Department of Vascular Surgery, Asahi General Hospital, Chiba, Japan.
Medicine (Baltimore). 2024 Apr 5;103(14):e37731. doi: 10.1097/MD.0000000000037731.
A hostile iliac access route is an important consideration when enforcing endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAA). Herein, we report a case of AAA with unilateral external iliac artery occlusion, for which bifurcated EVAR was successfully performed using a single femoral and brachial artery access.
A 76-year-old man who had undergone surgery for lung cancer 4.5 years prior was diagnosed AAA by computed tomography (CT).
Two and a half years before presentation, CT revealed an infrarenal 48 mm AAA, which had enlarged to 57 mm by 2 months preoperatively. CT identified occlusion from the right external iliac artery to the right common femoral artery, with no observed ischemic symptoms in his right leg. The right external iliac artery, occluded and atrophied, had a 1 to 2 mm diameter.
Surgery was commenced with the selection of a Zenith endovascular graft (Cook Medical) with an extended body length. Two Gore Viabahn VBX balloon expandable endoprosthesis (VBX; W.L. Gore & Associate) were delivered from the right axilla as the contralateral leg.
CT scan on the 2nd day after surgery revealed no endoleaks.
While the long-term results remain uncertain, this method may serve as an option for EVAR in patients with unilateral external iliac artery occlusion.
在进行腹主动脉瘤（AAA）的血管内修复（EVAR）时，一个不利的髂内入路是一个重要的考虑因素。在此，我们报告了一例单侧髂外动脉闭塞的 AAA 病例，该病例采用单一股动脉和肱动脉入路成功地进行了分叉式 EVAR。
一位 76 岁的男性，4.5 年前因肺癌接受了手术治疗，通过计算机断层扫描（CT）诊断为 AAA。
在就诊前 2.5 年，CT 显示下腔 48mm AAA，术前 2 个月增大至 57mm。CT 发现右侧髂外动脉至右侧股总动脉闭塞，但右侧下肢无缺血症状。右侧髂外动脉闭塞且萎缩，直径为 1 至 2mm。
选择了具有延长主体长度的 Zenith 血管内移植物（库克医疗）进行手术。从右侧腋窝输送了两个 Gore Viabahn VBX 球囊可扩张支架（VBX；戈尔公司）作为对侧肢体。
术后第 2 天的 CT 扫描显示无内漏。
虽然长期结果仍不确定，但这种方法可能是单侧髂外动脉闭塞患者 EVAR 的一种选择。
