Urgent Use of Gore Excluder Iliac Branch Endoprosthesis with Left Transaxillary Approach for Preservation of the Residual Hypogastric Artery: A Case Series

Background: Preservation of the residual hypogastric artery (HGA) in patients with previous endovascular aortic aneurysm repair (EVAR) may require complex operative strategies. We report an alternative technique to preserve the residual HGA with the Gore Excluder Iliac Branch endoprosthesis (IBE) in urgent situations. Methods: We report the case of 2 high-risk patients (unfit for open surgery), with previous EVAR and exclusion of 1 HGA, treated in emergency setting. Both patients met the anatomical requirements for Gore IBE use. Due to lack of the native aortic bifurcation, we used a transaxillary approach to deploy a covered stent (Gore Viabahn) in the target HGA. Results: Technical success was 100%. Computed tomography angiography at 30 days, 6 months, and 1 year showed regular placement of all endografts and patency of all residual HGAs without evidence of any endograft-related complication (i.e., stent fracture, stent thrombosis or stent displacement). There was not any detectable type 1, 2, or 3 endoleak at longest follow-up. Conclusions: Our case series shows the technical feasibility and the good results of this approach, which may prove useful when the native aortoiliac carrefour is no longer available. The procedure seems to be safe and effective, with optimal primary patency of the stent grafts, freedom from type 1, 2, and 3 endoleaks, and absence of pelvic ischemic complications.