case_images: PMC11763153_01
case_images: A) Preoperative CT-angiogram showing the anatomical features of the left common, internal and external iliac artery B) Technical drawing of the custom-made fenestrated leg extension.
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case_images: The anatomical measurements shown in Fig. 1A, ruled out the use of an off-the-shelf IBD. Inchinnan, UK) leg extension (Fig. 1B) due to the lack of an adequate proximal sealing zone in the internal iliac artery. Additionally, our aim was to avoid the need for endovascular aortic aneurysm repair (EVAR) as the abdominal aorta diameter was within normal limits. Informed consent for publication of this case was obtained.
case_images: A) Final intraoperative angiography showing an excluded internal iliac artery aneurysm with proximal cuff (red arrow) and Amplatzer plug (white arrow) B) 3-D cinematic rendering. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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case_images: To achieve a distal landing zone in the internal iliac artery, one internal artery side branch (superior gluteal artery) was occluded using a 14 mm Amplatzer plug (Abbott Laboratories, NY, USA) (Fig. 2A, white arrow) providing both proximal and distal sealing (inferior gluteal artery) with three Advanta V12 (Atrium Maquet, Getinge Group, Mijdrecht, the Netherlands) covered stents. (Fig. 2A) Intraoperative angiography revealed a low-flow type Ia endoleak, which was sealed using a 26x42mm proximal cuff (Cordis Medical GmbH). (Fig. 2A, red arrow). A follow-up angio-CT scan at 28 months showed patent stent grafts with no evidence of endoleak. (Fig. 2B).