The “buddy balloon technique” facilitates retrograde ipsilateral access to postdilate an iliac side branch after endovascular aneurysm repair

If unilateral common iliac aneurysms occur simultaneously with abdominal aortic aneurysm, endovascular treatment consists of implantation of a bifurcated stent graft with extension into the external iliac artery while the ipsilateral internal iliac artery is often occluded. The internal iliac artery may be preserved by an iliac branch device (IBD). In this technical note, we describe a technique to probe the side branch of an IBD for postdilation through an ipsilateral retrograde access using one balloon to block the way upstream while directing a second percutaneous transluminal angioplasty balloon into the side branch despite the hostile angle of side branch and IBD.