Endovascular abdominal aortic aneurysm repair in patients with common iliac artery aneurysms – Initial experience with the Zenith bifurcated iliac side branch device

Photograph of the unsheathed Zenith bifurcated iliac side branch device. A, Anterior/posterior view; B, Side view to demonstrate the gold markers. The balloon expandable covered stents that are used to bridge the gap between the side branch and the internal iliac artery must not extend proximally above the third gold marker (counting from above). [Courtesy of William A. Cook Australia Pty Ltd].

Line diagrams depicting deployment of the Zenith bifurcated iliac side branch device (IBD): A, The indwelling catheter is snared within the aortic aneurysm sac and brought out via the contralateral femoral artery. B, The IBD is partly deployed to open up its side branch prior to advancing the Balkin sheath over the through-and-through wire, into the proximal segment of the IBD and out of its side branch, C. Another 0.035 wire is then introduced through the Balkin sheath to allow cannulation of the internal iliac artery. D, This wire is then changed to a stiffer wire over which covered stents are introduced and later deployed after fully unsheathing the IBD. [Line diagrams used with permission of William A. Cook Australia Pty Ltd.]

Intraoperative fluoroscopy and digital subtraction images from case 3. A, Balkin sheath advanced over the aortic bifurcation, into the side branch of the partially deployed Zenith bifurcated iliac side branch device (IBD); B, The internal iliac artery has been cannulated and the wire advanced well into one of its branches, the IBD has been completely deployed, one covered stent has also been deployed, and a second one is about to be deployed; C, Completion angiograph at the end of the procedure (the right limb is not filling since no suction was applied to the sheath in the right groin to better visualize the left side).

Intraoperative digital subtraction images from case 5. A, Before stent insertion and deployment; B, At completion.

Intraoperative digital subtraction images from case 7: A, before stent insertion and deployment, demonstrating a distal type 1 endoleak despite the previous use of a “bell-bottom” technique and B, at completion demonstrating no endoleak after deployment of the Zenith bifurcated iliac side branch device and Advanta V12 stents.