Abstract
Endovascular aneurysm repair (EVAR) is an attractive management of the abdominal aortic aneurysm, however it is difficult modality to treat the aortoiliac aneurysms involving the both common iliac arteries. We successfully performed comcomitant EVAR and external-internal iliac artery bypass using venous graft for a case of aortoiliac aneurysm. The patient was a 68-year-old male presenting with abdominal aortic aneurysm. It’s maximum diameter was 34 mm and bilateral iliac artery aneurysms (right 56 mm, left 47 mm) in abdominal computed tomography (CT) and it was found accidentally during survey for rectal cancer. He had rectal cancer and multiple liver metastases, therefor the operative risk of open surgery was judged to be high, and recovery of his physical activity would take a long time. Also, intraperitoneal adhesion would exceed operation time and the increase the risk of vascular prosthetic infection. Then, the simultaneous EVAR and external-internal iliac artery bypass using autogenous saphenous vein graft was proposed. We needed to avoid ischemia of the rectum and combined EVAR and external-internal iliac artery bypass was performed concurrently. The postoperative course was uneventful. Six months after surgery, abdominal CT revealed no endoleak and internal iliac artery bypass graft was patent without any problems. He did not complain symptoms of ischemic colitis or buttock claudication. The EVAR with external-internal iliac artery bypass was less invasive and extremely effective for the treatment of abdominal aortic aneurysm with bilateral iliac artery aneurysms.
