Alternative hybrid reconstruction for bilateral common and internal iliac artery aneurysms associated with external iliac artery occlusion

摘要

Purpose: To describe an alternative reconstruction for bilateral common (CIA) and internalud(IIA) iliac artery aneurysms associated with external iliac artery (EIA) occlusion in a patientudunfit for open surgery.udCase Report: A high-risk 81-year-old man presented with contained rupture of a left CIAudaneurysm in the presence of bilateral CIA and IIA aneurysms associated with completeudocclusion of the left EIA and normal patency of both common femoral arteries. In anudemergent procedure, the left EIA was recanalized subintimally, and the right IIA wasudembolized with a 14-mm Amplatzer Plug. The main body of a standard Excluder endograftudwas deployed just distal to the origin of the left renal artery, and the ipsilateral leg wasudextended into the proximal right EIA. On the contralateral side, a short 10-mm-diameterudlimb was inserted through a 12-F sheath and deployed in the CIA, proximal to the iliacudbifurcation. Via a percutaneous left brachial artery access, 3 covered stents (9359 mm,ud10359 mm, 10359 mm) were deployed from the distal IIA to the endograft contralateraludlimb. A right-to-left femorofemoral crossover bypass graft concluded the operation. Theudpatient was discharged on the 5th postoperative day without complications; follow-upudimaging at 6 months showed patency of the stent-graft and crossover bypass, withudcomplete exclusion of the aneurysms and no evidence of endoleak.udConclusion: This case demonstrates an effective solution for complex aortoiliac lesionsudusing commercially available devices, underlining how an accurate knowledge ofudalternative endovascular techniques and materials is crucial in the management ofudcomplex cases.