CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2018; 02(03): S2
DOI: 10.1055/s-0041-1730649

Sandwich Technique for Complex Aortoiliac Aortic Aneurysms

Samer Koussayer
King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
› Author Affiliations

Background: Common iliac artery (CIA) aneurysm is commonly associated with abdominal aortic aneurysm in about 40% of patients. It is preferable to preserve the internal iliac artery (IIA) whenever feasible. Intentional occlusion of an IIA during endovascular aortic repair (EVAR) results in new-onset buttock claudication and erectile dysfunction in ~28% and 17% of patients, respectively, and bilateral internal iliac occlusion is associated with increased risk of pelvic ischemic complications. Buttock claudication symptoms may improve over time but persist in more than half of affected patients 1 year after EVAR and can have a significant negative effect on patient quality of life. Fortunately, the more serious and potentially life-threatening complications of colon ischemia, pelvic necrosis, and spinal cord injury are less common, affecting ~1% of patients. Methods: There are many endovascular techniques to preserve the IIA. The most common one is using iliac branch endoprosthesis. However, in emergency situation, sandwich technique using parallel graft can be done easily. Unfortunately, no sizing formula has been used to determine the size of the parallel graft. Using mathematically calculation, we came up with specific formula to help in the sizing of the chimneys and decrease Type III endoleak. Results: Area of CIA graft = Area of EIA + Area of IIA (πcc = π EE + π II ) = (CC = EE + II) (Radius of CIA: C radius of EIA: E radius of IIA: I). Also we have to add 4 mm the fabric thickness E = 10/2 = 5 mm I = 8/2 = 4 mm. So, CC = 25 + 16 = 41 C = 6.4 mm. CIA graft has to be 6.4x2 + 4= 16.8 mm CIA graft has to be 6.4 × 2 + 4 = 16.8 mm Conclusion: We feel this formula for sizing the chimneys for iliac aneurysms will decrease the Type 1b endoleak.

Publication History

Article published online:
11 May 2021

© 2018. The Arab Journal of Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India