Endovascular Treatment of Isolated Bilateral Internal Iliac Artery Aneurysms with a Branched Endograft: A Case Report
A 68-year-old male presented with severe pelvic pains. The patient had stable coronary artery disease (with a history of coronary artery bypass), severe left ventricular dysfunction (ejection fraction = 20%), hypertension, and hyperlipidemia. A computed tomography scan revealed a right IIA with a 46-mm aneurysm, a left IIA with a 27-mm aneurysm, and an ectatic right common iliac artery (CIA) (31 mm in diameter). The abdominal aorta (24 mm in diameter) and external iliac arteries (8.5 mm in diameter) were all healthy ().\nThe patient was considered high risk for open surgical repair, and an endovascular solution was developed.\nThe following was implemented via the femoral access. The right IIA aneurysm was embolized using three Cook Tornado embolization coils with a 10-mm tapering diameter (Cook Medical Inc., Bloomington, Indiana). A Zenith Iliac Branch endograft (ZBIS-12-45-41; Cook Medical Inc.) was deployed at the level of the left iliac bifurcation, and a Fluency Plus (Bard Peripheral Vascular, Inc., Tempe, Arizona) peripheral covered stent (9 × 80mm) was deployed in the left IIA (). Finally, a Zenith Flex main body endograft (TFFB-26-96-ZT; Cook Medical Inc.) was inserted from the right CIA; the main body graft was extended into the Zenith Iliac Branch endograft by an iliac leg extension (TFLE-16-56- ZT; Cook Medical, Inc.) and also extended into the right external iliac artery by another iliac leg extension (TFLE-12-107-ZT; Cook Medical, Inc). The procedure lasted for one hour forty-five minutes, and 300 cc of contrast dye was used. The patient was discharged 72 hours post-procedure.\nTwo years after the procedure, computed tomography angiography showed complete exclusion of the bilateral isolated IIA aneurysms, patency of the pelvic arteries, and no signs of endoleaks or device migration ().