BILATERAL ILIAC ANEURYSMS AND CONCOMITANT SEVERE MULTILEVEL OCCLUSIVE ARTERIAL DISEASE: STAGED HYBRID PROCEDURE AS SOLUTION TO A NIGHTMARE

Authors

  • Nuno Coelho Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Vila Nova de Gaia / Espinho, Vila Nova de Gaia, Portugal
  • Daniel Brandão Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Vila Nova de Gaia / Espinho, Vila Nova de Gaia, Portugal
  • Ricardo Gouveia Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Vila Nova de Gaia / Espinho, Vila Nova de Gaia, Portugal
  • Victor Martins Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Vila Nova de Gaia / Espinho, Vila Nova de Gaia, Portugal
  • Rita Augusto Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Vila Nova de Gaia / Espinho, Vila Nova de Gaia, Portugal
  • Carolina Semião Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Vila Nova de Gaia / Espinho, Vila Nova de Gaia, Portugal
  • João Ribeiro Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Vila Nova de Gaia / Espinho, Vila Nova de Gaia, Portugal
  • João Peixoto Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Vila Nova de Gaia / Espinho, Vila Nova de Gaia, Portugal
  • Luís Fernandes Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Vila Nova de Gaia / Espinho, Vila Nova de Gaia, Portugal
  • Alexandra Canedo Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Vila Nova de Gaia / Espinho, Vila Nova de Gaia, Portugal

DOI:

https://doi.org/10.48750/acv.362

Keywords:

common iliac aneurysms, severe ilio-femoral occlusive disease, critical limb threatening ischemia, endovascular aneurysm repair, hybrid intervention

Abstract

Introduction: Severe ilio-femoral occlusive disease can limit the endovascular treatment of aorto-iliac aneurysms. In high surgical risk patients, inventive and staged hybrid interventions can be the answer to achieve definitive treatment.

Clinical Case: A 68-year-old male, with multiple comorbidities, presented with simultaneous occurrence of bilateral common iliac aneurysms and severe ilio-femoral occlusive disease associated with right critical limb-threatening ischemia. In order to exclude the iliac aneurysms, preserve pelvic flow and revascularize the threatened limb we decided for a three-staged hybrid intervention. First, we began with a right external iliac angioplasty with femoral endarterectomy to create adequate arterial access. In a second intervention, we implanted a bifurcated aortoiliac endograft through this access. In order to prevent pelvic ischemia, contralateral leg outflow was directed to the left internal iliac artery with a combination of self-expandable and balloon-expandable covered stents. Finally, a right femoro-posterior tibial artery bypass completed the revascularization. At 1,5-year follow-up, no complications are reported and the patient is asymptomatic.

Conclusion: In patients with poor medical condition and complex aorto-iliac aneurysmal and occlusive disease, a staged hybrid approach like the one described in this case-report can be feasible and associated with durable midterm patency and excellent clinical outcome.

Downloads

Download data is not yet available.

References

1. Mills JL, Conte MS, Armstrong DG, Pomposelli FB, Schanzer A, Sidawy AN, et al. The society for vascular surgery lower extremity threatened limb classification system: Risk stratification based on Wound, Ischemia, and foot Infection (WIfI). J Vasc Surg. 2014;59(1):220-234.e2. Available from: http://dx.doi.org/10.1016/j.jvs.2013.08.003

2. Uchiyamada JS, Ichihashi S, Iwakoshi S, Itoh H, Tabayashi N, Kichikawa K. Technical tips and procedural steps in endovascular aortic aneurysm repair with concomitant recanalization of iliac artery occlusions. Springerplus. 2013;2(1):1–5.

3. Zeng Q, Huang L, Huang X, Peng M. Endovascular repair of abdominal aortic aneurysm with severely angulated neck and tortuous artery access: Case report and literature review. BMC Surg. 2015;15(1):1–5.

4. Takeuchi Y, Morikage N, Mizoguchi T, Nagase T, Samura M, Ueda K, et al. Using bifurcated endoprosthesis after iliac artery recanalization for concomitant abdominal aortic aneurysm and chronic total occlusions of access routes. J Vasc Surg. 2019;70(1):117–22. Available from: https://doi.org/10.1016/j.jvs.2018.08.191

5. Vallabhaneni R, Sorial EE, Jordan WD, Minion DJ, Farber MA. Iliac artery recanalization of chronic occlusions to facilitate endovascular aneurysm repair. J Vasc Surg. 2012;56(6):1549–54. Available from: http://dx.doi.org/10.1016/j.jvs.2012.05.089

6. Franz RW, Ibrahim MT, Tanga CF, Epstein DA. Endovascular Treatment of Abdominal Aortic Aneurysm with Complete Iliac Occlusion: Case Series and Literature Review. Int J Angiol. 2017;26(4):259–63.

7. Coelho A, Nogueira C, Lobo M, Gouveia R, Campos J, Augusto R, et al. Impact of Post-EVAR Graft Limb Kinking in EVAR Limb Occlusion: Aetiology, Early Diagnosis, and Management. Eur J Vasc Endovasc Surg. 2019;58(5):681–9. Available from: https://doi.org/10.1016/j.ejvs.2019.03.019

8. Bos WT, Tielliu IF, Van Den Dungen JJ, Zeebregts CJ, Sondakh AO, Prins TR, et al. Results of endovascular abdominal aortic aneurysm repair with selective use of the Gore Excluder. J Cardiovasc Surg (Torino) 2009; 50:159e64.

Downloads

Published

2021-09-10

How to Cite

1.
Coelho N, Brandão D, Gouveia R, Martins V, Augusto R, Semião C, Ribeiro J, Peixoto J, Fernandes L, Canedo A. BILATERAL ILIAC ANEURYSMS AND CONCOMITANT SEVERE MULTILEVEL OCCLUSIVE ARTERIAL DISEASE: STAGED HYBRID PROCEDURE AS SOLUTION TO A NIGHTMARE. Angiol Cir Vasc [Internet]. 2021 Sep. 10 [cited 2024 Nov. 4];17(2):135-8. Available from: https://acvjournal.com/index.php/acv/article/view/362

Issue

Section

Clinical Case