<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1646-706X</journal-id>
<journal-title><![CDATA[Angiologia e Cirurgia Vascular]]></journal-title>
<abbrev-journal-title><![CDATA[Angiol Cir Vasc]]></abbrev-journal-title>
<issn>1646-706X</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Angiologia e Cirurgia Vascular]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1646-706X2021000200135</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Bilateral iliac aneurysms and concomitant severe multilevel occlusive arterial disease: staged hybrid procedure as solution to a nightmare]]></article-title>
<article-title xml:lang="pt"><![CDATA[Doença aneurismática e oclusiva multissectorial: abordagem híbrida estadiada como solução para um pesadelo]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Coelho]]></surname>
<given-names><![CDATA[Nuno]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Brandão]]></surname>
<given-names><![CDATA[Daniel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gouveia]]></surname>
<given-names><![CDATA[Ricardo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Martins]]></surname>
<given-names><![CDATA[Victor]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Augusto]]></surname>
<given-names><![CDATA[Rita]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Semião]]></surname>
<given-names><![CDATA[Carolina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ribeiro]]></surname>
<given-names><![CDATA[João]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Peixoto]]></surname>
<given-names><![CDATA[João]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Fernandes]]></surname>
<given-names><![CDATA[Luís]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Canedo]]></surname>
<given-names><![CDATA[Alexandra]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Centro Hospitalar Vila Nova de Gaia / Espinho Serviço de Angiologia e Cirurgia Vascular ]]></institution>
<addr-line><![CDATA[Vila Nova de Gaia ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>30</day>
<month>06</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>30</day>
<month>06</month>
<year>2021</year>
</pub-date>
<volume>17</volume>
<numero>2</numero>
<fpage>135</fpage>
<lpage>138</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S1646-706X2021000200135&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S1646-706X2021000200135&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S1646-706X2021000200135&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[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.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo  Introdução:  A doença oclusiva íliofemoral TASC C e D pode limitar o tratamento endovascular de aneurismas aortoilíacos. Em doentes de alto risco cirúrgico, intervenções híbridas sequenciais e inventivas podem ser a resposta para alcançar o tratamento definitivo.  Caso clínico:  Um doente do sexo masculino de 68 anos, com múltiplas comorbidades, apresentou-se na consulta externa com ocorrência simultânea de aneurismas ilíacos comuns bilaterais e doença oclusiva ílio-femoral grave associada a isquemia crítica do membro inferior direito. Tendo em vista a exclusão dos aneurismas ilíacos, a preservação do fluxo pélvico e revascularização do membro ameaçado, optamos por uma intervenção híbrida em três estádios. Primeiro, começamos com uma angioplastia ilíaca externa direita associada endarterectomia femoral ipsilateral tendo em vista a criação de um acesso arterial adequado. Numa segunda intervenção, implantamos uma endoprótese aortoilíaca bifurcada por este acesso. Para prevenir a isquemia pélvica, o fluxo do ramo contralateral foi direcionado para a artéria ilíaca interna esquerda com uma combinação de stents revestidos autoexpansíveis e expansíveis por balão. Finalmente, com um bypass femoro-tibial posterior completámos a revascularização do membro. Aos 1,5 anos de seguimento, não verificamos nenhuma complicação e o doente permanece assintomático.  Conclusão:  Em doente com condições médicas desfavoráveis e aneurismas aortoilíacos associados a doença oclusiva aorto-ilíaca complexa uma abordagem híbrida estadiada como a descrita pode ser uma alternativa viável, com boa durabilidade e associada excelentes resultados clínicos.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Common iliac aneurysms]]></kwd>
<kwd lng="en"><![CDATA[Severe ilio-femoral occlusive disease]]></kwd>
<kwd lng="en"><![CDATA[Critical limb threatening ischemia]]></kwd>
<kwd lng="en"><![CDATA[Endovascular aneurysm repair]]></kwd>
<kwd lng="en"><![CDATA[Hybrid intervention]]></kwd>
<kwd lng="pt"><![CDATA[Aneurismas ilíacos]]></kwd>
<kwd lng="pt"><![CDATA[Doença oclusiva ílio-femoral grave]]></kwd>
<kwd lng="pt"><![CDATA[Isquemia crítica de membro]]></kwd>
<kwd lng="pt"><![CDATA[Tratamento endovascular]]></kwd>
<kwd lng="pt"><![CDATA[Intervenção híbrida]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mills]]></surname>
<given-names><![CDATA[JL]]></given-names>
</name>
<name>
<surname><![CDATA[Conte]]></surname>
<given-names><![CDATA[MS]]></given-names>
</name>
<name>
<surname><![CDATA[Armstrong]]></surname>
<given-names><![CDATA[DG]]></given-names>
</name>
<name>
<surname><![CDATA[Pomposelli]]></surname>
<given-names><![CDATA[FB]]></given-names>
</name>
