Preservation of One Anterior and One Posterior Internal Iliac Artery Branch in a Case of Bilateral Common and Internal Iliac Arterial Aneurysms

TL;DR

A new endovascular technique is described to preserve pelvic blood flow in a patient with complex bilateral iliac artery aneurysms.

Contribution

A novel approach using extended iliac branch devices to preserve anterior and posterior internal iliac artery branches is demonstrated.

Findings

Aortobi-iliac stent graft and bilateral iliac branch devices successfully treated aneurysms while preserving pelvic circulation.

At six weeks, aneurysm sizes were stable or reduced, with transient gluteal claudication resolving by 20 weeks.

The technique may reduce pelvic ischemia in complex anatomical cases unsuitable for standard devices.

Abstract

Endovascular treatment of iliac aneurysms with sparing of the internal iliac arterial circulation is feasible with iliac branch devices. However, insufficient distal seal with the endovascular devices on the market can be challenging. In this case, the anatomy was complex due to the extent of the aneurysms, and the available technical options were limited.

A 65 year old man with aneurysms in the left common iliac (43 mm) and bilateral internal iliac arteries (right 41 mm; left 49 mm) was treated with an aortobi-iliac stent graft and bilateral iliac branch devices with extensions to opposing anterior (right) and posterior (left) branches of the internal iliac artery through staged interventions. At six weeks of follow up all treated aneurysms had decreased or were stable in size. Clinical signs of right sided gluteal claudication were evident at six weeks of follow up but no symptoms remained 20 weeks post-operatively.

The presented case illustrates a technique to preserve pelvic circulation in a case of bilateral common and internal iliac arterial aneurysms. Extensions of the internal iliac limb of the iliac branch device, into the opposing anterior and posterior divisions of the internal iliac artery, may offer a strategy to reduce pelvic ischaemia in scenarios where the anatomy limits the use of standard iliac branch devices.

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