The risks, benefits and alternatives of procedure were discussed in detail with the patient and consent obtained by the vascular surgery team.
The abdomen and bilateral groins were prepped and draped in standard surgical fashion.
Bilateral groin incisions were made in the oblique fashion and cut down exposing the bilateral common femoral arteries just below the inguinal ligament, by the vascular surgery team.
Two 19 gauge introducer needles were inserted through tiny incisions inferior to the oblique incisions.
The right access was chosen was the ipsilateral side and a wire and a glide catheter was inserted, which was subsequently exchanged with a stiff wire and a 17 French sheath was placed, which was advanced to the level just above the aortic bifurcation.
Into the left access, which is the contralateral side, a wire was inserted and an 8 French sheath was placed.
A pigtail catheter was inserted into the aorta from the left side and an angiogram was performed obtaining size measurements.
For the main an Endologix unibody bifurcated stent graft of 28 mm x 16 x 120 mm was inserted from the right side. At this time a snare was advanced from the left access and deployed just above the aortic bifurcation. The side wire (hollow) from the right main graft was advanced into the snare and subsequently snared toward the left into the left left iliac artery and pulled down using the snare.
The main body was subsequently deployed, followed by deployment of the left iliac limb over the 014 wire, which was inserted into the snared hollow wire.
The right sheath was pulled back and the right iliac limb was deployed.
After this a pigtail catheter was inserted to assess the position of the renal arteries. The top of the aortic cuff stent was placed just inferior to the right renal which was the lowest renal artery. The aortic cuff stent, 34 mm x 80 mm, was successfully deployed.
After this, a compliant balloon was used to appose the graft against the aorta and against the common iliac arteries.
Follow up angiogram demonstrated no endoleak but the left iliac limb apposition was not complete so angioplasty was performed using a 12 mm x 4 cm balloon.
Post angioplasty angiogram performed through the sheath was satisfactory.
Subsequently, all wires, catheters and bilateral sheaths were removed.
The bilateral groin cut down was closed by the vascular surgery team.
Patient tolerated the procedure well without apparent immediate complications.
Patient was given 6000 units of IV heparin with boluses during the course of the procedure.
Successful infrarenal abdominal aortic aneurysm repair using Endologix unibody bifurcated stent graft of 28 mm x 16 x 120 mm inserted from the right side and aortic cuff stent of 34 mm x 80 mm as described.