Fig. 4.

Strategies for the concomitant iliac aneurysms. (A) Commercially available iliac branch device (IBD). (B-E) A physician-modified IBD was used to treat a patient with an abdominal aortic aneurysm and concomitant bilateral common iliac artery aneurysms (B). (C) A polytetrafluoroethylene graft measuring 7×20 mm was attached to the deployed limb endograft at the back table (arrow). (D) After introducing the physician-modified IBD, an 8 mm covered stent was inserted into the internal iliac artery (arrow). (E) Completion angiography showed no type Ib or type II endoleak and a patent internal iliac stent (arrow). (F) A 70-year-old male presented with a saccular abdominal aortic aneurysm, bilateral external iliac artery stenosis, occluded right internal and bilateral superficial femoral arteries, and a concomitant left internal iliac artery aneurysm (arrow). (G) An aortic extender cuff was used to treat a saccular abdominal aortic aneurysm. (H) An 8 mm Dacron graft was anastomosed to the left common iliac artery in an end-to-end fashion. This temporary conduit was used to deliver the aortic extender cuff, which was anastomosed to the distal external iliac artery (arrow). A 7F introducer sheath was inserted in the left hypogastric aneurysm sac for inserting the covered stent (dotted arrow). (I) The Dacron bypass graft was partially clamped with a Satinsky clamp, and the inserted Viabahn covered stent was clamped (arrow). (J) The Dacron graft-Viabahn anastomosis was performed in an end-to-side manner (arrow). (K) Postoperative maximal intensity image demonstrated no endoleak, a patent hypogastric stent (arrow), and a patent bilateral femoropopliteal vein bypass graft (dotted arrows).