Ipsilateral Hybrid Repair Of A Combined Type IB And III Endoleak After Fenestrated-Branched Endograft And Bilateral Iliac Branch Endoprosthesis
Nolan Cirillo-Penn, MD, Bernardo C. Mendes, MD.
Mayo Clinic, Rochester, MN, USA.
This patient is a 66-year-old male with arteriomegaly without genetic diagnosis who previously underwent multiple repairs for aortic dissection who presented with a complex combined type IB and III endoleak. Past surgical history is significant for aortic valve replacement, ascending aortic, and total arch repair with subsequent open Extent II thoracoabdominal aneurysm repair with left femoral aneurysm repair. He later developed an intercostal patch aneurysm, which was treated with staged fenestrated-branched endovascular aortic repair with subsequent bilateral iliac branch endovascular repair. Computed tomography angiography demonstrated a large endoleak within the left iliac aneurysm resulting from internal iliac branch disconnection and retrograde flow through the false lumen of an external iliac and femoral artery dissection proximal to a femoral interposition graft. The patient underwent staged hybrid repair of the endoleak with first stage ipsilateral femoral access and bridging stent placement with the use of a steerable sheath. In a second stage, 48 hours later, redo left femoral exposure and obliteration of the dissection flap was performed with iliofemoral bypass with a bifurcated Dacron graft to the superficial femoral and profunda femoral arteries. The patient was discharged from the hospital on postoperative day 4 and 6 from respective operations without complication. At 6-month follow-up, the patient was asymptomatic with resolution of the endoleak.
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