.
  
  
  CONCLUSIONS
  Total endovascular repairs were successfully performed for three patients with AAA and concomitant unilateral EIA occlusions. The proposed steps described in this report might reduce the complication rate and enhance the technical success rate associated with this procedure.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521 Japan.
authors.forename: Jorge Senkichi
authors.initials: JS
authors.lastname: Uchiyamada
authors.forename: Shigeo
authors.initials: S
authors.lastname: Ichihashi
authors.forename: Shinichi
authors.initials: S
authors.lastname: Iwakoshi
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Itoh
authors.forename: Nobuoki
authors.initials: N
authors.lastname: Tabayashi
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Kichikawa
keywords: Abdominal aortic aneurysm; Endovascular aneurysm repair; Iliac artery occlusion; Peripheral arterial disease; Stent placement