Uso de endoprótesis bifurcada ilíaca para revascularización hipogástrica durante tratamiento de aneurisma aorto-ilíaco

Abstract

Bifurcated iliac endograft in a patient with aortic-iliac aneurysm A diffi cult anatomy is the major challenge to overcome with abdominal aortic aneurysm endografting. Bilateral iliac aneurysm preventing an appropriate distal landing zone for an endograft is a common condi- tion and can be managed by: a) Increasing the diameter of the endograft, with limitations in available sizes; b) bilateral hypogastric embolization, accepting an increased morbidity; c) combining a surgical hypogastric revascularization by retroperitonel approach or d) retrograde revascularization from the ipsilateral external iliac artery using an endograft. Recently, branched endografts have been designed to revascularize the hypo- gastric artery. Their deployment is complex but allows antegrade and stable fl ow. We report a 57 year-old male, at high risk for an open procedure, who presented with a small aortic aneurysm, bilateral iliac and left hypogastric aneurysms. A right bifurcated iliac endograft was deployed, associated with left hypogastric aneurysm embolization and aortic endografting. The patient recovered event free, patency of the endograft and absence of endoleak was demonstrated on a CT scan. He presented minor left buttock claudication, sexual function was preserved. This new technique allows safe endovascular treatment of patients with bilateral iliac aneurysm, allowing preservation of pelvic perfusion and avoiding the risk of an open procedure in a high risk patient.