Department of Vascular Surgery, Asturias University Central Hospital (HUCA), Oviedo, Spain.
Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.
Vasc Endovascular Surg. 2024 Jan;58(1):105-109. doi: 10.1177/15385744231189019. Epub 2023 Jul 12.
Bilateral limb occlusion after endovascular repair of abdominal aortic aneurysms (EVAR) is an uncommon entity. The relationship between graft kinking and unilateral limb occlusion is widely described in the literature. Our aim is to report a case of complete endograft thrombosis due to bilateral limb kinking secondary to aneurysm sac shrinkage, treated by endovascular means.
A 67 year-old male with history of EVAR with an Incraft® endograft (Cordis, Bridgewater, NJ, USA) four years before, presented at the emergency department with disabling claudication of the right lower extremity and a better tolerated 10-month left extremity claudication. Complete endograft thrombosis with bilateral limb kinking and a remarkable reduction of the aneurysm sac was observed in the computed tomography angiography. An endovascular repair was performed, through bilateral open femoral access and with angiographic control through percutaneous left brachial access. Bilateral recanalization was achieved and the endograft was re-lined with two 10x150 mm Viabahn (WL Gore & Ass., Flagstaff, AZ, USA). Both sides were extended with a 11 × 50 mm Viabahn (WL Gore & Ass., Flagstaff, AZ, USA). The final angiographic control showed bilateral patency with no residual stenosis and the patient recovered distal pulses. Follow-up showed complete patency and no complications at 17 months.
Bilateral limb occlusion is a rare complication with technically challenging treatment options. Aneurysm sac shrinkage can affect the endograft configuration, leading to limb distortion and occasionally to bilateral limb occlusion after EVAR. Special attention should be put on imaging follow-up to detect these complications before occlusion occurs.
血管内修复腹主动脉瘤（EVAR）后出现双侧肢体闭塞是一种罕见的情况。移植物扭结与单侧肢体闭塞之间的关系在文献中广泛描述。我们的目的是报告一例因动脉瘤囊缩小导致双侧肢体扭结引起的完全移植物血栓形成的病例，采用血管内方法治疗。
一名 67 岁男性，四年前曾接受过 Incraft®移植物（Cordis，Bridgewater，NJ，USA）的 EVAR，因右下肢活动障碍和左下肢可耐受的 10 个月跛行而到急诊就诊。计算机断层血管造影显示完全性移植物血栓形成伴双侧肢体扭结和显著的动脉瘤囊缩小。通过双侧开放股动脉入路和经皮左肱动脉入路进行血管内修复，实现了双侧再通，并使用两个 10x150mm Viabahn（WL Gore & Ass.，Flagstaff，AZ，USA）重新覆盖移植物。在两侧延伸使用 11×50mm Viabahn（WL Gore & Ass.，Flagstaff，AZ，USA）。最终的血管造影控制显示双侧通畅，无残余狭窄，患者恢复了远端脉搏。随访 17 个月显示完全通畅，无并发症。
双侧肢体闭塞是一种罕见的并发症，治疗方法具有技术挑战性。动脉瘤囊缩小会影响移植物的结构，导致肢体扭曲，偶尔在 EVAR 后导致双侧肢体闭塞。应特别注意影像学随访，以在闭塞发生之前发现这些并发症。
