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case_images: (a) Pre-operative axial CT scan of the infrarenal aorta showing an aneurysm (arrow) measuring 6.10 cm. (b) Initial CTA scan. A detailed anatomy of the bilateral iliac arteries is presented, and the axial image of the CTA demonstrated bilateral common iliac artery ectasia, measuring 2.9 cm on the right side and 2.4 cm on the left side.
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case_images: The aneurysm had a healthy 2 cm infrarenal neck and bilateral common iliac artery ectasia, with the right common iliac artery measuring 2.9 cm and the left measuring 2.4 cm (Fig. 1a and b).
case_images: Postoperative 3D reconstruction CTA image of the EVAR without any sign of endo leak.
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case_images: Given the anatomical complexity and the risk of injury to the hypogastric artery, we opted for EVAR, along with a flared limb extension to address the common iliac artery ectasia (Fig. 2).
case_images: CTA scan showing the floating thrombus distal to the right iliac artery stent, following the patient presenting with acute embolic ischemia in the right leg.
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case_images: Trans-esophageal Echocardiography and CTA of the aorta were performed to rule out other sources of embolization, revealing a thrombus adherent to the wall distal to the stent graft (Fig. 3).
case_images: Coronal view of CTA scan showing right femoral artery embolic obstruction
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case_images: Despite these interventions, the patient experienced further episodes of acute limb ischemia (Fig. 4), leading to thrombolytic therapy a month later.
case_images: (a, b) Intraoperative images showing implantation of the iliac side branch device ISB.
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case_images: We ultimately chose the latter and implanted an E-iliac stent graft (Jotec ISB system) (Fig. 5a and b).