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

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

Pre-op CTA

Pre-op CTA

Large Accessory Renal

Severe Disease

Occluded Bifurcation

Subintimal Angioplasty

• Cross Occlusion

• Confirm Re-entry

• Pre-dilate

– 5 mm Balloon

Interim (Marking) Angiography

Cannulate Accessory Renal

Advance Parallel Stents

Viabahn(6 mm x 5 cm)

Viabahn(9 mm x 15 cm)

Viabahn(9 mm x 15 cm)

Deploy Accessory Renal Stent

Deploy Iliac Stents

Left Renal Balloon to Protect from Embolization

Seat Stents (Post-Dilation)

Interim Angiography

Left Iliac Limb

Extend to Iliac Bifurcation with Viabahn(9 mm x 5 cm)

Right Iliac Limb

Right Iliac Limb Extensions

iCast(6 x 22 mm)

Viabahn(8 mm x 5 cm)

Post CTA

Post CTA

Accessory Renal Viabahn

Left Aorto-Iliac Viabahn

Right Aorto-Iliac Viabahn

Post 3D Recon

Post-Op 18 Months