Abstract
An 81-year-old man who was complicated with chronic renal failure to need dialysis was admitted with pneumonia. Enhanced computed tomography showed aneurysm of descending aorta which was complicated with aneurysms of bilateral common and internal iliac arteries (left-sided aneurysms were occluded). After pneumonia was improved, TEVAR and EVAR were performed in twice. At the first operation, to keep the blood stream of right internal iliac artery for preventing spinal cord ischemia, we for intention did not treat the patient for iliac artery aneurysms. We implanted two pieces of GORE TAG® from left leg of Y-shaped vascular prosthesis with which bypass grafting from abdominal aorta (distal to IMA) to right external iliac artery and left common femoral artery was performed. About two months after the first operation, the second operation was performed. After the coil embolization of right internal iliac artery, we implanted iliac extender of EXCLUDER® from right leg of Y-shaped vascular prosthesis to right external iliac artery. After these operations, paraplegia and ischemic colitis were not occurred and CT showed no endoleak and migration of stent grafts. In order to prevent postoperative paraplegia and ischemic colitis, it is important to make treatment strategy for the patient of thoracic aortic aneurysm which is complicated with abdominal aortic or iliac aneurysm.
