ILIAC Branch Device a Possible Solution for the Preservation of the Inferior Mesenteric Artery in Complex Aortic Endovascular Procedure

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Objective: A 76 years old man, previously treated with a thoracic endografting for a descending thoracic aortic aneurysm (TAA) and left common femoral artery endarterectomy for chronic obstructive peripheral arteriopathy, was accepted to our department for a pararenal aortic aneurysm. CT scan showed an increased aortic sac diameter (64 mm), six couples of lumbar arteries, patency of subclavian artery and inferior mesenteric artery (IMA) with a diameter greater than 5 mm. The left internal iliac artery (IIA) was occluded, while the right common iliac artery (CIA) was stenotic. This report describes a total endovascular aneurysm repair with a new inner abdominal branch device and an iliac branch device (IBD) to save IMA in order to preserve distal aortic collateral network to limit spinal cord ischemia and to prevent a type II endoleak. Methods: A two staged endovascular procedure was performed. In the first step, under general anesthesia, a revascularization of the right common iliac artery with a covered balloon expandable (BE) stent and the deployment of an inner branched COLT II device by Jotec was carried out. The right iliac bifurcation was also restored with a covered endovascular reconstruction of the iliac bifurcation (CERIB) technique, using three covered BE stents. Subsequently, an IBD by Jotec was proximally connected to the COLT II device in order to preserve the IMA and distally it was linked to the iliac arteries with two BE covered stents. During the second stage, a percutaneous left brachial access was used to connect the visceral arteries to the graft branches with 5 covered self-expandable (SE) stents fixed proximally with 5 covered BE stents. The IMA stent was also relined distally with a bare SE stent . Results: The recovery was uneventful and the patient was discharged after 5 days. The CT scan performed 1 year later showed complete exclusion of the abdominal aortic aneurysm, patency of visceral vessel stents and no signs of endoleaks. Conclusion: IMA preservation during EVAR should be considered in case of extensive aortic coverage associated with IIA occlusion. In this case, IMA revascularization allowed us to preserve spinal collateral network and to avoid the risk of type II endoleak . IBD may be considered an easy and safe off the shelf solution. Publication History Article published online: 10 June 2022 © 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

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