Endovascular repair of abdominal aortic aneurysm associated with residual type B aortic dissection utilizing iliac branch endoprosthesis: a case report.

Abstract

Background: Iliac branch endoprosthesis (IBE) can preserve the internal iliac artery. Endovascular aortic repair (EVAR) for abdominal aortic aneurysms associated with residual type B aortic dissection has been rarely reported, and IBE has not been utilized in any of the reported cases. Herein, we describe a rare case of EVAR using IBE for an abdominal aortic aneurysm and a common iliac artery aneurysm associated with residual type B aortic dissection after thoracoabdominal aortic replacement.

Case presentation: A 70-year-old man underwent conservative treatment for acute type B aortic dissection 5 years ago. Contrast-enhanced computed tomography (CT) revealed type B aortic dissection and a thoracoabdominal aortic aneurysm, an abdominal aortic aneurysm, and an aneurysm in the right common iliac artery. Since the patient had a concomitant right common iliac artery aneurysm and reconstructing the right iliac artery would have been difficult in a one-stage operation, a two-stage surgical strategy for thoracoabdominal and abdominal aortic graft replacement, separately, was designed. Thoracoabdominal aortic graft replacement from the proximal descending aorta to the infrarenal abdominal aorta was performed using a triplex 24-mm prosthesis (Terumo Aortic, Inchinnan, UK) without any problem. We recommended abdominal aortic graft replacement; however, he preferred EVAR over abdominal aortic graft replacement. The risk of spinal cord ischemia was a concern because a conventional EVAR would require embolizing the right internal iliac artery. Therefore, EVAR was performed with IBE to preserve the right internal iliac artery. The postoperative course was uneventful, and no spinal cord injury was observed. Follow-up CT showed no enlargement of the aneurysms 1 year postoperatively.

Conclusions: Despite anatomic limitations, EVAR for abdominal aortic and common iliac artery aneurysms associated with residual aortic dissection after thoracoabdominal aortic graft replacement can be safely performed by embolizing the branch to the false lumen and using IBE.