A Tapered Contralateral Endurant Stent Graft Limb,Deployed ‘‘Up-And-Over’’ to Treat a Symptomatic Internal Iliac Aneurysm

Abstract

Internal iliac artery aneurysms are a rare variant of aorto-iliac aneurysm disease. They are associated with high mortality if managed conservatively. Open surgery is associated with significant morbidity and mortality especially when performed for rupture. Endovascular stent coverage after feeding vessel embolization has been proven a safe and effective treatment for this condition. Custom-tapered grafts which accommodate size discrepancies between common and external iliac arteries are either unavailable or not feasible in an emergent setting. We describe the use of an off-the-shelf, tapered, contralateral limb extension from an Endurant stent graft deployed through an ‘‘up-and-over’’ approach. This approach uses and demonstrates the improved flexibility and conformability of this device which facilitate a novel contralateral delivery path.