Abstract
Limb trouble after endovascular repair (EVAR) of abdominal aortic aneurysm (AAA) is one of the major complications. We report a case of bilateral limb trouble after EVAR of AAA with Endurant® stent graft system. A 75-year-old man with AAA (maximum diameter 50 mm) underwent EVAR without any troubles. Four months later of the surgery, intermittent claudication was occurred just after work with squatting posture. About 20 days after claudication occurred, this patient visited our department and computed tomography (CT) revealed the occlusion of the left limb. Bypass surgery between bilateral external iliac arteries (EIA) was performed and intermittent claudication was improved. Three months later of the second operation, ankle/brachial index (ABI) examination revealed malperfusion of bilateral lower extremities and CT revealed the stenosis at the distal edge of right limb. The percutaneous angioplasty with EpicTM Vascular Self-Expanding Stent System was performed successfully. In our case, bilateral distal stent limb of EVAR were deployed in each EIA. But this maneuver is reported to be a cause of limb trouble. Considering other case reports, there may be a relationship between the distal deployment site, especially in EIA, and squatting posture. After EVAR of AAA, not only the image examination for endoleak but ABI examination should be performed to detect of limb trouble in early stage.
