Bifurcated In-Stent in Situ Technique for Creation of a Bifurcated Bridging Stent-Graft System to 2 Target Vessels Using a Single Directional Branch: A Report of 2 Cases

The BIS2T is a feasible option to incorporate 2 target vessels via a single directional branch.Clinical ImpactTarget vessel anatomy is a frequent limitation for successful endovascular incorporation using fenestrations or directional branches during complex endovascular aortic aneurysm repair. Numerous anatomical variations such as aberrant or accessory vessels, common celio-mesenteric trunks, or extension of the aneurysm/dissection into a target vessel may preclude successful incorporation using standard endovascular techniques. This technical note describes a novel bifurcated in-stent in situ technique (BIS2T) for the creation of a bifurcated bridging stent-graft system to target 2 vessels using a single directional branch. This approach may enable target vessel incorporation in challenging anatomical situations that might otherwise preclude endovascular treatment or require intentional artery coverage.