Abstract
Isolated iliac artery aneurysms are rare, comprising only 7% of abdominal aortic aneurysms (AAAs). Open repair of isolated iliac aneurysms is technically challenging and associated with considerable morbidity and mortality, especially in the high risk patients. Recently, endovascular repair of isolated common iliac aneurysms has emerged as an alternative to open repair. We described a novel technique using back table manipulation of a commercially available stent graft to accommodate a challenging anatomical scenario. A 67-year-old male with a history of open low anterior resection for rectal cancer was referred to our hospital for the expanding right isolated common iliac aneurysm. The aneurysm was 37 mm in diameter adjacent to the internal iliac artery. The diameter of the proximal sealing zone was 17 mm, larger than that of the distal sealing zone, 14 mm. A reversed tapered device was needed. We described the off label use of the Gore Excluder contralateral leg endoprosthesis in a reversed configuration to accommodated this diameter mismatch. The procedure was minimally invasively completed without any complications and the aneurysm was totally excluded postoperatively without endoleaks and expansion.
