Alternative Hybrid Reconstruction for Bilateral Common and Internal Iliac Artery Aneurysms Associated With External Iliac Artery Occlusion

Abstract

¤ ¤Purpose: To describe an alternative reconstruction for bilateral common (CIA) and internal (IIA) iliac artery aneurysms associated with external iliac artery (EIA) occlusion in a patient unfit for open surgery.Case Report: A high-risk 81-year-old man presented with contained rupture of a left CIA aneurysm in the presence of bilateral CIA and IIA aneurysms associated with complete occlusion of the left EIA and normal patency of both common femoral arteries. In an emergent procedure, the left EIA was recanalized subintimally, and the right IIA was embolized with a 14-mm Amplatzer Plug. The main body of a standard Excluder endograft was deployed just distal to the origin of the left renal artery, and the ipsilateral leg was extended into the proximal right EIA. On the contralateral side, a short 10-mm-diameter limb was inserted through a 12-F sheath and deployed in the CIA, proximal to the iliac bifurcation. Via a percutaneous left brachial artery access, 3 covered stents (9359 mm, 10359 mm, 10359 mm) were deployed from the distal IIA to the endograft contralateral limb. A right-to-left femorofemoral crossover bypass graft concluded the operation. The patient was discharged on the 5th postoperative day without complications; follow-up imaging at 6 months showed patency of the stent-graft and crossover bypass, with complete exclusion of the aneurysms and no evidence of endoleak. Conclusion: This case demonstrates an effective solution for complex aortoiliac lesions using commercially available devices, underlining how an accurate knowledge of alternative endovascular techniques and materials is crucial in the management of complex cases.

Hypogastric Artery Management During Open and Endovascular Aortoiliac Repair

“…In these subgroups of patients, antegrade flow in the HA should be preserved to avoid pelvic ischemia. This issue can be achieved with different techniques during open surgical repair (see description above) or hybrid procedures [39] (Fig. 8.5a).…”

Isolated Common Iliac Artery Aneurysms:A Revised Classification to Assist Endovascular Repair

“…Other interventionists also described the use of 3 telescopically-overlapping covered endoprostheses to bridge a bifurcated aortic endograft with an IIA. 106,107…”