title: Reentry device aided endovascular aneurysm repair in patients with abdominal aortic aneurysm and unilateral iliac artery occlusion.
abstract: BACKGROUND
  We report 2 cases of patients undergoing endovascular aneurysm repair (EVAR) using reentry devices to recanalize unilateral iliac artery occlusions and complete a bifurcated endovascular repair.
  
  
  METHODS
  Patient 1 is a 70-year-old male with an enlarging 6.5-cm abdominal aortic aneurysm (AAA) and disabling left leg claudication with L external iliac occlusion with patent common and internal iliac arteries. Patient 2 is a 67-year-old male with an asymptomatic 4.0-cm AAA and L iliac chronic total occlusion (CTO) and disabling claudication. Both patients were poor operative candidates for open repair.
  
  
  RESULTS
  Both patients underwent elective percutaneous EVAR along with left iliac artery revascularization. Initial angiography in both cases showed a blind ending of the left common iliac artery. Retrograde subintimal dissection through the occluded iliac segment was attempted but in both cases the wire was unable to traverse back into the true aortic lumen. Using either the Outback LTD or Pioneer reentry catheter, direct visualization of the true aortic lumen was obtained to re-enter the true lumen. The subintimal iliac tract was then predilated to facilitate routine EVAR in both cases. Both patients were discharged the following day and 1-year and 6-month follow-up imaging revealed aneurysm exclusion, no endoleak, and patent bilateral common iliac arteries with resolution of claudication symptoms and normal ankle-brachial indexes. The previously patent internal iliac artery was preserved.
  
  
  CONCLUSIONS
  While not always technically possible, reentry device aided EVAR is safe, feasible, and durable in the mid-term and avoids the morbidity and mortality related to aortouniiliac/femoral-femoral bypass and open repair. This technique should be considered in patients with iliac artery CTO and concurrent AAA to allow total endovascular repair.
authors.affiliation: Division of Vascular Surgery, Stanford University Medical Center, Stanford, CA.
authors.forename: Vinit N
authors.initials: VN
authors.lastname: Varu
authors.affiliation: Division of Vascular Surgery, Stanford University Medical Center, Stanford, CA.
authors.forename: George K
authors.initials: GK
authors.lastname: Lee
authors.affiliation: Division of Vascular Surgery, Stanford University Medical Center, Stanford, CA.
authors.forename: Shu
authors.initials: S
authors.lastname: Chang
authors.affiliation: Division of Vascular Surgery, Stanford University Medical Center, Stanford, CA. Electronic address: jtlee@stanford.edu.
authors.forename: Jason T
authors.initials: JT
authors.lastname: Lee
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D003952:Diagnostic Imaging; D057510:Endovascular Procedures / Q000295:instrumentation*; D006801:Humans; D017543:Iliac Aneurysm / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D007383:Intermittent Claudication / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008297:Male