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.

Modified adaption of iliac branch endografts in rare congenital anomaly of proximal origin of bilateral internal iliac arteries

“… 1 , 2 , 3 , 4 , 5 , 6 , 7 Coincidence of this congenital anomaly with abdominal aortic aneurysms (AAAs) makes endovascular repair quite challenging. Very short or no common iliac artery (CIA) inappropriate for distal landing zones 6 , 8 can lead to interruption of IIA and resultant ischemic complications. 9 …”