A Unique Indication for the Altura Endograft to Repair Bilateral Common Iliac Artery Aneurysms Associated with a Short–Infrarenal Aorta

Abstract

A 71-year-old man with end-stage renal disease on hemodialysis presented with bilateral common iliac artery aneurysms diagnosed during the workup of his chronic kidney disease. On computed tomography angiography, common iliac artery aneurysm diameters measured 6.1 cm on the right side and 3.1 cm on the left side. The infrarenal aorta also had a small 3.2-cm aneurysm, but the length from the lowest left renal to the aortic bifurcation was only 6.7 cm, precluding use of most bifurcated endografts. Following an uneventful staged preoperative internal iliac artery embolization, a two-piece D-shaped Altura endograft for the aorta, with bilateral iliac components, landing at the level of the external iliac arteries was successfully performed. Postoperative course was uneventful with no endoleak or endograft migration on computerized tomographic angiography 45 days later, although billowing mimicking an endoleak was evident and will be closely followed.

Keywords

iliac artery aneurysm - endograft - embolization

• References

• 1 Muhs BE, Jordan W, Ouriel K, Rajaee S, de Vries JP. Matched cohort comparison of endovascular abdominal aortic aneurysm repair with and without EndoAnchors. J Vasc Surg 2018; 67 (06) 1699-1707
• 2 Qaderi SM, Tran NT, Tatum B, Blankensteijn JD, Singh N, Starnes BW. Aortic neck dilation is not associated with adverse outcomes after fenestrated endovascular aneurysm repair. J Vasc Surg 2019; 69 (04) 1059-1065
• 3 Stenson KM, Patterson BO, Grima MJ, De Bruin JL, Holt PJE, Loftus I. Midterm results of endovascular aneurysm sealing to treat abdominal aortic aneurysm. J Vasc Surg 2019; 69 (01) 53-62.e1
• 4 Adkar SS, Turner MC, Leraas HJ. , et al. Low mortality rates after endovascular aortic repair expand use to high-risk patients. J Vasc Surg 2018; 67 (02) 424-432.e1
• 5 Krievins D, Krämer A, Savlovskis J. , et al. Initial clinical experience using the low-profile Altura endograft system with double D-shaped proximal stents for endovascular aneurysm repair. J Endovasc Ther 2018; 25 (03) 379-386
• 6 Massmann A, Shayesteh-Kheslat R, Fries P, Buecker A. Endovascular aortic repair with the use of low-profile Altura and covera stent graft for accessory renal artery chimney. j vasc Interv Radiol 2018; 29 (09) 1285-1288
• 7 Helo N, Chang AC, Hyun C. , et al. Retrospective review of billowing phenomenon-A mimic of endoleak following placement of endologix covered stent for the treatment of abdominal aortic aneurysm. Ann Vasc Surg 2017; 45: 239-246
• 8 Chang H, Hadro NC, Norris MA, Rhee SW, Morris ME. The progression of billowing of endologix AFX2 abdominal aortic aneurysm device as a precursor for the rupture of an abdominal aortic aneurysm. Ann Vasc Surg 2019; 54: 335.e11-335.e14
• 9 Wu A, Karuppasamy K, Wang W. Billowing of endologix powerlink stent mimicking endoleaks. Res Cardiovasc Med 2016; 5 (02) e32448
• 10 Helo N, Chang AC, Hyun C, Chon KS, Yi AC. Billowing of endologix powerlink stent graft in post endovascular repair of abdominal aortic aneurysm: simultaneous findings on CT and ultrasound imaging. Ann Vasc Surg 2016; 35: 208.e1-208.e3