"Cracking and Paving": A Novel Technique to Deliver a Thoracic Endograft Despite Ilio-Femoral Occlusive Disease

Background: The use of endoluminal grafts to treat thoracic aortic aneurysms has been associated with a decreased morbidity and mortality compared with open thoracic aortic aneurysm repair. High‐risk surgical patients with ilio‐femoral occlusive disease may not be amenable to general anesthesia and the construction of a retroperitoneal conduit. Methods and Results: We report the use of a novel technique consisting of cracking and paving of the ilio‐femoral vessels with balloon angioplasty, followed by deployment of an endoconduit to deliver an endoluminal graft under local sedation to treat a high‐risk 80‐year‐old patient with a thoracic aneurysm. Conclusion: High‐risk surgical patients with iliofemoral disease can undergo endoluminal graft therapy to threat thoracic aortic aneurysms.