Transaxillary endovascular aortic aneurysm repair using a reverse mounted Gore Excluder endograft for a patient with abdominal aortic aneurysm and severe iliofemoral occlusive disease

Abstract

Adverse iliofemoral anatomy represents a unique challenge for endovascular aortic aneurysm repair (EVAR). This report describes a transaxillary EVAR in a patient with severe iliofemoral occlusive disease and an infrarenal aortic aneurysm. A reversely mounted Gore Excluder graft was advanced and deployed in the infrarenal aorta using the left axillary artery. Lithoangioplasty and stenting were performed on bilateral iliofemoral anatomy. At the 1-year follow-up, the aneurysm sac revealed regression without endoleaks and the iliofemoral stents remained patent. The transaxillary approach may be a feasible access site for EVAR in patients with a high risk for open repair and prohibitive iliofemoral anatomy.