Bitubular graft as an adjunct for laparoscopic hybrid repair of an abdominal aortic aneurysm

Laparoscopic repair (LR) of abdominal aortic aneurysms (AAAs) has been developed as a less invasive alternative to open repair. LR in the setting of diseased (ectatic, aneurysmal, calcified) aortic bifurcation or common iliac arteries (CIAs) is more challenging than LR of AAAs limited to the infrarenal aorta. In such cases, a bifurcated graft is necessary with an increased procedural time, more blood loss, and challenging distal anastomoses. We here present a new surgical technique using a custom-made bitubular graft (BTG), which allows LR of AAAs with diseased aortic bifurcation or CIAs while performing an aorto-aortic LR. During the same or a later intervention, covered stent grafts can be distally mated with the BTG using percutaneous femoral accesses to treat an extension of the disease to the aortic bifurcation and/or the CIAs. The BTG represents an interesting option for patients subjected to LR and presenting with an AAA associated with ectatic/aneurysmal proximal CIAs or heavily calcified aortic bifurcation.