BILATERAL ILIAC ANEURYSMS AND CONCOMITANT SEVERE MULTILEVEL OCCLUSIVE ARTERIAL DISEASE: STAGED HYBRID PROCEDURE AS SOLUTION TO A NIGHTMARE

• Autor(a) principal: Coelho, Nuno
• Data de Publicação: 2021
• Outros Autores: Brandão, Daniel, Gouveia, Ricardo, Martins, Victor, Augusto, Rita, Semião, Carolina, Ribeiro, João, Peixoto, João, Fernandes, Luís, Canedo, Alexandra
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://doi.org/10.48750/acv.362
• topic: common iliac aneurysms; severe ilio-femoral occlusive disease; critical limb threatening ischemia; endovascular aneurysm repair; hybrid intervention; Aneurismas ilíacos; Doença oclusiva ílio-femoral grave; Isquemia crítica de membro; Tratamento endovascular; Intervenção híbrida

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.