Common iliac artery access during endovascular thoracic aortic repair facilitated by a transabdominal wall tunnel

Purpose: To describe a technique for common iliac artery (CIA) access durin g endovascular aortic aneurysm repair when unfavorable angulation between t he CIA and the delivery sheath precludes direct arterial access. Technique: After retroperitoneal exposure of the CIA, a puncture site is ch osen inferolateral to the surgical incision, and an 18-G trocar/cannula is advanced in alignment with the CIA through the anterior abdominal wall or s kin of the upper thigh into the retroperitoneal space. Serial dilatation is performed over a guidewire placed through the cannula to create the subcut aneous tract. The trocar/cannula is replaced over the wire, and the CIA is punctured under direct vision. The guidewire is then advanced into the prox imal aorta. A CIA arteriotomy is performed and the delivery system introduc ed over the guidewire through the tunnel into the iliac artery. Conclusions: Retroperitoneal exposure of the CIA with tunneled transabdomin al wall delivery of the stent-graft avoids both external iliac artery injur y and creation of a temporary access conduit in patients with iliac tortuos ity and/or occlusive disease.