Endovascular exclusion of bilateral common iliac artery aneurysms with preservation of internal iliac artery perfusion.

Abstract

Patients with common iliac artery (CIA) aneurysms In July 1999, a 70-year-old man presented with a short present a particular challenge for endovascular repair. history of back pain and a pulsatile abdominal mass. Stent-graft devices generally require at least 1 cm CT scanning confirmed a 6 cm abdominal aortic anlength of normal artery distally to ensure secure placeeurysm with a large retroperitoneal haematoma. At ment. CIA aneurysms, however, frequently extend operation both common iliac arteries were noted to down to the iliac bifurcation, necessitating placement be ectatic but as the aortic bifurcation was not widely of the distal end of the stent in the external iliac artery splayed the aneurysm was treated by insertion of (EIA). In the absence of stent-grafts with aortic and an 18 mm Haemashield tube graft. He made a good iliac bifurcations, deliberate pre-operative occlusion recovery apart from a minor chest infection that reof the proximal internal iliac artery (IIA) is usually sponded well to antibiotics and he was discharged performed to produce complete aneurysm exclusion. home after 16 days. In June 2000 a follow-up CT Ischaemic colitis has been reported in 13% of patients scan was performed to reassess the iliac arteries. This who had one or both IIA’s interrupted and buttock revealed bilateral CIA aneurysms of maximum diaclaudication in 32%. Other series have produced more meters 4.1 cm on the right and 2.9 cm on the left. As favourable results with no serious ischaemic comsuch these were felt to warrant elective repair and in plications in 11 patients undergoing bilateral IIA ocview of his previous surgery we elected to treat his clusion. Nevertheless, standard teaching is to avoid iliac aneurysms by endovascular means. acute bilateral IIA occlusion and some regard the Under general anaesthetic, both common femoral necessity for this as a contra-indication to endovascular arteries were exposed and 5000 units of intravenous repair. heparin administered. Via an antegrade approach, the Two previous case reports have described mainright internal iliac artery was occluded just beyond its tenance of internal iliac artery perfusion by inserting origin by coil embolisation. A 26×200 mm tapered an aortomonoiliac stent-graft on the ipsilateral side Talent aortouniiliac stent-graft (Medtronic, Watford, with a crossover graft and linking the contralateral Herts, U.K.) was then placed via the right common internal and external iliac vessels with a covered femoral artery. The morphology of the right iliac sysstent. We describe a similar technique using a comtem was more favourable whereas the left CIA origin mercially available covered stent. was markedly angulated. The proximal end was sited in the proximal part of the previous aortic tube graft ∗ Please address all correspondence to: J. D. G. Rose, Department with the distal end sited in the right external iliac of Radiology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, artery (Fig. 1A). Exclusion of the right common iliac U.K. Tel: 0191 223 1120; Fax: 0191 223 1168. E-mail: John. Rose@tfh.nuth.northy.nhs.uk artery aneurysm was confirmed angiographically and