Abdominal endovascular aneurysm repair using an aorto-uni-iliac device resulting in resting lower extremity pain: a case report and discussion on patient selection

TL;DR

A patient with an abdominal aortic aneurysm developed leg pain after an AUI stent graft, requiring additional surgery.

Contribution

This case highlights the potential risk of rest pain when using an AUI stent graft without crossover bypass in select patients.

Findings

A 79-year-old female developed rest pain after AUI stent graft placement without crossover bypass.

The patient required a femorofemoral crossover bypass to resolve the rest pain.

This case suggests careful patient selection is crucial when using AUI stent grafts alone.

Abstract

Abdominal aortic aneurysms that meet criteria for repair are often managed with endovascular aneurysm repair using a bifurcated two-piece or bifurcated single-body stent. Patients with difficult anatomy, extensive calcifications, complete occlusion of common or external iliac artery, tortuous vessels, or small vessels may require placement of an Aorto-Uni-Iliac (AUI) stent graft. Placement of an AUI stent graft is typically combined with a femorofemoral crossover bypass to ensure adequate perfusion to the contralateral limb. In the elective setting, some literature now supports that select patients with unilateral occlusive common or external iliac disease may be treated with an AUI stent graft alone without femorofemoral crossover bypass. Here, we present a case of a 79-year-old female with an abdominal aortic aneurysms with unilateral occlusive iliac disease managed with an AUI stent graft who subsequently developed rest pain requiring a femorofemoral crossover bypass.

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