October 12, 2022American Journal of Case ReportsOpen Access

Minimally Invasive Two-Stage Procedure of Aorto-Bi-Iliac Stent-Graft Implantation Performed in a Patient with an Abdominal Aortic Aneurysm and Long-Segment Iliac Artery Occlusion: A Case Report

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Why the study?

Standard aorto-uni-iliac stent-graft implantation with femoro-femoral crossover bypass for abdominal aortic aneurysm and long-segment iliac artery occlusion is invasive and has patency issues.

Structured PICO

Population

A 76-year-old man with an abdominal aortic aneurysm and long-segment left iliac artery occlusion, frail constitution, and multiple comorbidities.

Intervention

Two-stage procedure of aorto-bi-iliac stent-graft implantation performed 2 days after iliac artery endovascular recanalization.

Outcome

Patency and endoleak assessed by computed tomography at 1-year follow-up.surrogate

A two-stage aorto-bi-iliac stent-graft implantation following endovascular recanalization is a feasible, minimally invasive approach for patients with abdominal aortic aneurysm and concurrent iliac artery occlusion.

Implication

May support feasibility in select complex AAA cases; hypothesis-generating and requires prospective validation before wider use.

Abstract

BACKGROUND Patients with an abdominal aortic aneurysm and long-segment iliac artery occlusion are usually treated with aorto-uni-iliac stent-graft implantation with femoro-femoral crossover bypass. However, it is more invasive than aorto-bi-iliac stent-graft implantation and poses patency issues. Herein, we describe a minimally invasive two-stage procedure of aorto-bi-iliac stent-graft implantation following iliac artery endovascular recanalization. CASE REPORT A 76-year-old man was diagnosed with an abdominal aortic aneurysm and long-segment left iliac artery occlusion. Abdominal aortic aneurysm was diagnosed during the examination of lower back pain. There were no other symptoms, including intermittent claudication. Factoring in his frail constitution and multiple comorbidities, we decided to perform aorto-bi-iliac stent-graft implantation after iliac artery endovascular recanalization to improve the patency of the left iliac artery. Aorto-bi-iliac stent-graft implantation was performed 2 days after iliac artery endovascular recanalization to avoid distal embolization. The postoperative course and 1-year follow-up were uneventful, with computed tomography revealing no endoleak and good patency. CONCLUSIONS The stent-graft implantation used in this patient is minimally invasive and results in good patency while reducing the risk of embolization. Furthermore, the long-term outcome of aorto-bi-iliac stent-graft implantation following iliac artery endovascular recanalization is more favorable than that involving treatment with aorto-uni-iliac stent-graft implantation with femoro-femoral crossover bypass.