Endovascular repair of bilateral iliac artery aneurysm with branched iliac stents: case report and review of the current literature
A 65-year-old man was admitted for iliac artery aneurysm, detected during coronary angiogram via femoral artery in another hospital. His electrocardiography and echocardiography were within normal range. Computed tomographic scan showed significant aneurismal dilatation of both iliac arteries and abdominal aorta (). The patient was asymptomatic and underwent elective repair without sign of rupture. The size of right and left CIA was 3.7 mm × 40 mm, 3.7 mm × 41 mm in maximal diameter and length, respectively. Left and right IIA was 36 mm, 15 mm in maximal diameter, respectively. The angulation between left and right CIA and IIA was 40° and 36° respectively. Calcification in both CIA and IIA was not significant. Size of AAA was 37 mm but in risk of further dilatation of the AAA and the difficulty of EVAR after both iliac artery graft stenting, we decided to perform branched iliac bifurcated stenting and EVAR simultaneously.\nInitially, a custom-made 15-Fr delivery right internal iliac branched device (IIBD, SEAL Bifurcated stent graft, S&G Biotech, Seoul, Korea) was introduced in right femoral artery and oriented under fluoroscopic guidance with the aid of the gold markers. The delivery sheath was withdrawn, and a 0.035-inch guidewire was reintroduced through the branched limb under fluoroscopic guidance from the contralateral femoral artery. After exchange for a stiff guidewire, an 8-Fr internal iliac stent-graft (IISG, SEAL Branched limb extension, S&G biotech, Seoul, Korea) was placed in the IIA to extend the IIBD into proximal IIA. The custom-made left IIBD was then placed from the ipsilateral femoral artery and IISG from the contralateral femoral artery same as above. Finally, conventional EVAR was performed successfully in AAA. The final aortogram showed abdominal and both iliac aneurysms were successfully sealed without any endoleak (). Procedure time was 325 minutes and dose of contrast dye was 160 g. The patient was discharged without complications. Follow-up computed tomography after 1 month showed patent stent but did not showed right renal artery. It might be caused by higher position or stent migration during or after EVAR. However, the patient did not express any discomfort and level of creatinine did not change ().