case_images: PMC11729647_01
case_images: Preoperative computed tomography angiography (CTA) three-dimensional reconstruction shows the aortic saccular aneurysm (A). The right common iliac artery presented some anatomical features that could expose to patient to higher risk of type IB endoleak: its maximum diameter was 24 mm with a conical shape. It also presented a narrowing to 11 mm just before the hypogastric artery origin (B).
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case_images: PMC11729647_01_gr1.jpg
case_images: fig1
case_images: Heli-FX endoanchor system with the Heli-FX steerable guide sheath was used to secure the distal segment of the right iliac limb. It is crucial to assess the optimal orientation of the delivery system to obtain equal distance between endoanchors. The four endoanchors have been delivered, placing the steerable guidesheat orthogonally to angiographic view: two of them have been released in 45  left anterior oblique view (A), and the others in 45  right anterior oblique view (B).
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case_images: PMC11729647_01_gr2.jpg
case_images: fig2
case_images: Six endoanchors (Heli-FX EndoAnchor, Medtronic) using the Heli-FX Guide and Heli-FX endoanchor system were deployed at the EVAR proximal sealing zone, whereas four were deployed at the right iliac limb distal sealing zone to provide additional fixation (Fig 2).
case_images: A, Cone beam computed tomography (CT) with CO2 performed at the end of the procedure shows the correct placement of the endoanchors. (B) Six months follow-up angio-CT scan confirms the correct placement with no evidence of migration and no signs of endoleak.
case_images: gr3.jpg
case_images: PMC11729647_01_gr3.jpg
case_images: fig3
case_images: A final cone-beam CT with CO2 was performed, showing the correct placement of the endoprosthesis and the endoanchors (Fig 3, A). The endoanchors were well-positioned (Fig 3, B), and there were no signs of iliac limb migration (Supplementary Video 2, online only).