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

  • 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
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.

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References

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Published
2021-09-10
Section
Clinical Case