Complex EVAR
Infrarenal aortic aneurysm with occluded external iliac artery
The case
6cm infrarenal aortic aneurysm with 15mm long neck 16mm diamater of distal neck. The challenge was an occulded right external iliac artery due to PCI about 20 years ago with dissection.
Revascularization of the external iliac artery
At first, a crossover approach with a 12F sheath was established. Then we tried to enter the occlusion from the proximal side. The guidewire didn´t have enough support to enter the lesion.
We built up a coaxial system with a 6F sheat inside of the 12F sheath. Then a guidewire with supportcatheter was inserted. With the enhanced pushability it was possible to cross the occlusion.
After confirmation of the right intraluminal position of the guidewire a 8mm covered stent was placed after predilation.
The angiogram showed a good result after revascularization.
A normal infrarenal aortic endograft was implanted in ballerina position.
The anatomically correct solution seems to have a better outcome than extraanatomic treatment like an aorto-uni-iliac reconstruction with crossover bypass.
