AB033. 236. Branching out: a pre-loaded approach to complex aortoiliac disease

Background: The use of fenestrated and branched technology usually requires a contralateral approach to access and stent the visceral vessels. In patients with occlusive aortoiliac disease it is not always possible to have contralateral iliac access. Pre-loaded endografts overcome this challenge by facilitating the access of two vessels through the main device delivery system.

Methods: We describe three patients with complex aortoiliac disease, necessitating the use of pre-loaded fenestrated devices. Two patients had occlusion of an iliac artery, and the third case had a narrow aortic bifurcation with a low left renal artery. In each case, the device was designed with pre-loaded catheters exiting the renal fenestrations and re-entering the superior mesenteric artery and coeliac artery fenestrations. These catheters allowed through-and-through access to be obtained and facilitated sheaths to be tracked into all four fenestrations.

Results: The technical success was 100%, with cannulation and stenting of all visceral vessels achieved.

Conclusions: Pre-loaded technology has expanded our utilization of fenestrated endografts and would appear to be associated with a shorter operative duration.

Keywords: Fenestrated endovascular aneurysm repair (fenestrated EVAR); preloaded aortic graft