A Case of Endarterectomy of the Distal Aorta and Bilateral Common Iliac Arteries

Abstract

A 53-year-old man with untreated diabetes presented with gangrene of the left foot. Computed tomographic angiography revealed stenosis and occlusion from the distal aorta to the bilateral common iliac arteries. Although stenting from the aorta to the right common iliac artery was successful, occlusion of the left common iliac artery persisted as a result of wire passage failure during a prior endovascular therapy attempt. Consequently, surgical reconstruction of the occlusive lesion was performed in our hospital. The stent was removed and endarterectomy of the distal aorta and the bilateral common iliac arteries was performed. The affected portion of the left foot was almost healed 5 months after the operation despite the need for debridement and split-thickness skin grafting. Although bypass grafting is usually chosen as a surgical option for aortoiliac occlusive disease, aortoiliac endarterectomy is an alternative plan in some cases of localized lesions that are limited to the distal aorta and proximal iliac arteries or when surgeons hesitate to use prosthetic grafts due to a high risk of infection.