Case Report A Steerable Sheath to Deploy Hypogastric Bridging Stent by Contralateral Femoral Approach in an Iliac Branch Procedure after Endovascular Aneurysm Repair Ciro Ferrer, 1 Luigi Venturini, 1 Raffaele Grande, 1 Katia Raccagni, 1 Luca Ginanni Corradini, 2 Mario Corona, 2 and Luca di Marzo, 1 Rome, Italy Aneurysmal degeneration of distal landing zones after endovascular aneurysm repair (EVAR) can be a potential cause of late failure of this technique. Aneurysmal degeneration of common iliac arteries increases the risk of rupture of the iliac aneurysm itself as well as of the abdominal aortic aneurysm owing to aneurysm’s reperfusion as a type Ib endoleak. Reoperation consists in plugging and covering the internal iliac artery (IIA), by extension into the external iliac artery, or preservation of antegrade flow in IIA by iliac branch devices (IBDs) or sandwich technique. The management of common iliac aneurysms after EVAR with the purpose of preserving antegrade flow into IIA generally requires a brachial or axillary access. However, this approach may be theoretically associated with local or systemic complications. We report a case of IBD implanta- tion after EVAR, using a steerable sheath for IIA bridging stent deployment via contralateral femoral approach. Aneurysmal degeneration of iliac landing zone rep- resents a potential cause of late failure after endo- vascular aneurysm repair (EVAR). 1 Reintervention consists in embolization and overstenting of internal iliac artery (IIA) or preservation of antegrade flow into the IIA by iliac branch devices (IBDs) or parallel stenting. The deployment of an IBD after EVAR generally requires an upper vascular access to deploy the bridging stent into the IIA. 2 This is why the traction exerted by a sheath, coming from the contralateral femoral access and held on a through-and-through guidewire, on the endograft bifurcation, may potentially cause aortic endograft dislocation. Brachial or axillary artery access may be potentially associated with local or systemic com- plications, and neurologic events even if relatively uncommon may complicate these procedures, espe- cially in case of thrombus aortic arch or shaggy aorta. 3,4 We report a case of IBD implantation for recur- rent common iliac aneurysm, using a steerable sheath for IIA bridging stent deployment via contra- lateral femoral approach, in the setting of a preexist- ing bifurcated aortic endograft. CASE REPORT A 78-year-old male was referred to our center for a 38-mm right common iliac aneurysm 5 years after implantation of Conflict of interest: The authors declare no conflicts of interest to disclose. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. 1 Department of Surgery ‘‘PietroValdoni’’, ‘‘Sapienza’’ University, Rome, Italy. 2 Department of Radiological Sciences, Sapienza University, Rome, Italy. Correspondence to: Raffaele Grande, MD, Department of Surgery ‘‘PietroValdoni’’, ‘‘Sapienza’’ University of Rome Policlinico Umberto I, Viale del Policlinico 151, 00161 Rome, Italy; E-mail: raffaele.eia@ alice.it Ann Vasc Surg 2017; -: 1–5 http://dx.doi.org/10.1016/j.avsg.2017.03.200 Ó 2017 Elsevier Inc. All rights reserved. Manuscript received: January 13, 2017; manuscript accepted: March 28, 2017; published online: --- 1