title: Complete Ipsilateral Femoral Approach Using an Iliac Branch Device to Preserve a Sole Internal Iliac Artery After Aortic Stent-Graft Placement.
abstract: To report implantation of an iliac branch device (IBD) for preserving antegrade blood flow to a sole internal iliac artery (IIA) via an ipsilateral approach during endovascular repair to reline an aortobi-iliac allograft.
  
  
  
  The technique is described in a 55-year-old man with an enteric fistula involving an aortobi-iliac Y-prosthesis. After complete excision, the prosthesis was replaced by an allograft. Due to rebleeding and resuturing of the graft, total stent-graft relining of the allograft was planned with preservation of the sole left IIA using an iliac side branch (ZBIS). During introduction of a 12-F sheath over the allograft's neobifurcation to establish a femorofemoral through-and-through approach, the allograft ruptured. A compliant balloon was inflated to control the hemorrhage. The IBD was first fully deployed, followed by stent-graft relining. Consequently, stent-graft implantation in the left IIA using a crossover maneuver was no longer feasible, so a 0.035-inch super stiff wire was introduced through the IBD's 20-F sheath. A 12-mm semi-compliant balloon was inflated in the common iliac artery above the iliac branch to act as an abutment for a 7-F sheath to run over the stiff wire into the IIA for delivery/deployment of a stent-graft.
  
  
  
  It is feasible to use a complete ipsilateral femoral approach for IBD implantation after aortic stent-graft placement.
authors.affiliation: Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany h.riess@uke.de.
authors.forename: Henrik Christian
authors.initials: HC
authors.lastname: Rieß
authors.affiliation: Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Tilo
authors.initials: T
authors.lastname: Kölbel
authors.affiliation: Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Diener
authors.affiliation: Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Heidemann
authors.affiliation: Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: E Sebastian
authors.initials: ES
authors.lastname: Debus
authors.affiliation: Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Fiona
authors.initials: F
authors.lastname: Rohlffs
authors.affiliation: Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Tsilimparis
mesh_terms: D000792:Angiography; D001011:Aorta / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D021721:Balloon Occlusion; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D020878:Device Removal / Q000379:methods*; D004378:Duodenal Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005263:Femoral Artery / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D007412:Intestinal Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D015641:Radiography, Interventional; D012039:Regional Blood Flow; D015607:Stents; D016896:Treatment Outcome
keywords: allograft; aortic rupture; buddy wire; iliac branch device; internal iliac artery; ipsilateral approach; prosthetic graft; relining; stent-graft