@article{Coelho_Brandão_Gouveia_Martins_Augusto_Semião_Ribeiro_Peixoto_Fernandes_Canedo_2021, place={Matosinhos, Portugal}, title={BILATERAL ILIAC ANEURYSMS AND CONCOMITANT SEVERE MULTILEVEL OCCLUSIVE ARTERIAL DISEASE: STAGED HYBRID PROCEDURE AS SOLUTION TO A NIGHTMARE}, volume={17}, url={https://acvjournal.com/index.php/acv/article/view/362}, DOI={10.48750/acv.362}, abstractNote={<p><strong>Introduction</strong>: 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.</p> <p><strong>Clinical Case</strong>: 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.</p> <p><strong>Conclusion</strong>: 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.</p>}, number={2}, journal={Angiologia e Cirurgia Vascular}, author={Coelho, Nuno and Brandão, Daniel and Gouveia, Ricardo and Martins, Victor and Augusto, Rita and Semião, Carolina and Ribeiro, João and Peixoto, João and Fernandes, Luís and Canedo, Alexandra}, year={2021}, month={Sep.}, pages={135–138} }