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Angiologia e Cirurgia Vascular
versión impresa ISSN 1646-706X
Resumen
COELHO, Nuno et al. Bilateral iliac aneurysms and concomitant severe multilevel occlusive arterial disease: staged hybrid procedure as solution to a nightmare. Angiol Cir Vasc [online]. 2021, vol.17, n.2, pp.135-138. Epub 30-Jun-2021. ISSN 1646-706X.
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.
Palabras clave : Common iliac aneurysms; Severe ilio-femoral occlusive disease; Critical limb threatening ischemia; Endovascular aneurysm repair; Hybrid intervention.