Novel chimney-graft technique for preserving hypogastric flow in complex aortoiliac aneurysms

We describe the feasibility and result of a novel approach to preserve pelvic perfusion during endovascular aortoiliac aneurysm repair (EVAR) in patients with aortoiliac aneurysms extending to the iliac bifurcation. The iliac chimney-graft technique consists of the deployment of a ViaBahn™ graft into the hypogastric artery in combination with standard abdominal aortic stent-grafts. The chimney graft was deployed using a transsubclavian access and placed parallel with the iliac limb into the standard aortic stent graft, which was deployed directly before. The technical procedure was successful. Postoperative control showed a sufficiently excluded aneurysm without evidence of endoleak and good distal perfusion of both iliac arteries. The CT-scan after 6 months confirmed the result. The chimney-graft stent grafts to maintain perfusion to hypogastric arteries are feasible and provide an alternative to hypogastric artery exclusion or branched grafts. Long-term follow-up is needed to evaluate stent-graft patency and failure rates.