Parallel Endografts for Total Occlusion of the Abdominal Aorta: Report of a Case

1. Parallel Endografts for Total
Occlusion of the Abdominal Aorta:
Report of a Case
Sibu Saha, MD and David Minion, MD
University of Kentucky Medical Center
Lexington, Kentucky

2. Case Report
• 75 yo male with recurrent rest pain
• Past Surgical History
– 21 years prior:
• Presented with non-healing ulcer R 1st toe
• Underwent Aorto-Bifemoral bypass (side-to-end)
– 19 years prior:
• Re-presented with severe claudication (ABI: R 0.54, L 0.56)
• Angiogram: Right limb occlusion, Left limb stenosis
• Underwent Re-do Aorto-Bifemoral bypass
– 13 years prior:
• Re-presented with rest pain and occluded ABF
• Underwent Axillo-Bifemoral bypass

3. Pre-op CTA

4. Pre-op CTA
Large Accessory Renal
Severe Disease
Occluded Bifurcation

5. Subintimal Angioplasty
• Cross Occlusion
• Confirm Re-entry
• Pre-dilate
– 5 mm Balloon

6. Interim (Marking) Angiography

7. Cannulate Accessory Renal

8. Advance Parallel Stents
Viabahn
(6 mm x 5 cm)
Viabahn
(9 mm x 15 cm)
Viabahn
(9 mm x 15 cm)

9. Deploy Accessory Renal Stent

10. Deploy Iliac Stents
Left Renal
Balloon to
Protect from
Embolization

11. Seat Stents (Post-Dilation)

12. Interim Angiography

13. Left Iliac Limb
Extend to Iliac
Bifurcation
with Viabahn
(9 mm x 5 cm)

14. Right Iliac Limb

15. Right Iliac Limb Extensions
iCast
(6 x 22 mm)
Viabahn
(8 mm x 5 cm)

16. Post CTA

17. Post CTA
Accessory Renal
Viabahn
Left Aorto-Iliac
Viabahn
Right Aorto-Iliac
Viabahn

18. Post 3D Recon

19. Post-Op 18 Months