Hybrid approach to AAA: bilateral "banana" technique to preserve hypogastric artery in complex anatomy aorto-biiliac aneurysm.

The surgical approach for hypogastric preservation in aorto-iliac aneurysm (AAA) open repair (OR) has been described and performed with different techniques but all of them represent a higher mortality and potencial complications to the procedure; this is even more critical in bilateral disease. Since the introduction of the first endograft, a continuous development has occurred, such as the stent graft with specific branch designed for preserving antegrade flow in the hypogastric artery. On highly angulated and tortuous iliac anatomies, the use of Sandwich-Graft technique, as described by Armando Lobato, represents a valid alternative to iliac branch. The hybrid approach could be a good treatment option in young patients with AAA affecting hypogastric arteries.We present the technical description and a case report of bilateral "banana" technique perfor- med with flexible covered stent (Viabahn(®) WL Gore) to preserve both hypogastric arteries combined with open repair in a 52 years old patient. Technical report and Results: A bilateral retrograde endograft was implanted from both external ilac arteries to hypo- gastric artery excluding bilateral common iliac aneurysms followed by an open repair to the AAA (aneurismectomy + aorto bifemoral by-pass) with good inmediate and short-midterm follow up (12 months)This hybrid technique could be a good approach to hypogastric preservation in low risk and young patients reducing potencial complications of hypogastric artery oclusion.