Bilateral internal iliac preservation using a short-tip distal branched custom-made device during fenestrated or branched aortic repair.

Short common iliac artery anatomy may preclude iliac branch device use during fenestrated or branched aortic repair. We describe two patients treated with a low-profile, short-tip distal branched custom-made device based on an aortouni-iliac configuration and combined with fenestrated or branched repair. The device incorporated iliac side branches to preserve bilateral internal iliac artery perfusion. In aneurysmal anatomy, complete release caused loss of ipsilateral branch access, requiring through-and-through control and balloon-assisted luminal modulation. In chronic dissection, staggered release preserved a working lumen but required adjunctive balloon dilatation. Device configuration, orientation, luminal constraint, and release sequence were critical to technical success.