Acute pelvic ischemia - a fatal outcome after endovascular aortoiliac aneurysm repair with iliac branch device

  • Rita Soares Ferreira Serviço de Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
  • Frederico Bastos Gonçalves Serviço de Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
  • João Albuquerque e Castro Serviço de Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
  • Edgar Berdeja Serviço de Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
  • Hugo Valentim Serviço de Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
  • Anita Quintas Serviço de Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
  • Rodolfo Abreu Serviço de Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
  • Hugo Rodrigues Serviço de Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
  • Nelson Oliveira Serviço de Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
  • Gonçalo Rodrigues Serviço de Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
  • Nelson Camacho Serviço de Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
  • Maria Emília Ferreira Serviço de Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
  • Luís Mota Capitão Serviço de Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal

Abstract

Introduction: The occlusion of internal iliac artery may be necessary in Endovascular Aortic Aneurysm Repair (EVAR). The intentional hypogastric occlusion may have several ischemic complications. The Iliac Branch Devices (IBD) are an alternative to hypogastric occlusion in patients at high risk to pelvic ischemia. The authors report a case of early IBD occlusion with serious clinical consequences. Case Report: A 74-year-old man presented a 55-mm abdominal aortic aneurysm with bilateral involvement of iliac bifurcation and proximal hypogastric arteries (maximum diameter of 31 and 32 mm). He underwent EVAR, left hypogastric revascularization by IBD and coiling + overstenting of contralateral hypogastric. There wasn´t intraoperative complications and final angiography showed hypogastric patency and poor pelvic collateral circulation. Postoperatively, the patient complained of bilateral lumbar and gluteal pain and presented with ischemic skin alterations and left lower limb monoparesis. As his clinical state deteriorates in the first 24 hours and computed tomography angiogram revealed left hypogastric stent occlusion, he underwent hypogastric revascularization again with good angiographic results. Despite successful revascularization, there was a progressive clinical deterioration with irreversible pelvic ischemia and rhabdomyolysis. Death on 5th postoperative day. Conclusion: The acute pelvic ischemia is a serious complication and often a fatal outcome, which may result of bilateral hypogastric artery occlusion. As IBD revascularization failure may be fatal, the authors advise an extra caution in final angiography and a high level of suspicion for postoperative complications. Bilateral hypogastric preservation using IBD may be recommended, if there is a higher risk of technical failure, embolization or poor pelvic collateral circulation.

Published
Dec 13, 2016
How to Cite
SOARES FERREIRA, Rita et al. Acute pelvic ischemia - a fatal outcome after endovascular aortoiliac aneurysm repair with iliac branch device. Angiologia e Cirurgia Vascular, [S.l.], v. 12, n. 3, p. 194-198, dec. 2016. ISSN 2183-0096. Available at: <http://acvjournal.com/index.php/acv/article/view/6>. Date accessed: 17 aug. 2017.
Section
Clinical Case