Access challenge in patient with ruptured infrarenal abdominal aneurysm treated with modified contralateral iliac limb technique

Access is an imperative component of endovascular aneurysm repair. The common femoral artery is the most common access site, and the artery is traditionally exposed via open cutdown or, more commonly, via percutaneous access. Access consideration is not limited to femoral arteries only but also includes both the external and the common iliac arteries. We report the case of a 72-year-old female patient who presented with a contained ruptured abdominal aortic aneurysm with small-diameter left common femoral (4 mm) and external iliac (3 mm) arteries. We used an innovative technique without the need for cutdown or the use of an iliac conduit. Balloon expandable covered stents were used that were compatible (in size) to an 8F sheath. The stents were postdilated to a larger diameter to achieve the appropriate seal at the flow divider. Endovascular exclusion of the aneurysm was achieved, and the patient was discharged home on postoperative day 2. At the 6-week office follow-up visit, the abdominal examination findings were benign, and she had positive signals in both feet. Aortic duplex ultrasound showed patent stents and no endoleak.