Iliac Bifurcation Devices: Tips and Tricks

Up to 40% of patients with abdominal aortic aneurism (AAA) have concomitant iliac artery aneurysm, while isolated common or internal iliac artery aneurysm is a rare situation (Hobo et al. J Endovasc Ther 15:12–22, 2008). Open repair of aorto-iliac aneurysms remains technically challenging with an increased risk of ureteric or iliac vein injury because of the deep pelvic location (Melas et al. J Endovasc Ther 18:697–715, 2011). The first endovascular strategy proposed was the occlusion of the internal iliac artery (coverage or embolization) associated with a high incidence of complications: buttock or thigh claudication, ischemic colitis, erectile dysfunction, gluteal or perineal necrosis, or spinal cord injury (Bratby et al. Cardiovasc Intervent Radiol 31:246–53, 2008; Rayt et al. Cardiovasc Intervent Radiol 31:728–34, 2008; Geraghty et al. J Vasc Surg 40:413–8, 2004; Warein et al. Eur J Vasc Endovasc Surg 51:641–6, 2016). Preserving blood flow in the internal iliac artery appeared as a key point to improve patient care. Many endovascular techniques have been proposed. Iliac branch devices are considered as the best option for many surgeons.