^ TECHNICAL NOTE —————————————————————————————— ^ Crossover Chimney Technique to Preserve the Internal Iliac Artery in Abdominal Aortic Aneurysm With Common Iliac Artery Aneurysms I-Hui Wu, MD; Chih-Yang Chan, MD, PhD; Yih-Sharng Chen, MD, PhD; Shu- Chien Huang, MD, PhD; Shoei-Shen Wang, MD, PhD; and Nai-Hsin Chi, MD Department of Surgery, Cardiovascular Division, National Taiwan University Hospital, Taipei, Taiwan. ^ ^ Purpose: To report a new technique to preserve the internal iliac artery (IIA) in cases of aortoiliac aneurysms. Technique: Under bilateral common femoral artery (CFA) exposure, a crossover sheath was inserted from the contralateral CFA to the ipsilateral IIA involved in the common iliac artery (CIA) aneurysm. A Viabahn stent-graft was positioned 2 cm inside the IIA. The main body abdominal stent-graft was inserted through the ipsilateral CFA with distal sealing in the external iliac artery (EIA). The gate was cannulated, and the limb extension was positioned in the contralateral CIA near the IIA orifice. After the first Viabahn deployment, a second device was deployed with a minimum 1-cm overlap inside the first Viabahn and 2 mm distal to the limb extension. For bilateral CIA aneurysms, the Viabahn and extension limb were landed in the EIA with IIA embolization. In the past year, this technique has been used in 5 patients with success. There was no acute branch occlusion or type I endoleak from the IIA or chimney graft gutters on imaging studies up to 6 months. Conclusion: This technique is easy to use and avoids the brachial access of the sandwich technique and the additional cost of an iliac branch device. J Endovasc Ther. 2013;20:298–302 Key words: abdominal aortic aneurysm, common iliac artery aneurysm, hypogastric artery, internal iliac artery, chimney graft, stent-graft ^ ^ Abdominal aortic aneurysm (AAA) accompa- nied by common iliac artery (CIA) aneurysms requires a more demanding procedure owing to the difficulties in preserving one or both See commentary page 303 internal iliac arteries (IIA). Intentional bilateral IIA coverage during endovascular aneurysm repair (EVAR) can carry a non-negligible rate of buttock claudication, ischemic colitis, and erectile dysfunction. 1,2 Open and/or endovas- cular techniques have been developed to preserve at least one IIA. 3–5 In open grafting, the extra-anatomical bypass graft with con- tralateral coil embolization and additional retroperitoneal incisions reduce the patency rate and increase the length of hospitalization and perioperative morbidty. 5 Endovascular iliac branch grafts, 6 sandwich grafts, 7,8 and bell-bottom limbs 9 have also been proposed for IIA preservation. However, the drawbacks of these techniques include the use of addi- tional brachial access in the classic sandwich The authors declare no association with any individual, company, or organization having a vested interest in the subject matter/products mentioned in this article. Corresponding author: Nai-Hsin Chi, MD, Department of Surgery, Cardiovascular Section, National Taiwan University Hospital, No 7, Chung-Shan S. Road, Taipei, Taiwan. E-mail: chinaihsin@gmail.com 298 J ENDOVASC THER 2013;20:298–302 Q 2013 by the INTERNATIONAL SOCIETY OF ENDOVASCULAR SPECIALISTS Available at www.jevt.org