Preservation of internal iliac artery flow during endovascular aortic aneurysm repair in a patient with bilateral absence of common iliac artery

Abstract

Bilateral absence of the common iliac artery is an extremely rare congenital vascular malformation in which the distal aorta divides directly into two external iliac arteries and two internal iliac arteries. In the case of the presence of this vascular malformation in association with an aortic aneurysm, preservation of the internal iliac artery flow during endovascular aortic repair represents a technical challenge. We have reported a case in which the bilateral absence of the common iliac artery associated with an infrarenal abdominal aortic aneurysm was successfully treated by endovascular aortic repair using commercially available iliac branched devices to maintain pelvic perfusion.

Congenital absence of left common and external iliac arteries

“…A search found only 12 cases of congenital CIA absence published between 1964 and 2021 (Table 1) [1,[4][5][6][7][8][9][10][11][12][13][14]. Nearly all of those patients were incidentally diagnosed and many had no history of limb ischemic symptoms.…”

“…A search found only 12 cases of congenital CIA absence reported from 1964 to 2021 ( Table ). 1 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 The congenital absence of the CIA had been diagnosed incidentally for nearly all those patients, and many had had no history of limb ischemic symptoms. This was probably because the collateral vessels develop well in the embryo and provide the blood supply to the lower extremity in cases of congenital iliofemoral atresia.…”

When a surgical approach is more favorable

“…Department of Vascular Surgery, Ospedale dell'Angelo, Via Paccagnella 11, 30174 8 1 congenital anomaly of the common iliac arteries affected by an abdominal aortic aneurysm 1 . In 2 our opinion, this setting is challenging for a vascular surgeon and it highlights some interesting 3 aspects we would like to discuss.…”

“…We are grateful to Pham and Le 1 for sharing such an interesting case of a patient with a rare congenital anomaly of the common iliac arteries affected by an abdominal aortic aneurysm (AAA). In our opinion, this setting is challenging for a vascular surgeon, and it highlights some interesting aspects we would like to discuss.…”

Reply

“…The patient was successfully treated by endovascular aortic aneurysm repair (EVAR) using a technical modification to maintain pelvic perfusion. 1 …”