Hybrid revascularization of an acute iliac vessel occlusion: Keep the hypogastric patent
Bilateral hypogastric artery occlusion is associated with increased morbidity in patients with acute limb ischemia. Although transfemoral lilac thrombectomy is considered a straightforward procedure, it might lead to an occlusion of the hypogastric artery. However, simple endovascular techniques can be helpful in keeping the hypogastric arteries patent.
Very interesting case and rationale. I agree that in the presence of one internal iliac artery you have to protect it and avoid inadvertent emboli intoit while attempting an ipsilateral fogarty embolectomy. Another approach to this same problem could had been to bring an 8mm non compliant balloon theought the ipsilaterla left common femoral artery in a retrograde approach and “oush” the clot up into the aorta. The balloon is left inflated then you go on to complete the open embolectomy through the right femoral approach.
I see this patient has a small aortic dilatation which was not covered by your stents. Do you see this being the etiology of the acute thrombosis?
Excellent suggestion! Regarding the etiology of the occlusion, the preoperative CT scan revealed a thrombosed atherosclerotic plaque of the common iliac arteries and the distal aorta. Thus we covered this lesions with 2 iCAST stent grafts.
It is not a real aortic dilation but an artifact caused from the position of the diagnostic catheter.