Endovascular Aneurysm Repair Using Physician-Modified Fenestrated Endurant Contralateral Limb for Internal Iliac Artery Preservation

Purpose: We developed a novel technique using a physician-modified fenestrated Endurant contralateral limb (Medtronic, Minneapolis, MN, USA) for iliac artery aneurysm repair and to preserve the internal iliac artery blood flow. Technique: To preserve the internal iliac artery, we developed a fenestration reinforced by a hydrogel coil in the Endurant contralateral limb with a preloaded wire. We employed a fenestrated repair approach with a physician-modified Endurant limb, along with the inclusion of Viabahn VBX as a bridging branch. The 0.025-in Radifocus guidewire was preloaded to deliver the sheath from the contralateral side, ensuring a reliable and straightforward cannulation of the internal iliac artery. The procedure was performed in 24 patients with common and/or internal iliac artery aneurysms. In total, 31 branch preservations were performed. The technical success rate was 100%, and no complications were observed after the 1-year follow-up. Conclusions: We believe that our procedure is safe, reliable, and effective in preventing ischemia in the internal iliac region. We believe our technique has the potential to broaden the range of anatomical indications for internal iliac artery-preserving procedures. Clinical Impact: We developed a novel Endovascular aortic repair technique for internal iliac artery preservation using a physician modified Endurant contralateral limb. This procedure was safe and reliable for preserving internal iliac artery flow in 24 patients with common and internal iliac artery aneurysms. We believe that our technique has the potential to expand the anatomic indications for internal iliac artery preserving procedures.