A modified technique for iliac artery branched endografting using a “tromboned” sheath

The iliac branched device (IBD) is the only totally endovascular option to preserve flow to the internal iliac artery for the treatment of aorto-iliac or solitary iliac artery aneurysms. This technique involves the use of two parallel guide wires, including the indwelling through-and-through wire and a wire to introduce the bridging stent-graft. We describe a technique which uses “tromboned” sheaths (ie, a 7F ANL 1 inside a 10F Balkin sheath) for increased cross-over stability and avoids problems associated with the use of parallel wires inside one sheath. In addition, reduction of the gap between the IBD and the origin of the internal iliac artery may result in a more stable position of the device.