Surgical repair of a common iliac artery aneurysm (CIA) after previous open aortic reconstruction is associated with significant morbidity and mortality. Endovascular repair is considered less invasive than surgery. However, if preservation of the internal iliac artery (IIA) is required, the applicability of endovascular techniques may represent a challenge and a limitation to the use of standard aortic endografts or iliac branch devices. In these cases, the off-label use of endovascular devices may be an effective alternative. Herein, we report a successful hybrid approach to treat CIA using a reversed iliac limb endograft coupled with a double-barrel technique with femoro-femoral crossover bypass in a patient who had previously undergone open aortic reconstruction.

Dacron vascular prostheses have been widely used in vascular surgery since the mid-1970s. They have been proven to be the most durable and reliable conduits for arterial replacement in aortic and peripheral surgeries for decades. However, an extremely rare complication, namely late non-anastomotic graft rupture, due to intrinsic structural prosthetic disruption can occur, resulting in acute hemorrhage or false aneurysm formation. We report a case of this rare complication due to non-anastomotic rupture of a bifurcated knitted Dacron aortic vascular graft in a patient who had undergone an aorto-bi-iliac bypass 6 years ago. The patient was successfully treated in an emergency setting with endovascular therapy using an iliac limb of an abdominal aortic endoprosthesis.