Objective: The aim of our study is to describe an original technique of distal anastomosis of a bifurcated graft, coining looped reconstruction, and our preliminary clinical experience.

Methods: This technique has been applied in 16 of 24 distal anastomoses of 12 patients with abdominal aortic aneurysm (AAA) and/or iliac artery aneurysm. Both the internal (IIA) and external iliac arteries (EIA) are transected and anastomosed with end-to-end fashion to reconstruct their continuity, and the limb of a bifurcated graft is anastomosed to the EIA with end-to-side fashion.

Results: Operative and in-hospital death, ischemic colitis, or ischemia of the lower extremities including blue toe syndrome has never occurred. All the 28 reconstructed IIAs and EIAs have been patent in 11 patients who could undergo early postoperative computed tomography scans with contrast medium.

Conclusions: The looped reconstruction of the IIA and the EIA in repair of an AAA and/or an iliac artery aneurysm with a bifurcated graft is an anatomically easy and technically simple method.