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REVISTA PORTUGUESA DE CIRURGIA CARDIO-TOR áCICA E VASCULARFigure 2Compliant balloon technique to achive hypogastric arterystable cannulation.Figure 4External-to-internal endografts (bilateral bananatechnique); tortuosity and Viabahn ® conformability.Step 4: remodeling with standard compliant balloon(Reliant ® , Medtronic) and angiogram to confirm patency ofthe graft and absence of retrograde flow to the commoniliac. A PTA balloon could be neccessary if hypogastric orexternal iliac artery is calcified. (Fig.3)technique, avoiding complications. This meant a fast andsafe OR procedure in this complex anatomy AAA.ResultsFigure 3Intraoperative angiogram: right and left banana control.The procedure was performed under general anesthesiawithout intraoperative complications. Blood loss wasless than 150cc and operative time was about 2.5 hours (35minutes of infrarenal aortic clamping). Fluoroscopy time was29 min for both hypogastric preservation. Due to differences inexternal and hypogastric diameter 3 viabahn were implantedoverlapped to preserve right hypogastric artery (8x50 + 9x50 +10x50) and the same technique was neccessary to preserve lefthypogastric artery where 4 overlapped Viabahn were implanted.55 cc of contrast media were injected. The complete procedurewas performed under intravenous heparinization (7500 iusodium heparine). Transperitoneal mini-laparotomy approachwas selected to perform the OR part of this hybrid procedure.Early resultsTechnical consideration: In our experience there isno other covered stent but Viabahn ® suitable to adapt theangulation and tortuosity of this anatomy. (Figure 4)OR sequenceAfter infrarenal clamp positioning, standard aorto--bifemoral procedure is performed. With the successful viabahnexclusion of both common iliacs there is no back-flowfrom common iliacs to the aorta (endoclamp) so there isno need to perform a common iliac dissection in the ORPatient was discharged from ICU the day after implantation(16 hours after procedure) and from the hospital after72 hours of ICU discharge without clinical complications.No postoperative angioCT was performed becauseno endoleak was found in the intraoperative control. Thispatient was included in a modified FU protocol after AAAsurgery (3 month, 12 months, 5 years, 10 years).Short-midterm results (3 months)After 3 months FU no clinical complications or secondaryadverse events were recorded. No secondary procedureswere performed. (Fig.5)228 Volume XVIII - N.º 4