Recurrent peripheral ischemia following endovascular repair of an infrarenal aortic aneurysm: what did we miss?

We document a case of a 75-year-old patient with a history of hypercholesterolemia and hypertension, who underwent endovascular aortic repair (EVAR) for an infrarenal abdominal aortic aneurysm (AAA) with common iliac artery ectasia. Despite an initially successful procedure, the patient experienced recurrent episodes of acute limb ischemia in his right leg. Subsequent imaging revealed thrombus formation distal to the stent graft, constituting a potential source of embolization, which warranted a reevaluation of the treatment strategy. This case highlights some of the complexities associated with managing AAA patients. In the context of EVAR, it emphasizes the significance of careful patient selection, meticulous endograft implantation, and watchful follow-up while tailoring treatment according to individual patient needs and anatomical considerations.