Combination of covered endovascular reconstruction of aortic bifurcation technique and on-table fenestration to preserve inferior mesenteric artery in the treatment of subacute infrarenal aortoiliac occlusion

A 64-year-old man presented with severe intermittent claudication for 4 weeks. Computed tomography angiography showed aortoiliac occlusion. Aortoiliac thrombectomy and followed by covered endovascular reconstruction of aortic bifurcation was performed successfully. On-table fenestration technique was used for preservation of inferior mesenteric artery (IMA) to minimize the risk of bowel ischemia. A follow-up computed tomography scan at 6 weeks showed aortoiliac artery and IMA were patent and patient was asymptomatic at 6 months follow-up. Comprehensive management with thrombectomy, covered endovascular reconstruction of the aortic bifurcation, and concurrent on-table fenestration for IMA preservation was an alternative novel, effective, and safe approach for treatment of complex aortoiliac occlusion.