Introduction:

The development of aneurysms in iliac arteries excluded from high-pressure direct flow from the aorta is very uncommon. We report a case of successful treatment of bilateral metachronous iliac artery aneurysms (MIA), found 10 years after an aortobifemoral bypass, with perfusion only by retrograde flow from the common femoral arteries (CFA).

Case Report:

A 76-year-old man came for consultation after incidental finding of bilateral MIAs, 10-years after aortobifemoral bypass for treatment of an aortic abdominal aneurysm (AAA). Computed tomography angiography (CTA) showed a right internal iliac artery (IIA) aneurysm of 43-mm diameter and a left common iliac artery (CIA) aneurysm of 45-mm diameter that were not present 10-years before. Exclusion of the left CIA aneurysm was achieved with a left IIA to external iliac artery (EIA) endograft using two covered stents (“banana” technique). The right IIA aneurysm was excluded with embolization of the distal internal iliac branches and aneurysm sac with coils and occlusion of the proximal EIA with an occluder. There were no postoperative complications. A CTA two months after surgery showed total exclusion of the left CIA aneurysm and normal filling of the left IIA, as well as complete occlusion of the right IIA aneurysm.

Conclusion:

This case highlights that aneurysmal degeneration of iliac arteries can be generated by retrograde blood flow after treatment of AAAs with aortobifemoral grafts. An endovascular approach using the “banana” technique proved to be effective in treating MIAs while maintaining patency of one IIA.

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