A novel hybrid device for avoiding redo surgery in synchronous iliac and femoral peri-anastomotic pseudo-aneurysms.

Synchronous peri-anastomotic pseudo-aneurysms were discovered in a 65-year-old man 26 years after an aorto-bi-iliac bypass and 11 years after an ileo-femoral bypass. He was a poor surgical candidate owing to his obesity, hostile abdomen, and multiple medical comorbidities. Therefore, a novel hybrid device was designed that was part stent graft with the addition of two 6-mm Dacron limbs for anastomosis onto the superficial femoral and profunda femoris arteries. An unexpected type 2 endoleak developed through the internal iliac artery, which was thought to be occluded. This was successfully treated with a direct injection of bovine thrombin. This was an excellent outcome, and the patient made an uneventful recovery.