title: Implantation of an Iliac Branch Device After EVAR via a Femoral Approach Using a Steerable Sheath.
abstract: OBJECTIVE
  To describe a contralateral femoral approach for iliac branch device implantation using a steerable sheath in the setting of an existing bifurcated stent-graft.
  
  
  METHODS
  The method is demonstrated in an 80-year-old man who developed a 4-cm iliac aneurysm 3 years after implantation of an Endurant bifurcated stent-graft. Both femoral arteries were cannulated after surgical cutdown. The steerable sheath was advanced from the contralateral side over the neobifurcation of the bifurcated stent-graft. A 0.014-inch Roadrunner wire was used as a through-and-through wire to stabilize the curve of the sheath and to get proper push. The bridging stent-graft for the iliac branch was advanced over this sheath to seal the iliac aneurysm. During the entire procedure, the sheath was stable over the neobifurcation without pulling it down.
  
  
  CONCLUSIONS
  The contralateral femoral approach for iliac branch graft implantation is feasible in cases with an extant bifurcated stent-graft using a steerable sheath and a through-and-through wire.
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Düsseldorf, Germany alexander.oberhuber@med.uni-duesseldorf.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Oberhuber
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Düsseldorf, Germany.
authors.forename: Mansur
authors.initials: M
authors.lastname: Duran
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Düsseldorf, Germany.
authors.forename: Neslihan
authors.initials: N
authors.lastname: Ertaş
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Düsseldorf, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Simon
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Düsseldorf, Germany.
authors.forename: Hubert
authors.initials: H
authors.lastname: Schelzig
mesh_terms: D000369:Aged, 80 and over; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D057510:Endovascular Procedures / Q000379:methods*; D005263:Femoral Artery; D006801:Humans; D017543:Iliac Aneurysm / Q000601:surgery*; D008297:Male; D015607:Stents; D016896:Treatment Outcome
keywords: abdominal aortic aneurysm; endovascular aneurysm repair; femoral approach; iliac aneurysm; iliac branch; steerable sheath; stent-graft