U-turn Dryseal sheath technique for additional Gore Iliac Branch Endoprosthesis placement

There are various techniques for additional placement of Gore Excluder Iliac Branch Endoprosthesis (IBE; W. L. Gore & Associates, Flagstaff, AZ) for common iliac artery aneurysms following endovascular aneurysm repair (EVAR). However, these techniques do not always allow for the placement of approved, dedicated, self-expanding stent grafts (SESGs), such as internal iliac components, for internal iliac artery bridging. Here, we introduce the "U-turn Dryseal sheath technique," which can successfully place SESGs using only a unilateral femoral approach. We inserted a modified 16-Fr Gore Dryseal Flex Introducer sheath (Dryseal sheath) and placed an iliac branch component. Then, we inserted a 12-Fr Dryseal sheath (33 cm) into a 16-Fr sheath and created a U-turn shape of the 12-Fr sheath toward the internal iliac artery portion using an ipsilateral U-turn wire. Next, we placed the SESG through the 12-Fr sheath via the shortest route. We used this technique to perform IBE placement following EVAR in eight cases and successfully placed the SESGs in all cases without any type Ⅰ or Ⅲ endoleaks. The U-turn Dryseal sheath technique allows the stable additional placement of IBE with approved SESGs for internal iliac artery bridging in selected cases.