Complex endovascular repair of bilateral iliac artery stenosis and coexisting aneurysm.

Concomitant stenosis and aneurysmal disease in the iliac artery lumen are a rare finding. Surgery has been the modality of choice for this degree of complexity; however, advancement in techniques, evolution of stent grafts and increasing operator experience have made endovascular intervention a feasible option. TransAtlantic InterSociety Classification (TASC) categorizes the presence of iliac stenosis adjacent to iliac aneurysm as the most severe category for aortoiliac lesions or a TASC II D lesion. The 2014 Society of Cardiovascular Angiography and Interventions (SCAI) expert consensus statement advocated endovascular approach for TASC II A, B and C lesions with a trend to favor endovascular approach for TASC II D lesions as well. If surgery is not an option or is refused, covered stent provides a viable option due to its ability to treat severe atherosclerotic disease and exclude the aneurysmal lumen at the same time. We here describe a case of a patient with Rutherford II (4) claudication symptoms who was found to have bilateral iliac artery stenosis with adjacent co-existing aneurysmal disease. After surgical intervention was refused, endovascular repair was performed with multiple Gore Viabahn covered stents with resolution of symptoms and good angiographic results.