The modified balloon-anchored technique for iliac branch device deployment via ipsilateral femoral access.

BACKGROUND: For iliac branch device (IBD) procedures, contralateral femoral access is generally regarded as the standard route, whereas upper-extremity access is usually reserved for selected anatomically challenging cases. However, both approaches may be difficult or undesirable in patients with a short common iliac artery (CIA), an unfavourable aortic bifurcation, prior endograft reconstruction, or access-related concerns. This study aimed to describe a modified balloon-anchored technique for IBD deployment via ipsilateral femoral access and to evaluate its technical feasibility and early outcomes.

METHODS: This retrospective, two-centre study included consecutive patients who underwent IBD deployment via ipsilateral femoral access between May 2023 and February 2024. Eligibility was limited to patients in whom contralateral femoral access was considered unsuitable because of predefined hostile anatomical or procedural features, including CIA length < 50 mm, an unfavourable aortic bifurcation or iliac tortuosity that limited coaxial sheath advancement, prior EVAR or aorto-iliac stent-graft configuration, or relevant access limitations. Computed tomography angiography (CTA) from the aortic arch to the femoral arteries was reviewed, and the modified balloon-anchored technique was applied according to a standardised algorithm. Technical success was defined as successful IBD deployment with preserved IIA branch patency and no type I or III endoleak on final angiography and CTA within 30 days.

RESULTS: Twenty-three patients (91.3% male; median age, 75 years) were included. Indications were aorto-iliac aneurysm with reduced CIA working length (n = 13, 56.5%) and type Ib endoleak after previous aortic stent-graft placement (n = 10, 43.5%). Technical success was achieved in all cases (100%). Over a median follow-up of 16 months (interquartile range [IQR], 14-18 months), the 1-year patency rates for the IBD main body and bridging stent were 100% and 95.7%, respectively. No aortic- or IBD-related re-interventions were required. Two complications occurred (8.7%): one asymptomatic bridging-stent occlusion and one conservatively managed type II endoleak. No major adverse events or clinically evident pelvic ischaemic complications were observed.

CONCLUSION: The ipsilateral balloon-anchored technique appears feasible for IBD deployment and was associated with encouraging early outcomes in selected patients unsuitable for conventional access strategies.