Three-vessel fenestrated and bilateral iliac branched graft repair of a juxtarenal aortic aneurysm with bilateral common iliac aneurysms

We describe a patient with large bilateral common iliac artery aneurysms as well as a large juxtarenal abdominal aortic aneurysm successfully treated by a novel approach. The procedure, completed in one setting, involved this sequence: positioning and deployment of bilateral iliac branch grafts with appropriate internal iliac limbs; insertion of a three-vessel fenestrated proximal device with cannulation and stenting of the left renal artery; and positioning and deployment of a bifurcated endograft and two mating limbs to the bilateral iliac branch device. The procedure was completed with percutaneous access; the patient recovered well and was discharged on postoperative day 1.