Iliac Stent Grafting to Facilitate Distal Suture during Abdominal Aortic Aneurysm Open Repair

Hybrid Surgical Technique for Open AAA Repair in the Setting of Severe Iliac Artery Calcification

In the present report, we describe the case of a patient with an infrarenal abdominal aortic aneurysm that had been incidentally noted on an imaging study. Treatment decisions for this case were complicated by the presence of a hostile infrarenal aortic neck and significant bilateral iliac artery circumferential calcification, precluding iliac artery clamping and standard distal anastomotic techniques. We performed a hybrid surgical procedure, deploying bilateral iliac stent grafts into the distal aneurysmal aorta and sewing our aortic graft to the proximal extent of these stents. The findings from the present case add to the previously reported techniques of hybrid surgical management of abdominal aortic aneurysms with iliac disease and expand the technique to a larger application.

Staged in situ aorto-iliac hybrid technique: an original technique to treat complex juxtarenal and iliac aneurysms

BACKGROUND

To report a novel staged hybrid technique to treat complex juxtarenal abdominal aortic aneurysm (JAAA) associated with at least one iliac artery aneurysm (IA) with no adequate distal fixation zone.

METHODS

The novel technique herein described has two main "staged" steps. The first step consists in creating an adequate distal fixation zone by endovascular means; after hypogastric embolization an iliac stent-graft has placed from 5 mm above the aortic bifurcation to the external iliac artery. The second step is the surgical resection of the JAAA and graft placement sutured distally to the stent-graft which was always performed the day after.

RESULTS

The five cases included (mean age 74 years), were rejected for fenestrated or branched endovascular aortic repair or iliac branch devices. Four tube grafts and one aorto-bi-iliac graft were sutured to one stent-graft (N.=3), two stent-grafts in iliac kissing configuration (N.=1) and to a main body of a bifurcated stent-graft (N.=1). Mean follow-up duration was 14 (4-27) months with no mortality. Technical success was obtained in all cases (2 suprarenal clamping). Postoperative complications included two pleural effusions, two transient gluteal intermittent claudications, and one renal failure.

CONCLUSIONS

The technique herein described seems to be a feasible and cost-effective alternative treatment for selected concomitant complex JAAAs and IAs unsuitable for totally endovascular treatment.