Iliac Fenestration-An Alternative Endovascular Option for Common Iliac Aneurysms

We report the use of manufacturer-customized fenestrated iliac stent grafts to treat common iliac artery aneurysms (CIAAs) in patients with challenging iliac anatomy, unsuitable for iliac branched devices (IBDs). A 71-year-old woman presented with bilateral CIAAs measuring 44 mm and 29 mm and a perivisceral abdominal aortic aneurysm (AAA). The second patient, a 72-year-old male, had a 42-mm CIAA and an AAA, which expanded to 50 mm during the short-term follow-up. The contralateral internal iliac was occluded. Both patients were deemed high risk for open repair, and endovascular repair was recommended. The aneurysm anatomies were unsuitable for isolated CIAA repair. Suitable sealing zones for endovascular repair were the visceral segment proximally and the external iliac arteries. Preservation of both internal iliac arteries (IIAs) was important to reduce the risk of spinal cord ischemia, but due to distal CIA narrowing, neither patient had sufficient "space" for the branches used in conventional IBD deployment. Three fenestrated Vascutek Anaconda™ iliac limbs were successfully deployed. All three IIAs were preserved with no endoleak, and the patients were discharged after an uneventful postprocedural course. To our knowledge, this is the first successful report of iliac aneurysm repair with manufacturer-customized fenestrated iliac limbs.