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  1. Presentation • 76 y/o male referred for bilateral 4 cm common iliac aneurysms • s/p open repair of symptomatic 6.5 cm type IV thoracoabdominal aneurysm by CT surgery at Stanford 7/06, 22mm main graft body • Surg hx – three vessel CABG 1982, infra-renal abdominal aortic aneurysm repair 1985 • Med hx – A fib, angina • Physical examination • Palpable femoral pulses, left groin mass • Abdomen with multiple healed incisions, no hernia

  2. External iliac artery Internal iliac artery

  3. Intervention

  4. 6fr terumo destination sheath parked In the right common iliac artery Runs demonstrate two distal arteries Coming off the right hypogastric artery aneurysm

  5. Selective catheterization of the larger Hypogastric aneurysm branch

  6. 6fr sheath advanced into the hypogastric Aneurysm to facilitate coil deployment

  7. Deployment of the initial 10/5 Tornado coil

  8. Additional tornado coils

  9. Selective catheterization of the other Hypogastric aneurysm branch

  10. Deployment of 4/8 tornado coils

  11. Additional 10/5 tornado coils were Attempted to be placed into the Proximal hypogastic artery but Were pushed into the aneurysm sac By the arterial flow

  12. Aortic run to confirm length measurements

  13. Cook Zenith 32x12x147 AUI Deployed, retrograde run demonstrates Hypogastric artery not complete excluded

  14. Cook zenith 12x54 iliac extender placed

  15. Cook zenith 24mm blocker Placed in left common iliac Artery aneurysm

  16. Omniflush catheter used to Cannulate the hypogastric artery

  17. 035 Amplatz and meier wires do Not take the curve, stiff angled Glidewire used

  18. Predeployment of the Fluency 10x60mm stent

  19. Two fluency stents used to Cross from external iliac artery To the hypogastric artery

  20. Completion run prior to Fem fem bypass

  21. Post-operative course • Patient tolerated procedure well, plan for discharge to home POD#4

  22. Gore Viabahn

  23. 45 patients with isolated iliac artery aneurysms • 5 patients with bilateral iliac artery aneurysms • Both internals were coiled as they were severely stenotic, no ischemia • One internal coiled, operative revascularization of other one abandoned • Patient with previous operative dissection • Orifice covered with covered stent, no later ischemia • Revascularization of internal with a bypass • Both internals already thrombosed • One internal preserved as there was an adequate common iliac landing zone • Coil embolization resulted in buttock claudication of 23% of patients, half resolved • Within 30 days, others resolved within a year, one patient with persistent symptoms

  24. 4 patients, two with custom made grafts and two treated with Wallgrafts (Boston Scientific), blood loss 1.5l per case 10 month f/u with 100% patency of grafts