Fig. 5.

Parallel limb endograft technique. (A) An 89-year-old male presented with a huge abdominal aortic aneurysm and bilateral common and internal iliac artery aneurysms. (B) The preoperative measuring and planning sheet demonstrated that the diameter of the left internal iliac artery was 14 mm. To preserve unilateral pelvic flow, embolization of the right internal iliac artery and parallel limb endograft placement in the left external and internal iliac arteries were planned. (C) After placement of the AFX (Endologix) main body (diameter=28 mm), a 14F introducer sheath was inserted with the up-and-over technique (arrow). Thereafter, a 16 mm limb endograft was inserted into the left internal iliac artery (dotted arrow). Subsequently, a 13 mm limb endograft was inserted into the left external iliac artery. (D) Kissing balloon angioplasty was performed to fix all endografts that were inserted into the left external (arrow) and internal (dotted arrow) iliac arteries. (E) Completion angiography showed no endoleak and patent endografts that were inserted into the left external (arrow) and internal (dotted arrow) iliac arteries.