Staged Operations in a Patient with Multiple Peripheral Aneurysms Associated with Arteriomegaly

Abstract

A 78-year-old man was hospitalized with left lower limb ischemia. Computed tomography and angiography revealed the diffuse aneurysmal disease with arteriomegaly extending between the infrarenal abdominal aorta and the bilateral popliteal arteries. The left superficial femoral and popliteal arteries showed thrombotic occlusion. Staged operations were performed. Initially, we performed left ilioprofunda reconstruction with a heparin-bonded expanded polytetrafluoroethylene (HePTFE) graft and a concomitant profunda femoris-below knee popliteal bypass using a reversed saphenous vein graft. Subsequently, the infrarenal abdominal aorta, bilateral external iliac arteries and the left internal iliac artery were reconstructed using a trifurcated knitted Dacron graft. The inferior mesenteric artery was directly implanted into the graft; however, the right internal iliac artery had to be sacrificed. Eventually, the right superficial femoral and the above-knee popliteal arteries were reconstructed using a HePTFE graft. Postoperative computed tomography demonstrated complete revascularization between the infrarenal abdominal aorta and the bilateral popliteal arteries.