# A Complex Case of Highly Tortuous Abdominal Aorta Complicated with Infrarenal Aortoiliac Aneurysm

## TL;DR

This paper presents a rare case of an abdominal aortic aneurysm complicated by a tortuous aorta, requiring open surgery due to anatomical challenges.

## Contribution

The paper highlights the rarity and management challenges of coexisting abdominal aortic aneurysm and tortuous aorta.

## Key findings

- A 63-year-old patient with AAA and ATA required aortobifemoral bypass surgery due to infeasibility of endovascular repair.
- ATA complicates endovascular treatment, necessitating alternative surgical approaches for optimal outcomes.
- Further research is needed to understand aortic tortuosity's impact on treatment and rupture prediction.

## Abstract

Aneurysms, characterized by localized dilatation involving all three layers of the vascular wall, pose significant risks, with abdominal aortic aneurysm (AAA) being prevalent, particularly among the elderly. However, the cooccurrence of AAA with abdominal tortuous aorta (ATA) remains exceptionally rare.

We present the case of a 63-year-old male with an AAA extending into the iliac arteries, accompanied by ATA. Computed tomography revealed complex structural abnormalities, necessitating immediate surgical intervention. Due to the anatomical complexities, endovascular repair was not feasible, leading to a successful aortobifemoral bypass surgery using the Piljic method. The patient recovered well postoperatively, highlighting the efficacy of the chosen approach.

While AAA is often treated with endovascular repair, ATA complicates this approach, underscoring the need for open surgery in such cases. Research on aortic tortuosity's role in rupture prediction and stress alleviation shows varied findings, necessitating additional studies. ATA may also hinder vascular catheter insertion, requiring alternative routes for interventions. Future research is imperative to develop tailored treatment strategies for patients with concurrent AAA and ATA, ensuring optimal outcomes.