<name>
<surname><![CDATA[Schanzer]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Sidawy]]></surname>
<given-names><![CDATA[AN]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The society for vascular surgery lower extremity threatened limb classification system: Risk stratification based on Wound, Ischemia, and foot Infection (WIfI)]]></article-title>
<source><![CDATA[J Vasc Surg]]></source>
<year>2014</year>
<volume>59</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>220-234.e2</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Uchiyamada]]></surname>
<given-names><![CDATA[JS]]></given-names>
</name>
<name>
<surname><![CDATA[Ichihashi]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Iwakoshi]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Itoh]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Tabayashi]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Kichikawa]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Technical tips and procedural steps in endovascular aortic aneurysm repair with concomitant recanalization of iliac artery occlusions]]></article-title>
<source><![CDATA[Springerplus]]></source>
<year>2013</year>
<volume>2</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>1-5</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Zeng]]></surname>
<given-names><![CDATA[Q]]></given-names>
</name>
<name>
<surname><![CDATA[Huang]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Huang]]></surname>
<given-names><![CDATA[X]]></given-names>
</name>
<name>
<surname><![CDATA[Peng]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Endovascular repair of abdominal aortic aneurysm with severely angulated neck and tortuous artery access Case report and literature review]]></article-title>
<source><![CDATA[BMC Surg]]></source>
<year>2015</year>
<volume>15</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>1-5</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Takeuchi]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Morikage]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Mizoguchi]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Nagase]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Samura]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Ueda]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Using bifurcated endoprosthesis after iliac artery recanalization for concomitant abdominal aortic aneurysm and chronic total occlusions of access routes]]></article-title>
<source><![CDATA[J Vasc Surg]]></source>
<year>2019</year>
<volume>70</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>117-22</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Vallabhaneni]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Sorial]]></surname>
<given-names><![CDATA[EE]]></given-names>
</name>
<name>
<surname><![CDATA[Jordan]]></surname>
<given-names><![CDATA[WD]]></given-names>
</name>
<name>
<surname><![CDATA[Minion]]></surname>
<given-names><![CDATA[DJ]]></given-names>
</name>
<name>
<surname><![CDATA[Farber]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Iliac artery recanalization of chronic occlusions to facilitate endovascular aneurysm repair]]></article-title>
<source><![CDATA[J Vasc Surg]]></source>
<year>2012</year>
<volume>56</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>1549-54</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Franz]]></surname>
<given-names><![CDATA[RW]]></given-names>
</name>
<name>
<surname><![CDATA[Ibrahim]]></surname>
<given-names><![CDATA[MT]]></given-names>
</name>
<name>
<surname><![CDATA[Tanga]]></surname>
<given-names><![CDATA[CF]]></given-names>
</name>
<name>
<surname><![CDATA[Epstein]]></surname>
<given-names><![CDATA[DA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Endovascular Treatment of Abdominal Aortic Aneurysm with Complete Iliac Occlusion Case Series and Literature Review]]></article-title>
<source><![CDATA[Int J Angiol]]></source>
<year>2017</year>
<volume>26</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>259-63</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Coelho]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Nogueira]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Lobo]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Gouveia]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Campos]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Augusto]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Impact of Post-EVAR Graft Limb Kinking in EVAR Limb Occlusion: Aetiology, Early Diagnosis, and Management]]></article-title>
<source><![CDATA[Eur J Vasc Endovasc Surg]]></source>
<year>2019</year>
<volume>58</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>681-9</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bos]]></surname>
<given-names><![CDATA[WT]]></given-names>
</name>
<name>
<surname><![CDATA[Tielliu]]></surname>
<given-names><![CDATA[IF]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Results of endovascular abdominal aortic aneurysm repair with selective use of the Gore Excluder]]></article-title>
<collab>Van Den Dungen JJ.Zeebregts CJ.Sondakh AO.Prins TR</collab>
<source><![CDATA[J Cardiovasc Surg (Torino)]]></source>
<year>2009</year>
<volume>50</volume>
<page-range>159e64</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
