# Endovascular Management of an Infrarenal Abdominal Aortic Aneurysm With Severe Tortuosity of the Left Common Iliac Artery: A Case Report

## TL;DR

A complex endovascular repair was successfully used to treat an abdominal aortic aneurysm in a patient with a severely twisted artery.

## Contribution

Demonstrates a novel EVAR approach for challenging anatomy using artery occlusion and a bypass graft.

## Key findings

- Complex EVAR techniques can manage infrarenal AAA with severe left common iliac tortuosity.
- Use of an Amplatzer Vascular Plug II and femoral-femoral bypass graft ensured successful treatment.
- The patient recovered without complications, highlighting the effectiveness of the procedure.

## Abstract

Abdominal aortic aneurysms (AAA) require careful management. Endovascular aneurysm repair (EVAR) is a less invasive alternative to open surgery, but complex aneurysms involving challenging iliac artery anatomy may require advanced procedures. A 72-year-old man presented with a symptomatic infrarenal AAA and a severe tortuosity of the left common iliac artery. Due to this unfavorable anatomy, a complex EVAR approach was undertaken. This involved occlusion of the left common iliac artery using an Amplatzer Vascular Plug II (Abbott Laboratories, Abbott Park, IL), followed by deployment of an aorto-uni-iliac EVAR stent graft via the right femoral artery. To maintain left lower extremity perfusion, a femoral-femoral crossover bypass graft was created. The patient recovered without complications. This case demonstrates the feasibility and effectiveness of complex EVAR techniques in managing challenging aortic aneurysms, emphasizing the need for careful patient selection, meticulous technique, and close follow-up to ensure successful outcomes.