Internal endoconduit: an innovative technique to address unfavorable iliac artery anatomy encountered during thoracic endovascular aortic repair.

Various strategies have been used to combat arterial access limitations encountered during thoracic endovascular aortic repair (TEVAR). Most require retroperitoneal dissection or aggressive angioplasty techniques that can lead to devastating complications. We describe a novel technique using an "internal endoconduit." Deployment of an iliac stent graft across the prohibitively stenotic area, followed by angioplasty and controlled rupture of the iliac artery, allows for safe passage of the delivery sheath. Adverse events associated with decreased pelvic perfusion or hemorrhage from iliac artery rupture are theoretically possible but have not been observed. Faced with unfavorable iliac anatomy, we use internal endoconduits rather than retroperitoneal access procedures and believe their use will increase the number of procedures that will be able to be performed through femoral access and substantially reduce the frequency of access-related complications.