Profunda Femoris as an Access Site Vessel for a Hybrid Approach to the Treatment of a Para-Anastomotic Common Iliac Artery Aneurysm and Intermittent Claudication, Occurring after Previous Abdominal Aortic Tube Graft Repair and Femoro-Femoral Bypass Graft. A Case Report

Abstract

A true para-anastomotic right common iliac artery aneurysm and intermittent claudication developed in a 76-year-old man 5 years after open abdominal aortic aneurysm repair with a Dacron tube graft. Following the initial operation the patient developed acute left iliac occlusive disease necessitating an immediate right-to-left femoro-femoral crossover bypass graft. The patient was a poor open surgical candidate because of multiple medical comorbidities. Therefore, a hybrid approach was used consisting of exposure and catheterization of the right profunda femoris artery, which was used as the access site vessel for the deployment of a covered stent graft extending from the ostium of the common iliac artery into the external iliac artery. Simultaneously, the right profunda femoris provided inflow for an open above-knee profunda femoro-popliteal bypass graft to perfuse the right lower extremity. Postoperative angiography demonstrated primary technical success, with exclusion of the aneurysm and no endoleak. The patient is doing well 34 months postoperatively, with a patent endograft and no sign of intermittent claudication. Profunda femoris proved to be an excellent alternative to the common femoral artery for the application of a hybrid technique in a high-risk patient with complicated anatomy.