The BeGraft Balloon Expandable Covered Stent as a Proximal Extension to an Iliac Branch Device for Endovascular Repair of Isolated Common Iliac Artery Aneurysms

INTRODUCTION: Isolated common iliac artery aneurysms (CIAA) are rare and can be treated by endovascular exclusion using iliac branch devices (IBD). The use of a balloon expandable covered stent as a proximal extension to an IBD to allow adequate sealing in the proximal common iliac artery (CIA) for exclusion of isolated CIAA is demonstrated. REPORT: Two patients with isolated CIAA of ≥4.5 cm with a proximal neck length of ≥20 mm (patient A: 26 mm; patient B: 24 mm) and a neck diameter of ≤20 mm (patient A: 16.4 mm; patient B: 15.6 mm) were treated by combining a Zenith IBD with an aortic BeGraft balloon expandable covered stent. After deploying the BeGraft covered stent at 12 mm a second balloon was used to further dilate the proximal part of the stent outside the IBD to allow adequate sealing in the CIA. Completion angiography and follow up computed tomography angiography 1 month post-operatively showed adequate sealing and no endoleaks. DISCUSSION: The feasibility of the application of a balloon expandable covered stent as a proximal extension to an IBD for isolated CIAA was demonstrated. It is not necessary to insert an aortic bifurcation endograft, thus reducing procedure time, radiation exposure, contrast use, and cost. A patent inferior mesenteric artery and lumbar arteries can be spared and procedures that require crossing over the aortic bifurcation remain possible. Comorbidity, prior interventions, and disease extension can make this endovascular approach preferred over open repair. Isolated CIAA can be efficiently treated combining the BeGraft balloon expandable covered stent and IBD, which allows proximal sealing in the CIA.