How to do it: a modified transabdominal wall approach for direct external iliac artery access during endovascular thoracic aneurysm repair.

We describe the combined application of a transabdominal wall sheath tunnel, 'pre-close' purse-string sutures and manual external support of the iliac artery to facilitate introduction of an 18F sheath for endovascular exclusion of a 6-cm thoracic aortic aneurysm.