Delivery of endovascular grafts by direct sheath placement into the aorta or iliac arteries

Delivery of endovascular grafts via femoral access in patients with iliac arterial tortuosity or occlusive disease can be problematic. Aortomonoiliac grafts or arterial conduits sewn to proximal iliac arteries through an abdominal incision have been used as alternatives. A technique is described in which the proximal access vessel, aorta or iliac artery, is punctured directly and a large sheath inserted, through which the endovascular graft may be delivered. Hemostasis is achieved by use of a superficially placed concentric double purse-string suture. The technique has been employed successfully for placement of both thoracic and abdominal endografts.