Up-and-Over Technique for Implantation of Iliac Branch Devices After Prior Aortic Endograft Repair

David L. Dawson, Giuliano de Almeida Sandri, Emanuel Tenorio, Gustavo S. Oderich

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Purpose: To describe a modified up-and-over access technique for treatment of iliac artery aneurysms in patients with prior bifurcated stent-grafts for endovascular aneurysm repair (EVAR). Technique: This technique uses a coaxial 12-F flexible sheath that is docked with a through-and-through wire into a 7-F sheath advanced from the contralateral femoral approach. This maneuver allows both sheaths to be moved as a unit while maintaining position of the apex of the system as it loops over the flow divider, avoiding damage to or displacing the extant endograft. Once the 12-F sheath is positioned in the iliac limb of the aortic stent-graft and secured in place with the through-and-through wire, the repair is extended into the internal iliac artery using a bridging stent-graft or covered stent introduced via a coaxial sheath. Conclusion: The up-and-over technique with a flexible 12-F sheath mated with a 7-F sheath from the opposite side allows bilateral femoral access to be used for iliac branch device placement after prior aortic endograft procedures that create a higher, acutely angled bifurcation. Use of a through-and-through wire and a coaxial sheath for stent delivery creates a very stable platform for intervention.

Original languageEnglish (US)
Pages (from-to)21-27
Number of pages7
JournalJournal of Endovascular Therapy
Issue number1
StatePublished - Feb 1 2018


  • abdominal aortic aneurysm
  • branched stent-graft
  • contralateral approach
  • covered stent
  • endovascular aneurysm repair
  • femoral access
  • iliac branch device
  • internal iliac artery
  • through-and-through wire

ASJC Scopus subject areas

  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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