Document Type : Case Report


1 Çorlu Province Hospital, Department of Cardiovascular Surgery, Tekirdağ,Turkey

2 Assoc. Prof. Dr., Kocaeli University Faculty of Medicine, Department of Radiology, Kocaeli,Turkey

3 Kırıkkale Yüksek İhtisas Hospital, Department of Cardiovascular Surgery, Kırıkkale,Turkey


Background: There are some clinical conditions described in literature which limit the application of full endovascular aneurysm repair, and the most important of these limitations are inappropriately short and angled aneurysm neck, narrow terminal aorta, and curved and very small diameter or highly calcified iliac arteries that make access difficult, and unilateral iliac artery occlusion is another one of these limitations, which is less frequently observed.

Case report: In our case report, we present a patient whose abdominal aortic aneurysm was considered to be high risk for classical open surgical repair. Our patient has a unilateral iliac artery occlusion co-existing with abdominal aortic aneurysm and the occluded left common iliac artery and severely stenotic external iliac artery segment was applied percutaneous transluminal balloon dilatation and after which abdominal aortic aneurysm was successfully treated with standard endovascular aneurysm repair.

Conclusion: A standard successful endovascular aneurysm repair procedure was applied for the patient who did not develop any intraoperative complications. The left iliac artery blood flow was also ensured by the dilatation of occluded iliac artery segment, simultaneously. When there are such limitations related to the iliac artery as iliac artery occlusion, the standard endovascular aneurysm repair procedure combined with invasive techniques for iliac artery revascularization is a practical and safe treatment option which reduces the procedural morbidity and mortality compared to the other treatment options.


  1. N Fujimura, H Harada, H Yashiro, T Akiyoshi, M Nakagawa, T Kanai, et al. Endovascular Repair of Abdominal Aortic Aneurysm using Bifurcated Stentgraft in a Patient with Complete Occlusion from the Common to the External Iliac Artery. Ann Vasc Surg 2014; 28: 740.e1–740.e5.
  2. Prinssen M, Verhoeven EL, Buth J, Cuypers PWM, van Sambeek MRHM, Balm R, et al. A randomized trial comparing conventional and endovascularrepair of abdominal aortic aneurysms. N Engl J Med. 2004; 351(16):1607-18. doi: 10.1056/NEJMoa042002.
  3. M Elkassaby, M Alawy, MZ Ali, WA. Tawfick, S Sultan. Aorto-Uni-Iliac Stent Grafts with and without Crossover Femorofemoral Bypass for Treatment of Abdominal Aortic Aneurysms: A Parallel Observational Comparative Study. International Journal of Vascular Medicine 2015. doi:10.1155/2015/962078.
  4. Vinit N. Varu, George K. Lee , Shu Chang , Jason T. Lee. Re-Entry Device Aided EVAR in Patients With AAA and Unilateral Iliac Artery Occlusion. Annals of Vascular Surgery 2014. doi: 10.1016/j. avsg.2014.05.008.
  5. Arko FR, Filis KA, Seidel SA, et al. How many patients with infrarenal aneurysms are candidates for endovascular repair? The Northern California experience. J Endovasc Ther 2004;11:33-40.
  6. V. C. Katsikas, I.Dalainas, V. G. Martinakis, K. Xiromeritis. The role of aortouniiliac devices in the treatment of aneurysmal disease, European Review forMedical and Pharmacological Sciences 2012;16 (8): 1061–71.
  7. Vallabhaneni R, Sorial EE, Jordan WD, et al. Iliac artery recanalization of chronic occlusions to facilitate endovascular aneurysm repair. J Vasc Surg 2012;56:1549-54.
  8. Yilmaz LP, Abraham CZ, Reilly LM, et al. Is cross-femoral bypass grafting a disadvantage of aortomonoiliac endovascular aortic aneurysm repair? J Vasc Surg 2003;38:753-7.
  9. A. Mingoli, P. Sapienza, R. J. Feldhaus, L. Di Marzo, C. Burchi, A. Cavallaro. Femorofemoral bypass grafts: factors influencing long-term patency rate and outcome. Surgery 2001;129 (4): 451–8.
  10. Lederle FA, Freischlag JA, Kyriakides TC, Matsumura JS,Padberg FT, Kohler TR, et al. Long term comparison of endovascular and open repair of abdominal aortic aneurysm. N Engl J Med 2012;367:1988-97. DOI: 10.1056/NEJMoa1207481.
  11. RW. Franz, M.T Ibrahim, CF. Tanga, DA. Epstein. Endovascular Treatment of Abdominal Aortic Aneurysm with Complete Iliac Occlusion: Case Series and Literature Review. Int J Angiol 2017;26:259-63.
  12. Henretta JP, Karch LA, Hodgson KJ, et al. Special iliac artery considerations during aneurysm endografting. Am J Surg 1999;178:212-8.
  13. Wu T, Carson JG, Skelly CL. Use of internal endoconduits as an adjunct to endovascular aneurysm repair in the setting of challenging aortoiliac anatomy. Ann Vasc Surg 2010;24:114. 7-11.
  14. Jean-Baptiste E, Batt M, Azzaoui R, et al. A comparison of the mid-term results following the use of bifurcated and aorto-uni-iliac devices in the treatment of abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 2009;38:298-304.
  15. Jae Hoon Lee, Ki Hyuk Park. Self expandable stent application to prevent limb occlusion in external iliac artery during endovascular aneurysm repair. Ann Surg Treat Res 2016;91(3):139-44.
  16. Conway AM, Modarai B, Taylor PR, Carrell TW, Waltham M, Salter R, et al. Stent-graft limb deployment in the external iliac artery increases the risk of limb occlusion following endovascular AAA repair. J Endovasc Ther 2012;19:79-85.
  17. Hobo R, Buth J; EUROSTAR collaborators. Secondary interventions following endovascular abdominal aortic aneurysm repair using current endografts. A EUROSTAR report. J Vasc Surg 2006;43:896-902.
  18. Oshin OA, Fisher RK, Williams LA, Brennan JA, Gilling-Smith GL, Vallabhaneni SR, et al. Adjunctive iliac stents reduce the risk of stent-graft limb occlusion following endovascular aneurysm repair with the Zenith stent-graft. J Endovasc Ther 2010; 17:108-14.
  19. Sivamurthy N, Schneider DB, Reilly LM, Rapp JH, Skovobogatyy H, Chuter TA. Adjunctive primary stentingofZenith endograftlimbs duringendovascular abdominal aortic aneurysm repair: implications for limb patency. J Vasc Surg 2006; 43:662-70.