Fenestrated/Branched Endovascular Aortic Repair Using Unilateral Femoral Access in Patients With Unilateral Iliac Occlusive Disease

Fenestrated/branched endovascular aortic repair (FB-EVAR) in patients with occluded iliac arteries is challenging owing to the limited access for branch vessel catheterization. We analyzed technical strategies and outcomes of FB-EVAR arteries. performed a retrospective review all consecutive treated by two institutions (2003-2020). Patients were included analysis. All had one patent artery, which was used advancement fenestrated-branch component. A distal seal achieved an aorto-uni-iliac (AUI) converter or placement stent-graft into infrarenal segment. Preloaded catheter guidewire systems as adjuncts facilitate The primary endpoints success, mortality, major adverse events (including stroke, spinal cord injury, dialysis, bowel ischemia, myocardial infarction, respiratory failure), patency, freedom from reintervention. total 959 undergone FB-EVAR. Of patients, 12 (1.25%; mean age, 74 years; 75% male) iliofemoral artery. 7 thoracoabdominal aneurysm 5 juxtarenal aneurysm. Brachial (100%) preloaded 6 (50%). remaining 50% staggered deployment stent-grafts sequential In addition, seven physician-modified grafts five company-manufactured devices used. 10 (83%), using AUI converters 2 (16%), aorta. Concomitant femoral crossover bypass (FCB) prior FCB. Technical success 100% without type I III endoleaks. No intraoperative complications early lower extremity ischemic occurred, FCBs preserved. One patient (8%) died within 30 days retrograde dissection. Major occurred 17% patients. median follow-up 26.5 months (range, 2-85 months). required reintervention Ib endoleak that successfully extension at 21 thrombolysis 50 months. At last follow-up, except 1, grafts, including new claudication chronic limb ischemia. experienced single renal artery stent occlusion no overall survival 58%, aortic-related deaths. Although challenging, unilateral femoral/brachial approach feasible limbs arteries, few satisfactory long-term outcomes.