Hypogastric Preservation Using a Retrograde Endovascular Bypass in a Patient with Ruptured AAA and Concomitant Bilateral Common Iliac Aneurysms: A Feasible Option in the Acute Setting

• Published in: Annals of vascular surgery Vol. 74; pp. 497 - 501
• Main Authors: Alexiou, Vangelis G., Kakisis, John D., Karaolanis, Georgios I., Baltagiannis, Evangelos G., Ntanika, Anna, Chatzis, Dimitrios, Koutsias, Stylianos
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-07-2021
• Subjects: Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - surgery; Aortic Rupture - diagnostic imaging; Aortic Rupture - surgery; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - methods; Computed Tomography Angiography; Endovascular Procedures - methods; Humans; Iliac Aneurysm - diagnostic imaging; Iliac Aneurysm - surgery; Male; Middle Aged; Vascular Grafting - methods
• ISSN: 0890-5096; 1615-5947
• DOI: 10.1016/j.avsg.2021.02.021

Preservation of the hypogastric circulation is of major clinical importance in cases of endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (rAAA). Pelvic ischemia can be detrimental and significantly increase post-operative morbidity and mortality. However, the application of a side branch device or a bell-bottom graft is not possible in ruptured aortoiliac aneurysms (due to off-the-shelf unavailability and/or prolonged operative time) and in most cases pelvic circulation may have to be sacrificed. We report a case of a rAAA with bilateral common iliac artery (CIA) aneurysms that was successfully repaired with an aorto-uni-iliac (AUI) endograft, a cross-femoral bypass, and an inverted-U shaped contralateral EIA to IIA endovascular bypass. The procedure is described in detail and certain technical points are further discussed. The steps in cases where the aneurysm has ruptured are different compared to elective repairs and vascular surgeons need to be aware of certain pitfalls. This strategy may be feasible in the acute setting and permits preservation of the hypogastric circulation with the combination of standard techniques and grafts that are readily available in most institutions.